gms | German Medical Science

Objective: To determine the safety and efficacy of surgical debridement with instrumentation in treating pyogenic infection of the spine.

Method: Between June 2006 and December 2013, 229 consecutive patients suffering from spondylodiscitis were admitted to our department. 211 (92%) underwent surgical debridement and instrumentation while 18 were treated conservatively. Surgically treated patients were analyzed. Long-term clinical outcome was assessed at a minimum of 12 months following surgery with a telephone interview.

Results: The mean age at presentation was 67 years, 139 patients were male (66%). Distribution of the inflammation was lumbar in 134 (63%), thoracic in 37 (18%) and cervical in 30 (14%) cases. Ten patients (5%) had two concomitant non-contiguous spondylodiscitis in different segments of the spine. Epidural abscess was found in 74 patients (35%). 191 patients (90%) had pain. Neurological deficit was found in 96 patients (45%). In the thoracic and lumbar cases, dorsal instrumentation alone was considered sufficient in 34 cases, additional interbody fusion from dorsal was performed in 86 cases. 360-degree instrumentation was performed in 53 cases. In the cervical cases, ventral spondylodesis was performed in 13 cases and ventral plating, dorsal instrumentation alone in 8 cases and 360-degree instrumentation 13 cases. Postoperative intravenous antibiotics were administered for 13,6 ± 8,2 days followed by 3.0 ± 0.9 months of oral antibiotics. Complete healing of the inflammation was achieved in 204 (97%) of cases. Only 4 patients had a relapse of the inflammation, in 3 cases following dorsal instrumentation alone and in one case after additional interbody fusion with a PEEK cage from dorsal in the lumbar spine. This was followed by debridement and anterior interbody fusion upon relapse. Five patients died due to septic shock (two because of fulminant endocarditis and three by multiple organ dysfunction syndrome). 1 patient died postoperatively due to pulmonary embolism. From the 96 patients with neurological deficit, 44 (46%) had full recovery and 33 (34%) had improved incompletely after surgery.

Conclusions: Surgical debridement and instrumentation is relatively safe and very effective approach to achieve complete healing of spinal inflammation. Thereby, a short period of intravenous antibiotics of 1-2 weeks is followed by 3 months of oral antibiotics is appropriate in most cases.