gms | German Medical Science

Objective: To assess the long-term functional outcome and identify contributing factors, and to evaluate patient reported outcome measures (PROMs) after treatment for pyogenic spinal infections.

Method: Retrospective analysis of written and digital patient data as well as imaging data and microbiology reports. Follow-up was completed by means of invited clinic visits or by telephone interview for the long-term outcome analysis. All cases of pyogenic spinal infections defined as spondylodiscitis, spinal epidural abscess or spondylodiscitis with spinal epidural abscess treated at our institution surgically and conservatively between January 1998 and December 2008. Statistical tests used: Mann-Whitney U, Kruskal-Wallis, Chi Squared test and Fisher’s exact test. Outcome Measures: PROMs were assessed using a German version of the Core Outcome Measures Index (COMI). Neurologic examinations were conducted to assess functional outcome.

Results: 141 patients (83 male and 58 female) were included. Median age was 62 years. 119 patients were treated operatively, 22 conservatively. Postoperatively 96 patients (81%) recovered well without the need for additional surgery. Median follow-up was 38 months (range: 12 to 84 months). Motor skills and ability to walk were significantly worse in patients aged 62 years and older (p=0.02 and p=0.01 respectively). Patients with a history of surgery and those with diabetes showed significantly worse neurological outcomes. C-reactive protein (CRP) levels were significantly higher in patients with epidural abscess with or without concomitant spondylodiscitis than in those with spondylodiscitis alone (p<0.01). Higher CRP levels and elevated white blood cell (WBC) counts correlated significantly with neurological deficits. Mean pain at follow-up was rated 2.9 for back pain and 2 for leg pain on the visual analog scale. Treatment outcomes were widely regarded as either good or at least satisfactory in nearly all patients (96%). Outcome did not differ when comparing decompression only versus decompression and fusion. The majority of patients reported no (31%) or only little interference (23%) of their back problems with their daily work.

Conclusions: Treatment satisfaction and patient reported outcome, but also the rates of eradication of infectious foci make for encouraging results and further underline the important role of surgical therapy in the multi-modal treatment of pyogenic spinal infections.