gms | German Medical Science

Objective: Infectious lumbar spondylodiscitis is a serious and increasingly frequent diagnosed disease. Ideal management remains controversial and no current evidence based recommendation exists. In this retrospective study we wanted to investigate the impact of risk factors on hospital stay after medical management or surgery with dorsal fusion in combination with medical management.

Method: We included 54 cases of consecutive infectious lumbar spondylodiscitis from our clinic, from 2004 to 2013. Patient demographics, presenting complaints, current chronic diseases and therapies, pre/post-treatment neurologic status (MRC 1-5), treatment (medical vs. surgical, timing of surgery) and duration of hospital stay were recorded.

Results: There were 40 males and 14 females with a mean age of 64.2 years. 48 patients (85%) suffered from one or more relevant chronic diseases at the time of clinical manifestation. Fourteen patients were treated with antibiotics alone (group A), 8 patients were treated with solely abscess decompression (group B), 18 patients were treated by primary early dorsal instrumented fusion (<10 d after admission) (group C) and 14 patients were treated with secondary delayed dorsal instrumented fusion (>9 d after admission (group D). There was a statistical significant shorter hospital stay for group C (33.2 d) compared to group D (57.0 d). The solely medical treated patients (group 1) had an average duration of 35.5 d inpatient treatment. The patients receiving solely abscess decompression (group B) had an average hospital stay of 64.2 d. In patients receiving instrumented dorsal fusion, CRP regulary dropped after surgery. All groups showed a substantial pain reduction at the end of treatment. In group A only 7.1% of patients had more than two current chronic diseases, but in group B 62.5% in group C 61% and in group D 57% of patients suffered from more than two current chronic diseases.

Conclusions: In our study primary dorsal instrumented fusion led to better clinical outcome with shorter hospital stay in patients older than 65y with relevant chronic diseases compared to the secondary delayed fusion or solely abscess evacuation. Metabolic syndrome, autoimmune diseases, malignant diseases, and age older than 65y were a predictor of failure of solely medical treatment. These patients would benefit from early surgical therapy with dorsal fusion. Patients younger than 65y without any relevant chronic diseases are suitable for solely medical treatment without prolonged hospital stay.