gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

A retrospective study of 113 consecutive cases of surgically treated spondylodiscitis patients. A single center experience

Meeting Abstract

  • E. Shiban - Neurochirurgische Klinik und Poliklinik, Technische Universität München
  • I. Janssen - Neurochirurgische Klinik und Poliklinik, Technische Universität München
  • F. Ringel - Neurochirurgische Klinik und Poliklinik, Technische Universität München
  • B. Meyer - Neurochirurgische Klinik und Poliklinik, Technische Universität München
  • M. Stoffel - Neurochirurgische Klinik und Poliklinik, Technische Universität München

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.08.06

DOI: 10.3205/12dgnc072, URN: urn:nbn:de:0183-12dgnc0723

Published: June 4, 2012

© 2012 Shiban et al.
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Outline

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Objective: To date there are no guidelines for surgical treatment and treatment strategies of pyogenic spinal infections. Aim of this study is to evaluate the different surgical approaches as well as the postoperative antibacterial treatment regime.

Methods: Between 2006 and 2010 113 patients suffering from spondylodiscitis underwent surgical debridement and instrumentation. The mean age at presentation was 65 years, 78 patients were male (69%). Distribution of the inflammation was lumbar in 68 (60%), thoracic in 19 (17%) and cervical in 20 (18%) cases. Six patients (5%) had two concomitant non-contiguous spondylodiscitis in different segments of the spine. Epidural abscess was found in 33 patients (29%).

Results: 104 patients (92%) had pain. Neurological deficit was found in 51 patients (45%). All patients in this series underwent surgical debridement with instrumentation of the spine. In the thoracic and lumbar cases, dorsal instrumentation alone was considered sufficient in 26 cases; additional interbody fusion from dorsal was performed in 44 cases (38 autologous bone material and 6 PEEK cages). 360-degree instrumentation was performed in 22 cases (19 with alloplastic material and three with autologous bone). In the cervical cases, ventral spondylodesis was performed in 12 cases (7 PEEK cages and 5 autologous bone) and ventral plating, dorsal instrumentation alone in 6 cases and 360-degree instrumentation in 6 cases (3 PEEK cages and 3 autologous bone). Postoperative intravenous antibiotics were administered for 14.4 ± 9.3 days followed by 3.2 ± 0.8 months of oral antibiotics. Complete healing of the inflammation was achieved in 111 (98%) of cases. Only two patients had a relapse of the inflammation following dorsal instrumentation alone. This was followed by debridement and anterior interbody fusion. Two patients died due to septic shock, both with fulminant endocarditis. From the 51 patients with neurological deficit, 23 (45%) had full recovery and 21 (41%) had improved incompletely after surgery.

Conclusions: Staged surgical immobilisation and instrumentation and optional debridement within the disc space is a reliable 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. The choice of fusion material (autologous bone, Titanium, PEEK) seems less important.