gms | German Medical Science

67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12. - 15. Juni 2016, Frankfurt am Main

Oral cavity infection: An underestimated source of pyogenic spondylodiscitis?

Meeting Abstract

  • Alexander Romagna - Neurochirurgische Klinik und Poliklinik des Klinikums der Ludwig-Maximilians-Universität München, Campus Großhadern, Germany
  • Matthias Tröltzsch - Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie des Klinikums der Ludwig-Maximilians-Universität München, Campus Innenstadt, Germany
  • Jörg-Christian Tonn - Neurochirurgische Klinik und Poliklinik des Klinikums der Ludwig-Maximilians-Universität München, Campus Großhadern, Germany
  • Stefan Zausinger - Neurochirurgische Klinik und Poliklinik des Klinikums der Ludwig-Maximilians-Universität München, Campus Großhadern, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocDI.10.07

doi: 10.3205/16dgnc158, urn:nbn:de:0183-16dgnc1580

Veröffentlicht: 8. Juni 2016

© 2016 Romagna et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: While the incidence of pyogenic spondylodiscitis is increasing, the source of infection has been reported to remain unknown (52% cases). We analysed predisposing factors, pathogens and outcome of patients undergoing surgical and/or conservative treatment of spondylodiscitis with focus on the source of infection and a comprehensive ENT assessment.

Method: Identification of infection source included a detailed clinical, microbiological and radiological workup of the oral cavity. The assessment of prognostic factors comprised the analysis of BMI, comorbidities, nicotine dependence, symptom duration and oral cavity peculiarities. Outcome analysis included assessment of pain (Verbal Numerical Rating Scale; VNRS), clinical status (Odom’s criteria) and the dental situation.

Results: 28 patients with proven pyogenic spondylodiscitis (median age 63.5 years, 21 male) were examined. 21 and 7 patients underwent surgical resp. conservative treatment. The most common source of primary infection was the oral cavity (8/28 patients), followed by prior spine surgery in 7/28 patients; no focus was found in 5/28 patients. Of 8 patients with oral cavity infection 2 patients suffered from severe, 5 patients from moderate and 1 patient from mild periodontitis; 1 patient suffered from severe rhinosinusitis. Root canal pathologies were seen in 5 patients, periapical lesions and caries were seen in 4/8 and in 6/8 patients respectively. Typical oral cavity pathogens (e.g. Eikenella corrodens) as well as Staphylococcus aureus could be identified in 5 and in 3 patients in the intervertebral disc. All 8 patients with an oral focus required maxillofacial surgery: after surgical restoration, no recurrence of spondylodiscitis was seen. Patients with oral cavity infection had more often a history of nicotine dependence > 10py (87% vs. 60%; p<0.0001). Symptom duration prior to therapy and BMI did not differ in patients with and without oral cavity focus. Both surgical and conservative groups showed an amelioration of pain on VNRS and clinical status on Odom's score compared to the pre-treatment status on last follow-up (p<0.001 resp.; median follow-up 28 months).

Conclusions: Oral cavity infection revealed as a frequent source of pyogenic spondylodiscitis with smoking as its most relevant risk factor. Local surgical restoration of the oral focus is strongly advocated to avoid recurrence of spondylodiscitis. In case of an unidentified infection focus, a detailed diagnostic work up of the oral cavity is mandatory.