gms | German Medical Science

Objective: It is the objective of our study to determine the safety and efficacy of surgical debridement with instrumentation in treating pyogenic spinal infection.

Methods: Between June 2006 and June 2016, 387 consecutive patients suffering from spondylodiscitis were admitted to our department. 368 (95%) underwent surgical debridement and instrumentation while 19 were treated conservatively. Surgically treated patients were analyzed. Clinical outcome was assessed with neurological and laboratory examinations at 3 months following surgery. 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, 244 patients were male (66%). Distribution of the inflammation was lumbar in 241 (66%), thoracic in 57 (15%) and cervical in 51 (14%) cases. 19 patients (5%) had two concomitant non-contiguous spondylodiscitis in different segments of the spine. Epidural abscess was found in 74 patients (35%). 338 patients (92%) had pain. Neurological deficit was found in 160 patients (43%). In the thoracic and lumbar cases, dorsal instrumentation alone was considered sufficient in 125 cases, additional interbody fusion from dorsal was performed in 89 cases. 360-degree instrumentation was performed in 94 cases. In the cervical cases, ventral spondylodesis was performed in 18 cases and ventral plating, dorsal instrumentation alone in 19 cases and 360-degree instrumentation 21 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. 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 160 patients with neurological deficit, 44 (46%) had full recovery and 33 (34%) had improved incompletely after surgery.

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