gms | German Medical Science

Objective: Patients with pyogenic spondylodiscitis might present with neurological deficits with or without epidural abscess requiring spinal decompression. The aim of this study was to investigate the role of epidural abscess and spinal decompression in the treatment of patients with pyogenic Spondylodiscitis.

Methods: We reviewed data of 218 patients who underwent surgical treatment for pyogenic spondylodiscitis at our institution between 2008 and 2018. In addition to the medical treatment, dorsal instrumentation was the standard surgical approach. Additional spinal decompression to alleviate neural impingement was performed in case of neurological deficit at admission, regardless of the presence of epidural abscess. Analysis included preoperative MRI-imaging, preoperative and last CRP values, microbiological yield, duration of hospital stay as well as relapse and wound infection.

Results: Epidural abscess was found in 68 patients (31%) at admission, while a neurological deficit requiring spinal decompression was found in 80 patients (37%) at admission. Of them, 33 patients (41%) had an epidural abscess. No correlation was found between epidural abscess and preoperative neurological deficit (OR 5-95%, 0.818 to 2.6, P = 0.257) or CRP values at admission (105 vs. 82 mg/l, P = 0.087). Patients with epidural abscess did not have a longer hospital stay (median 23 vs. 24 days, P = 0.412). Spinal decompression was associated with a higher microbiological yield (OR 5-95%, 1.101 to 3.435, P = 0.031) but did not correlate with lower last CRP values (33 vs. 31 mg/l, P = 0.644) or shorter hospital stay (median 23 vs. 24 days, P = 0.412). Neither epidural abscess nor spinal compression was associated with relapse infection (OR 5-95%, 0.486 to 4.948, P = 0.636 and OR 5-95%, 0.306 to 2.431, P = 0.984, respectively) or surgical wound infection (OR 5-95%, 0.670 to 2.816, P = 0. 497 and OR 5-95%, 0.906 to 3.641, P = 0.13, respectively).

Conclusion: Spinal decompression in patients with pyogenic spondylodiscitis might be justified in case of neurological deficit at admission but not to treat epidural abscess per se. Our data showed that neither epidural abscess nor spinal decompression influenced the course of the infection.