gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Septic shock in spondylodiscitis: better survival with critical tretment strategies

Meeting Abstract

  • Shadi Al-Afif - Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
  • Sefanos Apallas - Hannover, Deutschland
  • Gökce Hatipoglu Majernik - Hannover, Deutschland
  • Elvis J. Hermann - Hannover, Deutschland
  • Joachim K. Krauss - Hannover, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 174

doi: 10.3205/17dgnc737, urn:nbn:de:0183-17dgnc7374

Published: June 9, 2017

© 2017 Al-Afif et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Septic shock represents a formidable complication of spondylodiscitis. Despite advances in surgical and intensive care treatment, it is still burdened by high morbidity and mortality. Here, we present our experience in the treatment of this emergency over a 10-year period.

Methods: Eight patients with spondylodiscitis complicated by septic shock were identified in our department from 2005 until 2016. Clinical, laboratory and radiological data were analyzed retrospectively.

Results: There were 7 men and 1 woman. Age ranged between 53 und 78 years (mean age: 62 years). All patients had a history of chronic disease: diabetes mellitus (3 patients), malignancies (2 patients), cardiovascular diseases (5 patients: arterial hypertension, cardiomyopathy, arrhythmia, valvopathies). Six patients presented with paraparesis. Besides spondylodiscitis, intraspinal and/or paravertebral abscesses were evident on MRI imaging studies in all patients. Surgery was performed in all cases including decompression of the abscesses and of the spinal canal. Bacteria were isolated in blood cultures in only 3 patients, and in samples obtained during surgery in 6 patients. Isolated bacteria were gram positive in 6 patients and gram negative in one patient. The mean duration of stay in the intensive unit was 21 days. The clinical course was complicated with respiratory failure (ARDS, in 5 patients) and renal failure (in all patients). Reanimation was necessary in one patient. Another patient succumbed due to septic shock and multi-organ failure. Seven Patients could be referred to rehabilitation in a stable condition.

Conclusion: The management of septic shock in spondylodiscitis needs an interdisciplinary team work. Surgery is necessary for decompression but it also allows determining the causal bacteria and the optimal antibiotic regimen in patients with negative blood culture. Aggressive treatment strategies might result in an increase of the survival.