gms | German Medical Science

Objective: Spinal infections embody a severe problem of modern medicine. Due to their unspecific symptoms and trouble in diagnosis, it may take time to final diagnosis. Therapeutic options consist of conservative and/or operative methods in a high variability, with a lack of standardized treatment procedures.

Methods: We analysed clinical data of 185 patients with different forms of pyogenic spinal infections, who were medicated conservatively or by surgery from 2006 to 2016 with one year of follow-up period.

Results: Most of the patients suffered from spondylodiscitis (50%) and were treated operatively (78%). The comparison of non-instrumentation surgery with spondylodesis and interbody fusion did not show any significant difference. Conservative therapy appeared to be significantly (p=0.032) better than surgical interventions regarding complications in follow-up period. Possible reasons are lower inflammation and absence of implant complications. In 33% of all patients complications occurred during follow-up, mostly reinfections leading to revisions. There was a significant correlation between final lab values and the probability of complications (p=0.001). In about 90% of all patients, at least one predisposition or risk factor present. Previous infections (bacteraemia or infection of urinary tract) was the most relevant risk factor.

Conclusion: This study explored the differences between conservative and surgical therapy including debridement, complete laminectomy- and hemilaminectomy, spondylodesis and interbody fusion using titanium, tantalum, PEEK or bone cages regarding their clinical outcome with a 1 year follow-up in just one trial. Due to the high variability of operative techniques no method was found to be significantly better than the others. The treatment of spinal infections is challenging, usually prolonged and prone to complications. Predispositions and risk factors are relevant and should be analysed exactly.