gms | German Medical Science

Objective: Spinal infections are a source of significant morbidity due to spinal instability, neurological deficits, and sepsis. The traditional conservative therapy has been replaced in clinical practice by surgery. The aim of this study was to evaluate surgically treated patients with spondylodiscitis, to identify factors, which determine the outcome and to develop recommendations for treatment and follow up.

Methods: We performed a retrospective review of all patients who underwent surgical treatment for spondylodiscitis between 2010 and 2018. Data were gathered through a review of patients’ case notes, relevant imaging, and electronic records.

Results: We have identified 237 consecutive patients who underwent surgery for spondylodiscitis. The mean age of presentation was 71.4 years. Distribution of the spondylodiscitis was 45 in cervical, 73 in thoracic and 119 in the lumbar spine. 26 patients had an infection in more than one segment of the spine. An epidural abscess was found in 146 cases. 225 patients had pain and 176 patients had a neurological deficit. Decompression surgery without instrumentation was performed in 26 patients. In patients who underwent instrumentation, the ventral approach was used in 54 cases, dorsal in 134 cases and 360° fusion in 23 cases. The most common cause was infection with Staph. aureus. Endocarditis was the most common concomitant infection (10 patients). In 57 cases the microorganism could not be isolated in the intraoperative specimen. 26 patients died during the follow-up, out of them 21 during the primary hospital stay. Neurological status improved in 38 of 211 patients, in 160 it remained unchanged and in 13 it worsened. Antibiotic i.v. therapy was performed for 9.6±3.4 days and subsequent oral therapy for 47.4±0.9 days. Recurrence occurred in 18 patients who needed further surgery. Complete healing defined as normalization of infection parameters (leukocyte count and C-reactive protein) was achieved in 211 (89%) of cases. 156 patients had an excellent outcome (healed infection without neurological deficits), which was significant in comparison to patients with moderate and poor outcomes (p<0.05).

Conclusion: Surgical treatment with spinal instrumentation in the cases of instability together with i.v. antibiotic use is the mainstay of the therapy of spondylodiscitis. Antibiotic therapy should be applied until normalization of the infection parameters.