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Objective: The German health care system increasingly incorporates clinical pathways as a tool to organize surgical, intervention or conservative therapies. Does a computerized clinical pathway offer advantages in severity-based surgical therapy of spondylodiscitis?Methods: A hospital has adopted a computerized system based on three severity grades of spondylodiscitis. From 01/01/2012 to 12/31/2013, 32 patients with spondylodiscitis were randomly chosen at admission and prospectively analysed with regard to duration, costs of treatment, pain level and inflammatory markers.Results: Of the 32 patients treated for spondylodiscitis who had not been transferred from another facility, 17 (53%) were treated according to a clinical pathway based on three well-established treatment regimens dependent on severity. The SponDT, as a parameter for the course of disease, was initially slightly higher in the pathway patient’s group (6.82) than in the control group (6.2). Compared to a control group (n = 15) there were differences in the total duration of stay (17.2 vs. 26.0) and the number of blood samples taken (7 vs. 10). No differences could be shown for the extent of documentation, the physical and neurological outcome, the level of pain and or the course of inflammatory markers. The most prevalent germ was Staphylococcus aureus (18.8%). In 43.8% of the patients, no infectious agent could be detected. Material costs and personnel-costs were significantly reduced in the pathway group (12,076 €) compared to 21,341 € in the control group.Conclusions: An IT-based clinical pathway is preferable for surgical therapy of spondylodiscitis based on three grades of severity and offers various advantages as a clinical and administrative regulative mechanism. The cost-effective treatment particularly stands out.

Spondylodiscitis is a rare but serious infection of the spine. Recognised methods of treatment include immobilisation and systemic antibiotics. However, available data for specific and recommendations for continuing treatment are also rare. The aim of the present study is the optimisation of the therapy of spondylodiscitis using a clinical pathway that depends on a classification of spondylodiscitis. From 1 October 1998 to 31 December 2013, a classification of the severity of spondylodiscitis was established, including specific treatment recommendations. As part of the re-evaluation, the classification of severity was adapted. On this basis, electronically based clinical pathways were developed. A total of 296 cases were included. With a steadily increasing number of treatments, the mean age of the patients increased to 67.3 years. In 34.3% of these patients, spondylodiscitis developed spontaneously and 68.6% of patients did not receive treatment until the diagnosis. In the context of the specific treatment, pain intensity decreased from 6.0 to 3.1 NRS (numeric rating scale). The inflammatory values (CRP) decreased from 119.2 to 46.7 mg/dl. The time from the onset of symptoms to the surgical treatment was almost 65.6 days and has not changed significantly. Nevertheless, the time from admission to surgical treatment could be reduced to less than 3 days. The classification of patients into 3 degrees of severity of spondylodiscitis (SSC) depends on the SponDT: spondylodiscitis diagnosis and treatment. The SponDT describes vertebral destruction and the current neurological status. The severity-adapted therapy was mapped electronically and includes specific surgical care, systemic antibiotic therapy and physical therapy.

The world is battling a "very intense outbreak" of the coronavirus infection (COVID19), and its economic impact on the world is more severe than that from SARS in 2003. Coronaviruses are enveloped viruses with positive single-stranded RNA genome [1]. So far, humans are infected with six known strains of coronaviruses. Recently a novel coronavirus (COVID-19) was detected in Wuhan, China [2,3]. Similar to highly pathogenic coronaviruses SARS-CoV and MERS-CoV, COVID-19 also caused severe respiratory diseases. COVID-19 was started by zoonotic transmission likely from bats and spread rapidly among humans [4]. At present, there are potential drugs which are successful in eradicating SARS-CoV. Currently, remdesivir is a most promising antiviral drug for COVID-19, which is under clinical development for the treatment of Ebola virus infection [5].The coronavirus may take longer to be eradicated here compared to the severe acute respiratory syndrome, or SARS, with confirmed cases of COVID-19 globally exceeding one million-plus and more countries going into lockdown to slow the widespread COVID-19 infection. There is a general agreement that the prevalent COVID-19 infection will decline with the development of herd immunity. That transpires when a large number of people in a community develop immunity against a pathogen. There are two outcomes: One is immunization. Researchers must develop a safe and effective vaccine against the coronavirus, and health authorities would have to get it to enough people. The second path to herd immunity is grimmer: It can also come about after a large portion of a community is infected with a pathogen and develops resistance to it that way.

We report a difficult healing process after a femoral shaft fracture in childhood. We present surgical correction options of femoral shortening due to pseudarthrosis after elastic stable intramedullary nailing. First, we tried to establish distraction using an external fixator, followed by plate osteosynthesis. After material failure of plate osteosynthesis, we treated the refracture with intramedullary nailing, after which bone healing occurred.