A Comprehensive Review of Pyogenic Spondylitis Management for Neurosurgeons

Abstract

Older populations have been increasing recently, resulting in an increase in cases of pyogenic spondylitis. Neurosurgeons who frequently treat the elderly are at a higher risk of encountering this condition. Therefore, this article provides a summary of the literature and our experience to help neurosurgeons effectively manage pyogenic osteomyelitis. It is important not to rule out pyogenic spondylosis when examining a patient with back pain, even in the absence of a fever. This is because the chronic type is common, easily overlooked, and early diagnosis and treatment are crucial. Empirical antibiotics should be avoided in cases where blood culture and biopsy are negative, to prevent microbial resistance and an increase in difficult-to-treat cases. Biopsies, such as computed tomography-guided percutaneous biopsy and full endoscopic debridement and drainage, should be attempted. Currently, 6 weeks of parenteral antibiotic therapy is the main treatment for pyogenic spondylitis. Surgical treatment is recommended if this method is ineffective. However, in the early stages, full endoscopic debridement and drainage and percutaneous pedicle screw fixation are optional.

Spectrum of Surgical Site Infection Pathogens in Chronic Infectious Spondylitis Requiring Revision Surgery: A 5-Year Cohort Study

“…The standard treatment for acute CS forms (disease duration of no more than 30 days) includes isolated etiotropic antibacterial therapy for types A1–B2 according to Pola et al (2017) or surgical sanitation of the infectious process area combined with extrafocal instrument fixation and lengthy etiotropic antibacterial therapy [ 4 ]. The most important stage of preoperative verification of spondylitis is percutaneous trepan biopsy from the vertebral lesion, followed by bacteriological, molecular genetic, and histological examination of the surgical material [ 5 , 6 ]. The frequency of verification of the pathogen through this method reaches 35–47% in acute infectious spondylitis, while the assignment of empirical antibacterial therapy at the first stage of treatment reduces the chances of detecting the pathogen microorganism to 14–21% [ 7 , 8 , 9 ].…”