Die schweregradorientierte Therapie der Spondylodiszitis – eine prospektive Betrachtung anhand von elektronisch basierten Behandlungspfaden

Abstract

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.

Multimodal management for low-back pain associated with spondylodiscitis

“…Early identification and management of spondylodiscitis are essential for maximizing the probability of a positive outcome, although they are frequently delayed owing to its vague presentation and absence of fever [5]. This condition can result in disability and advanced spinal deformities [4].…”

“…Surgery may lead to a significant pain reduction for spondylodiscitis than medications alone, according to the functional results between patients who received medications and surgery, but patients often do not feel improvement for several months [1]. There is limited data to suggest treatment modalities and extending care [4]. Physical therapy and rehabilitation play significant roles in enhancing the functional prognosis of patients with spondylodiscitis [10].…”

“…It is crucial for clinicians to recognize the signs and symptoms, establish a prompt diagnosis, and treat this problem using a multidisciplinary approach to avoid more serious complications [3]. As there are limited data to suggest treatment modalities and extend care [4], we report a case of multimodal management featuring systematic antibiotic and chiropractic therapy of low-back pain associated with spondylodiscitis.…”

Editorial

“…Originalarbeiten, die aktuelle Themen aufgreifen wie "Transfusionstrigger in der orthopädischen Endoprothetik" [2] oder die "schweregradorientierte Therapie der Spondylodiszitis" [3] bilden den Schwerpunkt unserer Zeitschrift. Einen wichtigen Faktor zur erneuten Steigerung des Impact-Faktors und damit auch der Akzeptanz bilden auch die ins Englische übersetzte Originalartikel wie in der aktuellen Ausgabe "Die Dual-Energy-Computertomografie in der muskuloskeletalen Radiologie mit Fokus auf Insuffi-zienzfrakturen des Beckens" [4].…”