Early surgery with antibiotics treatment had better clinical outcomes than antibiotics treatment alone in patients with pyogenic spondylodiscitis: a retrospective cohort study

Abstract

BackgroundPyogenic spondylodiscitis is a form of spinal infection that can result in severe back pain and even death. However, information is lacking on the relative effectiveness of various therapies. A retrospective chart review was conducted to investigate whether early surgical treatment of pyogenic spondylodiscitis coupled with intravenous antibiotics results in better patient prognoses than intravenous antibiotics therapy alone.MethodsAll patients treated for pyogenic spondylodiscitis at a single medical center from July 2006 to July 2011 were retrospectively reviewed. The inclusion criteria consisted of diagnosis of an early stage infection without neurological deficit, and patients without severe sepsis who were suitable candidates for early surgery as determined by a Pittsburgh bacteremia score < 4, and patients with delayed diagnosis and lost to outpatient follow-up were excluded. Clinical outcomes included patient demographic data, kyphosis angle, length of treatment, Oswestry Disability Index and visual analogue pain scale were analyzed.ResultsOf 90 enrolled patients, Group 1 (n = 47) received only antibiotic therapy and Group 2 (n = 43) received early surgery with post-surgery antibiotics for 2 to 4 weeks. Group 2 exhibited significantly better results than Group 1 for mean antibiotic administration period, mean hospitalization period, kyphotic angle correction. Of 61 patients who participated in telephone follow-up after discharge, Group 2 (n = 26) had significant lower mean ODI score, and mean back pain score than Group 1 (n = 35).ConclusionsWhile infection control was similar for both groups, patients treated with early surgery and antibiotics were hospitalized for fewer days and required less antibiotics than those treated with antibiotics alone, also having better functional outcomes. In short, early surgical treatment of pyogenic spondylodiscitis typically achieves a better prognosis, shorter hospitalization period, and subsequent significant improvement in kyphotic deformity and quality of life.

One‐stage Debridement via Oblique Lateral Interbody Fusion Corridor Combined with Posterior Pedicle Screw Fixation in Treating Spontaneous Lumbar Infectious Spondylodiscitis: A Case Series

“…Tsai et al . report that early active debridement followed by treatment with antibiotics achieves better therapeutic results in cases of pyogenic spondylodiscitis.…”

Clinical Results Of A Lamina With Spinous Process And An Iliac Graft As Bone Grafts In The Surgical Treatment Of Single-Segment Lumbar Pyogenic Discitis: A Retrospective Cohort Study

“…MRI is considered the modalityof choice for radiographic diagnosis, especially in severe lower back pain. Previous studies have reported an MRI sensitivity of 96%, a speci city of 93% and an accuracy of 94% in LPD, and MRI plays the key role in the continuous observation of LPD [24][25][26][27].…”

Die konservative und operative Therapie der unspezifischen Spondylodiszitis

“…Biopsie während der operativen Therapie und ohne bis dahin begonnene Antibiotikagabe dar. In 83,7 % konnte so in der Arbeitsgruppe Tsai et al bei der intraoperativen Keimgewinnung ein Nachweis gelingen [7]. Die deutlich geringere Trefferwahrscheinlichkeit der CT-gesteuerten (perkutanen) Biopsie dokumentiert sich in der Arbeitsgruppe Ascione et al mit einem mikrobiologischen Erregernachweis von lediglich 22,2 % [4].…”

“…Unabhängig von der Art der Therapie und des Regimes werden gleichwohl immer folgende Ziele angestrebt: Relative OP-Indikation: ▪ Schmerzen ▪ geringgradige Destruktion/Deformität Tsai und Kollegen empfehlen in ihrer Arbeit ein frühzeitiges operatives Vorgehen auch bei Abwesenheit absoluter OP-Indikationen, also im Anfangsstadium einer Spondylodiszitis [7]. In der Vergleichsgruppe konservativ behandelter Patienten zeigte sich ein besseres Ergebnis hinsichtlich des Kyphosewinkels, der Dauer des Krankenhausaufenthaltes und der Dauer der Antibiotikagabe.…”

“…Es besteht bei der Spondylodiszitis sowohl eine signifikante Mortalität (zwischen 4,8 % [3] und 10 % [7]) sowie eine signifikante Rezidivrate (5,6 % bei [3]). Somit ist auch nach der Beendigung der stationären Therapie die Gewährleistung einer adäquaten Nachbehandlung essenziell.…”