Is posterior percutaneous screw-rod instrumentation a safe and effective alternative approach to TLSO rigid bracing for single-level pyogenic spondylodiscitis? Results of a retrospective cohort analysis

Nasto, Luigi Aurelio; Colangelo, Debora; Mazzotta, Valentina; Meco, Eugenia Di; Neri, Valentina; Nasto, Riccardo Aurelio; Fantoni, Massimo; Pola, Enrico

doi:10.1016/j.spinee.2013.07.479

Cited by 84 publications

(76 citation statements)

References 14 publications

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“…This postulation was further underscored by the included articles in this review, although with a low level of recommendation [27,34,43]. Moreover, there are also some indications that surgical treatment in uncomplicated spondylodiscitis could result in faster recovery, faster mobilization and a better short-term quality of life when compared to conservative treatment.…”

Section: Discussionmentioning

confidence: 90%

“…They analyzed the differences in the clinical outcome between these groups and report a lower VAS, higher SG-36, and higher EQ-5D in the first 3-6 months in the surgical treatment group. However, no statistically significant differences were found after 9 months [43] (Table 7).…”

Section: Systemic Antibiotics Versus Surgical Treatmentmentioning

confidence: 86%

“…The nine articles that described the outcome of surgical treatment strategies show that a large variety of surgical techniques can successfully treat spondylodiscitis, whereas the less elaborate and less invasive approaches appear to have a better functional outcome [16-18, 29, 32, 39-42]. So far, no additional long-term beneficial effect of surgical treatment could be shown in the studies comparing surgical versus conservative treatment [27,34,43]. However, we should consider that most of the surgical interventions were performed in cases with complications and/or inadequate response to a conservative approach and the groups are difficult to compare.…”

Section: Discussionmentioning

confidence: 99%

“…Three studies retrospectively compared systemic antibiotics alone versus surgical treatment [27,34,43]. The indication for surgical treatment in the first two studies was neurologic compromise, extensive bone destruction, epidural abscess formation, failure of nonoperative treatment or intractable back pain.…”

Section: Systemic Antibiotics Versus Surgical Treatmentmentioning

confidence: 99%

“…Similarly, the retrospective comparative study by Valancius et al described the results of antibiotics alone and surgical treatment in great detail without statistical analysis and also reported that antibiotics therapy alone was safe and effective in spondylodiscitis without complications [34]. In contrast to these studies, Nastro et al offered the patients to choose between a TLSO for 3-4 months and bridging percutaneous pedicle screw constructs followed by a soft brace for 4 weeks [43]. They analyzed the differences in the clinical outcome between these groups and report a lower VAS, higher SG-36, and higher EQ-5D in the first 3-6 months in the surgical treatment group.…”

Section: Systemic Antibiotics Versus Surgical Treatmentmentioning

confidence: 99%

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Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

et al. 2015

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Background Spondylodiscitis is a spinal infection affecting primarily the intervertebral disk and the adjacent vertebral bodies. Currently many aspects of the treatment of pyogenic spondylodiscitis are still a matter of debate. Purpose The aim of this study was to review the currently available literature systematically to determine the outcome of patients with pyogenic spondylodiscitis for conservative and surgical treatment strategies. Methods A systematic electronic search of MEDLINE, EMBASE, Cochrane Collaboration, and Web of Science regarding the treatment of pyogenic spondylodiscitis was performed. Included articles were assessed on risk of bias according the Cochrane Handbook for Systematic Reviews of Interventions, and the quality of evidence and strength of recommendation was evaluated according the GRADE approach. Results 25 studies were included. Five studies had a high or moderate quality of evidence. One RCT suggest that 6 weeks of antibiotic treatment of pyogenic spondylodiscitis results in a similar outcome when compared to longer treatment duration. However, microorganism-specific studies suggest that at least 8 weeks of treatment is required for S. aureus and 8 weeks of Daptomycin for MRSA. The articles that described the outcome of surgical treatment strategies show that a large variety of surgical techniques can successfully treat spondylodiscitis. No additional long-term beneficial effect of surgical treatment could be shown in the studies comparing surgical versus antibiotic only treatment. Conclusion There is a strong level of recommendation for 6 weeks of antibiotic treatment in pyogenic spondylodiscitis although this has only been shown by one recent RCT. If surgical treatment is indicated, it has been suggested by two prospective studies with strong level of recommendation that an isolated anterior approach could result in a better clinical outcome.

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Section: Discussionmentioning

confidence: 90%

Section: Systemic Antibiotics Versus Surgical Treatmentmentioning

confidence: 86%