Long-term Outcomes and Effectiveness of Treatment Methods for Vertebral Osteomyelitis With Different Types of Lesions According to the E. Pola Classification

Abstract

Introduction: treatment of vertebral osteomyelitis is accompanied by various problems associated with the multidisciplinary nature of disease. The use of tactical classifications is absolutely essential. It is advisable to evaluate the results and effectiveness of treatment methods in accordance with the classification type of lesions.
 Purpose: to analyze outcomes of vertebral osteomyelitis treatment depending on lesions typesand treatment methods, according to E. Pola, 2017 classification.
 Materials and methods: results of treatment 266 patients with vertebral osteomyelitis, who were treated in 2006-2019, were analyzed. Type A lesions accounted for 24.1% (n=64), B - 47.0% (n=125), C" - 26.3% (n=70),vertebral processes lesions- 2.6% (n=7). Neurological deficit was in 53 cases. Conservative treatment, debridement, instrumentation, 3600 fusion were used. The evaluation of the results was carried out for more than a year after discharge.
 Results: conservative treatment of type A lesions led to recovery - 97.4% of cases compared with 3600 fusion (p=0.002) and relapses (p=0.034), mortality (p=0.001) are more common after reconstructive surgery. With lesions type B, the mortality after debridement was the highest - 15.8% (p=0.022). Analysis of type C lesions did not reveal significant differences between treatments methods. Mortality with sepsis was 17.4%, in its absence - 4.9% (p=0.039), relapses - 21.7% vs. 7.8% (p=0.043), recovery 56,6% vs. 83.5% (p=0.004), respectively. Differences in the long-term period for ODI, NDI, SF-36 were not revealed. Overall survival was 84.4%, long-term - 90.4% with a significant increase in conservative treatment compared with reconstructive surgery (p=0.045).
 Conclusion: conservative treatment and extrafocal stabilization show maximum efficiency with minimal destruction and uncomplicated lesions (type A), while reconstructive surgery leads to an increase in the number of relapses and mortality. Debridement in the septic course of lesions B leads to an increase in hospital mortality. For C lesions, there were no significant differences in the results of using the treatment methods.