New classification for the treatment of pyogenic spondylodiscitis: validation study on a population of 250 patients with a follow-up of 2 years

Abstract

Pyogenic spondylodiscitis (PS) is still burdened by a high rate of orthopedic and neurological complications. Despite the rising incidence, the choice of a proper orthopedic treatment is often delayed by the lack of clinical data. The aim of this study was to propose a clinical-radiological classification of pyogenic spondylodiscitis to define a standard treatment algorithm. MethodsBased on data from 250 patients treated from 2008 to 2015, a clinical-radiological classification of pyogenic spondylodiscitis was developed. According to primary classification criteria (bone destruction or segmental instability, epidural abscesses and neurological impairment), three main classes were identified. Subclasses were defined according to secondary criteria. PS without segmental instability or neurological impairment were treated conservatively. When significant bone loss or neurological impairment occurred, surgical stabilization and/or decompression were performed. All patients underwent clinical and radiological two-year follow-up. ResultsType A PS occurred in 84 patients, while 46 cases were classified as type B and 120 as type C.Average time of hospitalization was 51.94 days and overall healing rate was 92.80%. 140 patients (56.00%) were treated conservatively with average time of immobilization of 218.17±9.89 days.Both VAS and SF-12 scores improved across time points in all classes. Residual chronic back pain occurred in 27 patients (10.80%). Overall observed mortality was 4.80%. ConclusionsStandardized treatment of PS is highly recommended to ensure patients a good quality of life. The proposed scheme includes all available orthopedic treatments and helps spine surgeons to significantly reduce complications and costs and to avoid overtreatment.

Spondylodiscitis: A Retrospective Analysis of Clinical, Etiological, and Radiological Diagnosis

“…Also noted were the presence of concomitant abscess of the psoas muscle in 12 patients (35.3%), paravertebral abscesses in 14 patients (41.2%), and epidural abscesses in 12 patients (35.3%). Table 5 shows patient distribution according to the classification proposed by Pola et al 10…”

“…Because tuberculosis is more difficult to diagnose and it usually presents with a more insidious onset, we analyzed these cases as a subset, according to the collected data. Cases were classified as proposed by Pola et al 10 The study was approved by the institutional ethics committee.…”

“…Classification of spondylodiscitis according to the classification proposed by Pola et al10 It should be noted that the agent most commonly identified by methods other than blood culture was M. tuberculosis.…”

Letter to the Editor concerning “New classification for the treatment of pyogenic spondylodiscitis: validation study on a population of 250 patients with a follow-up of 2 years” by Enrico Pola et al. Eur Spine J (2017) doi:10.1007/s00586-017-5043-5

“…In their article, Pola et al proposed a classification of pyogenic spondylitis as a guide to surgical management [1]. I would like to make the following observations in this regard:…”

Evaluation of Neutrophil-to-lymphocyte ratio as a marker of inflammatory response in Spondylodiscitis

“…Laboratory and imaging methods were used to make pre-diagnosis of spondylodiscitis. Then in the archive scan; the cases with spondylodiscitis, diagnosed after microbiological evaluation of the specimens obtained by performing subcutaneous or open biopsy, were included in the study (18).…”