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

Abstract

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.

Pyogenic Cervical Spondylodiskitis: Case Report and Current Literature Review

“…Currently, an increase in minimally invasive procedures, cervical and pharyngeal sharps injuries secondary pyogenic SD has been reported, and also a case secondary to prosthetic voice device placement has been described [5]. Three types of SD are recognized according to their etiological agent: pyogenic, parasitic and granulomatous including tuberculous, aspergilar and fungal (representing the latter less than 24%) [5].…”

“…Currently, an increase in minimally invasive procedures, cervical and pharyngeal sharps injuries secondary pyogenic SD has been reported, and also a case secondary to prosthetic voice device placement has been described [5]. Three types of SD are recognized according to their etiological agent: pyogenic, parasitic and granulomatous including tuberculous, aspergilar and fungal (representing the latter less than 24%) [5]. The majority of pyogenic SD (>90%) are those of a monomicrobial flora and most frequently caused by Gram-positive microorganisms (69.3%), being Staphylococcus aureus the most commonly isolated etiologic agent (10-12% methicillin-resistant), followed by Streptococcus and coagulase negative Staphylococcus [3][4][5][6].…”

“…Three types of SD are recognized according to their etiological agent: pyogenic, parasitic and granulomatous including tuberculous, aspergilar and fungal (representing the latter less than 24%) [5]. The majority of pyogenic SD (>90%) are those of a monomicrobial flora and most frequently caused by Gram-positive microorganisms (69.3%), being Staphylococcus aureus the most commonly isolated etiologic agent (10-12% methicillin-resistant), followed by Streptococcus and coagulase negative Staphylococcus [3][4][5][6]. Also but minor in frequency Gram negative bacilli (21.5%), anaerobic bacteria (Propinobacterium) and fungi have been isolated (especially in immunosuppressed individuals) [4].…”

“…SD has an insidious course, with variable degree of neurological affection, occasional rapid progression and is highly aggressive [1,5,7]. Diagnosis is usually late, more often in early chronic stage (more than 3 months) and is diagnosed in the acute stage (less than 3 weeks) less than 30% of the time.…”

“…This scheme is associated with a lower recurrence rate [16][17][18]. However, there are other authors who advise antibiotic change to an oral administration if the blood culture reports good sensitivity for said drug after 2 weeks intravenous therapy [5,18].…”