Pyogenic spinal infections and outcome according to the 36-Item Short Form Health Survey

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Pyogenic vertebral infections are rare. In most papers investigators have focused on risk factors, clinical characteristics, and diagnostic findings, and discussed different management strategies. The optimal strategy for dealing with spinal infections, however, remains controversial. Additionally, outcome data regarding quality of life (QOL) after pyogenic spinal infections are sparse. The aim of this study was to provide further data in this field.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors retrospectively investigated 62 patients suffering from pyogenic spinal infections. In 37 patients (59%), lumbar lesions were observed; thoracic and thoracolumbar infections were documented in 19 (31%) and a cervical infection was demonstrated in six patients (10%). Overall 28 patients (45%) underwent conservative treatment, and 34 (55%) underwent surgery with or without the placement of instrumentation. At follow-up examination the authors recorded each patient’s satisfaction as well as QOL according to the 36-Item Short Form Health Survey. Quality of life after treatment of pyogenic spine infections did not reach the level of the normative sample. Most patients continued to suffer some sort of pain. Despite different indications, the surgically treated patients experienced a slightly better QOL and self-reported satisfaction levels, as well as a statistically significant better outcome, than patients treated conservatively.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The results obtained in the present study suggest that surgery, especially in conjunction with the placement of instrumentation, may be more beneficial than conservative treatment in patients with a spinal infection.</jats:p></jats:sec>

Treatment of spondylodiscitis

“…Moreover, it primarily affects elderly patients in reduced states of health or with the accompanying risk factors mentioned above. Mean hospital stay has been reported as 30-49 days, and hospital mortality as 2-17% [2,7,21,36,43]. With our own patients, mean hospital stay is four weeks with a hospital mortality of 2%.…”

“…In addition, quality of life for all patients was far lower than that of a normal population. Slightly improved quality of life and significantly higher levels of patient satisfaction were found in the surgicallytreated patients [43]. In a group of 25 spondylodiscitis patients, Lerner et al identified an improvement of neurological deficits for 76% after a mean of 2.6 years, while 20% showed no change.…”

Anterior instrumentation for the treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine

“…After a surgical debridement and subsequent 4 weeks of intravenous antibiotic therapy, the patients underwent autogenous bone grafting and anterior plating. Since then, several series have been presented with patients undergoing anterior corpectomy and plate fixation [10,15,24,30,37,38,44,48,51], but the number of patients enrolled in these studies was relatively small and most of them were cervical cases.…”

Mortality and health-related quality of life in patients surgically treated for spondylodiscitis

“…5,6,10,13,14 The overall mortality of spondylodiscitis is 5-10%, [2][3][4]7,15 but studies reporting outcome after surgical treatment are scarce, and few studies have reported the health-related quality of life (HRQL) after surgery. [16][17][18][19][20] A few studies have shown that a preoperative neurological deficit is a predictor of a negative outcome, 4,8,9 and neurological deficits are more often present when the spinal infection affects the cervical or thoracic regions. 8 No studies so far have examined HRQL in these groups.…”