Spondylodiscitis in the elderly patient: clinical mid-term results and quality of life

Sobottke, Rolf; Röllinghoff, Marc; Zarghooni, Keta; Zarghooni, Kourosh; Schlüter-Brust, Klaus; Delank, Karl‐Stefan; Seifert, Harald; Zweig, Thomas; Eysel, Peer

doi:10.1007/s00402-009-0972-z

Cited by 55 publications

(63 citation statements)

References 32 publications

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“…With the surgical risks in mind, conservative therapy often is the primary option for elderly patients and for patients in poor general condition [27].…”

Section: Conservative Treatmentmentioning

confidence: 99%

Treatment of spondylodiscitis

Zarghooni

Röllinghoff

Sobottke

et al. 2011

International Orthopaedics (SICOT)

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Purpose Pyogenic infections of the spine are relatively rare with an incidence between 1:100,000 and 1:250,000 per year, but the incidence is increasing due to increases in average lifeexpectancy, risk factors, and medical comorbidities. The mean time in hospital varies from 30 to 57 days and the hospital mortality is reported to be 2-17%. This article presents the relevant literature and our experience of conservative and surgical treatment of pyogenic spondylodiscitis. Method We have performed a review of the relevant literature and report the results of our own research in the diagnosis and treatment of pyogenic spondylodiscitis. We present a sequential algorithm for identification of the pathogen with blood cultures, CT-guided biopsies and intraoperative tissue samples. Basic treatment principles and indications for surgery and our surgical strategies are discussed. Results Recent efforts have been directed toward early mobilisation of patients using primary stable surgical techniques that lead to a further reduction of the mortality. Currently our hospital mortality in patients with spondylodiscitis is around 2%. With modern surgical and antibiotic treatment, a relapse of spondylodiscitis is unlikely to occur. In literature the relapse rate of 0-7% has been recorded.

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“…With the surgical risks in mind, conservative therapy often is the primary option for elderly patients and for patients in poor general condition [27].…”

Section: Conservative Treatmentmentioning

confidence: 99%

Treatment of spondylodiscitis

Zarghooni

Röllinghoff

Sobottke

et al. 2011

International Orthopaedics (SICOT)

Self Cite

175

139

View full text Add to dashboard Cite

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“…For example, due to the risks associated with surgery, conservative therapy is often considered the best option for very elderly or weak patients [8]. On the other hand, because long-term immobilization of the spine is an important part of conservative therapy, clinicians must also weigh the dangers of bed rest (e.g., deep vein thrombosis, muscular atrophy, and pneumonia), especially for elderly patients, against the aforementioned risks of surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

Early surgery with antibiotics treatment had better clinical outcomes than antibiotics treatment alone in patients with pyogenic spondylodiscitis: a retrospective cohort study

Tsai

Yang

Niu

et al. 2017

BMC Musculoskelet Disord

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BackgroundPyogenic spondylodiscitis is a form of spinal infection that can result in severe back pain and even death. However, information is lacking on the relative effectiveness of various therapies. A retrospective chart review was conducted to investigate whether early surgical treatment of pyogenic spondylodiscitis coupled with intravenous antibiotics results in better patient prognoses than intravenous antibiotics therapy alone.MethodsAll patients treated for pyogenic spondylodiscitis at a single medical center from July 2006 to July 2011 were retrospectively reviewed. The inclusion criteria consisted of diagnosis of an early stage infection without neurological deficit, and patients without severe sepsis who were suitable candidates for early surgery as determined by a Pittsburgh bacteremia score < 4, and patients with delayed diagnosis and lost to outpatient follow-up were excluded. Clinical outcomes included patient demographic data, kyphosis angle, length of treatment, Oswestry Disability Index and visual analogue pain scale were analyzed.ResultsOf 90 enrolled patients, Group 1 (n = 47) received only antibiotic therapy and Group 2 (n = 43) received early surgery with post-surgery antibiotics for 2 to 4 weeks. Group 2 exhibited significantly better results than Group 1 for mean antibiotic administration period, mean hospitalization period, kyphotic angle correction. Of 61 patients who participated in telephone follow-up after discharge, Group 2 (n = 26) had significant lower mean ODI score, and mean back pain score than Group 1 (n = 35).ConclusionsWhile infection control was similar for both groups, patients treated with early surgery and antibiotics were hospitalized for fewer days and required less antibiotics than those treated with antibiotics alone, also having better functional outcomes. In short, early surgical treatment of pyogenic spondylodiscitis typically achieves a better prognosis, shorter hospitalization period, and subsequent significant improvement in kyphotic deformity and quality of life.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Dragsted

Aagaard

Ohrt-Nissen

et al. 2017

J Orthop Surg (Hong Kong)

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Mortality and health-related quality of life in patients surgically treated for spondylodiscitis Dragsted, Casper; Aagaard, Theis; Ohrt-Nissen, Søren; Gehrchen, P.M.; Dahl, Benny To assess mortality, disability, and health-related quality of life (HRQL) in patients surgically treated for spondylodiscitis. Methods: A retrospective longitudinal study was conducted on all patients surgically treated for spondylodiscitis over a 6-year period at a single tertiary spine center. Indications for surgery, pre-and postoperative neurological impairment, comorbidities, and mortality were recorded. A survey was conducted on all eligible patients with the EuroQol 5-dimension (EQ-5D) questionnaire and Oswestry Disability Index (ODI). Results: Sixtyfive patients were diagnosed with spondylodiscitis not related to recent spine surgery. One-year mortality rate was 6%. In all, 36% and 27% had pre-and postoperative neurological impairment, respectively, with only one patient experiencing deterioration postoperatively. At final follow-up (median 2 years), mean ODI was 31% (SD ¼ 22) and mean EQ-5D time trade-off score was 0.639 (SD ¼ 0.262); this was significantly lower than that in the normal population (p < 0.001). Patients with neurological impairment prior to index surgery had lower EQ-5D scores (p ¼ 0.005) and higher ODI (p ¼ 0.02) at final follow-up compared with patients without neurological impairment. Conclusions: Several years after surgery, patients surgically treated for spondylodiscitis have significantly lower HRQL and more disability than the background population. Neurological impairment prior to index surgery predicts adverse outcome in terms of disability and lower HRQL.

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Spondylodiscitis in the elderly patient: clinical mid-term results and quality of life

Abstract: Ultimately, if surgery is indicated the operative risks should be borne in mind, but advanced age should not be the crucial factor in decision-making.

Cited by 55 publications

References 32 publications

Treatment of spondylodiscitis

Treatment of spondylodiscitis

Early surgery with antibiotics treatment had better clinical outcomes than antibiotics treatment alone in patients with pyogenic spondylodiscitis: a retrospective cohort study

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

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