The outcome following spinal instrumentation in haemodialyzed patients with pyogenic spondylodiscitis

Abstract

Aims The aim of this study was to evaluate the outcome of spinal instrumentation in haemodialyzed patients with native pyogenic spondylodiscitis. Spinal instrumentation in these patients can be dangerous due to rates of complications and mortality, and biofilm formation on the instrumentation. Patients and Methods A total of 134 haemodialyzed patients aged more than 50 years who underwent surgical treatment for pyogenic spondylodiscitis were included in the study. Their mean age was 66.4 years (50 to 83); 66 were male (49.3%) and 68 were female (50.7%). They were divided into two groups according to whether spinal instrumentation was used or not. Propensity score matching was used to attenuate the potential selection bias. The outcome of treatment was compared between these two groups. Results A total of 89 patients (66.4%) underwent non-instrumented surgery and 45 (33.5%) underwent instrumented surgery. There were no significant differences in the rates of postoperative complications, except for an increased rate of wound problems in the instrumented group, which was found in the unmatched cohorts (p = 0.034). There were no significant differences in the rate of recurrent infections (p = 0.328 for the unmatched cohort; p = 0.269 for the matched cohort) and mortality rate, including in-hospital (p = 0.713 for the unmatched cohort; p = 0.738 for the matched cohort) and one-year rates (p = 0.363 for the unmatched cohort; p = 0.787 for the matched cohort), between the groups. However, the interval between the initial diagnosis and the first recurrence was significantly longer in the instrumented group (p = 0.008 for the unmatched cohort; p = 0.032 for the matched cohort). Conclusion Instrumented surgery for haemodialyzed patients with pyogenic spondylodiscitis showed similar outcomes, including recurrence and mortality, to non-instrumented surgery, despite the instrumented group having more severe neurological deficit, a larger number of involved levels, and increased kyphotic angle.

Treatment outcomes in patients with pyogenic vertebral osteomyelitis who have cirrhosis

“…According to the classification of Pola et al ., 94.1% of the cohort (80/85 patients) had structural instability (type B) or neurological compromise (type C), which theoretically requires surgical treatment 18 . Compared with the results of previous reports 15,42 , our results showed that PVO patients with cirrhosis are considered to have an even more extensive spinal involvement than other groups of PVO patients. We hypothesized that immune dysfunction 11 and impaired bony microarchitecture 14 contributes to aggressive infection.…”

“…Previous studies reported the early mortality of PVO patients, including in-hospital mortality or 90-day mortality ranging from 2.8% to 16.8% 27–32 . A recent study investigating the clinical outcome of PVO patients with hemodialysis reported an in-hospital mortality of 14.9% and 1-year mortality of 22.4% 15 . Compared with the results of previous studies, the mortality in our PVO patients with cirrhosis was considerably higher.…”

“…Cirrhosis was diagnosed by liver pathological examination or a combination of laboratory biochemical, radiological, and endoscopic findings, if a liver biopsy result was not available 14 . PVO was defined using the following criteria: suggestive clinical symptoms, accompanying typical radiological features on MRI, and microbiological identification 15 . Microbiological confirmation included isolation from blood culture, CT-guided needle biopsy, or surgical biopsy.…”

“…The clinical outcomes were investigated in patients with at least a 90-day survival. Recurrence was defined as having recurrent symptoms and signs after the completion of antibiotics and receiving a second course of intravenous antibiotics 15 .…”

“…Decreased bone mineral density with deteriorated bony microarchitecture in patients with cirrhosis 14 , disuse osteoporosis caused by immobilization, and long-term hospitalization aggravates skeletal destruction by the pyogenic organism, and can easily cause neurological and structural instabilities that require surgical treatment. However, the basic principles in the surgical treatment of PVO 15 , including sufficient removal of paraspinal abscesses and firm spinal instrumentation, are technically challenging in patients with cirrhosis who have poor bone quality and bleeding tendency with coagulopathy.…”