Treatment of spondylodiscitis

Zarghooni, Kourosh; Röllinghoff, Marc; Sobottke, Rolf; Eysel, Peer

doi:10.1007/s00264-011-1425-1

Cited by 175 publications

(174 citation statements)

References 40 publications

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“…3,4 The primary indication for surgery is progressive neurological impairment but indications also include epidural abscess, pain caused by spinal instability, progressive deformity, or failure to respond to conservative treatment. [5][6][7][8][9] Although several guidelines have been proposed, [7][8][9] there is no consensus regarding the indications for surgery. Correspondingly, various surgical methods have been described, all based on varying degrees of debridement of vertebral bodies and discs through anterior, posterior, or combined surgical approaches.…”

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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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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“…Consequently, clinical presentation is often unclear and a considerable delay in diagnosis frequently occurs [2,3,10]. Spondylodiscitis remains a life-threatening disease with a mortality rate of 2-20 % [10,11]. Although some therapeutic guidelines are available, treatment of spondylodiscitis is certainly not standardized and is mostly based on local preferences resulting in physician-related variability [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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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.

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“…De Moraes Barros Fucs et al [23] present a review article focused on children's spondylodiscitis, a rare disease of unknown incidence. Cheung and Luk, Zarghooni et al and Guerado and Cervan [24][25][26] each wrote a review article about the incidence and treatment of spondylodiscitis in adults, Cheung and Luk [24] describe in detail the clinical and diagnostic protocols to follow in these cases, Zarghooni et al [25] present a treatment algorithm and Guerado and Cervan [26] discusses surgical controversies. Cervan et al [27] collected an important number of spondylodiscitis in patients on haemodialysis.…”

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confidence: 99%