Who Needs Surgical Stabilization for Pyogenic Spondylodiscitis? Retrospective Analysis of Non-Surgically Treated Patients

Blecher, Ronen; Frieler, Sven; Qutteineh, Bilal; Pierre, Clifford; Yılmaz, Emre; Ishak, Basem; Glinski, Alexander von; Oskouian, Rod J.; Kramer, Moti; Drexler, Michael

doi:10.1177/21925682211039498

Cited by 7 publications

(10 citation statements)

References 27 publications

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“…After admission or referral to the emergency unit, the assessment of patient status is of the upmost importance to determine proper diagnostic steps and the following treatment. Scores for sepsis have long been used to improve a patient's assessment and treatment outcomes as an essential tool in modern clinical practice [29]. We therefore highlight the need for fitting tools to be implemented to further improve the level of care when S is diagnosed.…”

Section: Discussionmentioning

confidence: 99%

“…In our cohort, 100 patients (33%) showed signs of sepsis at administration, and 76 (25%) patients developed such complication during their hospital stay. The Sepsis-3 criteria introduced in 2016 describe sepsis as a life-threatening immune response to infection [29]. Considering existing sepsis guidelines, any kind of organ dysfunction in patients with S must be considered a red flag [35].…”

Section: Discussionmentioning

confidence: 99%

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The Hamburg Spondylodiscitis Assessment Score (HSAS) for Immediate Evaluation of Mortality Risk on Hospital Admission

Heuer

Strahl

Viezens

et al. 2022

JCM

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(1) Background: Patients with spondylodiscitis often present with unspecific and heterogeneous symptoms that delay diagnosis and inevitable therapeutic steps leading to increased mortality rates of up to 27%. A rapid initial triage is essential to identify patients at risk for a complicative disease course. We therefore aimed to develop a risk assessment score using fast available parameters to predict in-hospital mortality of patients admitted with spondylodiscitis. (2) Methods: A retrospective data analysis of 307 patients with spondylodiscitis recruited from 2013 to 2020 was carried out. Patients were grouped according to all-cause mortality. Via logistic regression, individual patient and clinical characteristics predictive of mortality were identified. A weighted sum score to estimate a patient’s risk of mortality was developed and validated in a randomly selected subgroup of spondylodiscitis patients. (3) Results: 14% of patients with spondylodiscitis died during their in-hospital stay at a tertiary center for spinal surgery. Univariate and logistic regression analyses of parameters recorded at hospital admission showed that age older than 72.5 years, rheumatoid arthritis, creatinine > 1.29 mg/dL and CRP > 140.5 mg/L increased the risk of mortality 3.9-fold, 9.4-fold, 4.3-fold and 4.1-fold, respectively. S. aureus detection increased the risk of mortality by 2.3-fold. (4) Conclusions: The novel Hamburg Spondylodiscitis Assessment Score (HSAS) shows a good fit identifying patients at low-, moderate-, high- and very high risk for in hospital mortality on admission (AUC: 0.795; p < 0.001). The implementation of the HSAS into clinical practice could ease identification of high-risk patients using readily available parameters alone, improving the patient’s safety and outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Hamburg Spondylodiscitis Assessment Score (HSAS) for Immediate Evaluation of Mortality Risk on Hospital Admission

Heuer

Strahl

Viezens

et al. 2022

JCM

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“…8,21 The preservation of spinal stability in an acceptable alignment is one of the core objectives of spinal infection treatment; however, variables surrounding spinal instability in DNSI have been poorly defined. 6,10,12,13,22 In trying to address this deficiency, we sought to draw on the previously accepted general principles applied in SINS 23 and by Panjabi, 12 thereby defining spinal instability in DNSI as a loss of spinal integrity from an infectious process associated with or without neural element impingement, symptomatic or progressive deformity, and pain associated with mechanical loading or an inability to ambulate.…”

Section: Discussionmentioning

confidence: 99%

“…Based on currently limited evidence, several studies have shown a higher failure rate of medical treatment for DNSI patients with diabetes mellitus. 10,30,35,36 The impact of a history of IVDA on treatment outcomes appears to be more complex. Previous studies have demonstrated a higher failure rate among IVDA patients treated medically along with an increased probability of surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

“…The first review was done to identify clinical variables with proven influence on nonsurgical and surgical treatment outcomes for spinal infection. [8][9][10][11] The search term "Spondylodiscitis"[All Fields] OR ("discitis"[MeSH Terms] OR "discitis"[All Fields] OR "spondylodiskitis"[All Fields]) OR "vertebral osteomyelitis"[Title/Abstract] OR "osteodiscitis"[Title/Abstract] OR "osteodiskitis"[Title/Abstract] OR "discitis"[Title/ Abstract] OR ("discitis"[MeSH Terms] OR "discitis"[All Fields] OR "diskitis"[All Fields]) AND ("treatment failure"[Title/Abstract] OR "treatment"[Title/Abstract]) resulted in 2059 publications. All publications were screened for their headlines.…”

Section: Literature Reviewmentioning

confidence: 99%

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A novel scoring system concept for de novo spinal infection treatment, the Spinal Infection Treatment Evaluation Score (SITE Score): a proof-of-concept study

Pluemer

Freyvert

Pratt

et al. 2023

Journal of Neurosurgery: Spine

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OBJECTIVE De novo infections of the spine are an increasing healthcare problem. The decision for nonsurgical or surgical treatment is often made case by case on the basis of physician experience, specialty, or practice affiliation rather than evidence-based medicine. To create a more systematic foundation for surgical assessments of de novo spinal infections, the authors applied a formal validation process toward developing a spinal infection scoring system using principles gained from other spine severity scoring systems like the Spine Instability Neoplastic Score, Thoracolumbar Injury Classification and Severity Score, and AO Spine classification of thoracolumbar injuries. They utilized an expert panel and literature reviews to develop a severity scale called the "Spinal Infection Treatment Evaluation Score" (SITE Score). METHODS The authors conducted an evidence-based process of combining literature reviews, extracting key elements from previous scoring systems, and obtaining iterative expert panel input while following a formal Delphi process. The resulting basic SITE scoring system was tested on selected de novo spinal infection cases and serially refined by an international multidisciplinary expert panel. Intra- and interobserver reliabilities were calculated using the intraclass correlation coefficient (ICC) and Fleiss’ and Cohen’s kappa, respectively. A receiver operating characteristic analysis was performed for cutoff value analysis. The predictive validity was assessed through cross-tabulation analysis. RESULTS The conceptual SITE scoring system combines the key variables of neurological symptoms, infection location, radiological variables for instability and impingement of neural elements, pain, and patient comorbidities. Ten patients formed the first cohort of de novo spinal infections, which was used to validate the conceptual scoring system. A second cohort of 30 patients with de novo spinal infections, including the 10 patients from the first cohort, was utilized to validate the SITE Score. Mean scores of 6.73 ± 1.5 and 6.90 ± 3.61 were found in the first and second cohorts, respectively. The ICCs for the total score were 0.989 (95% CI 0.975–0.997, p < 0.01) in the first round of scoring system validation, 0.992 (95% CI 0.981–0.998, p < 0.01) in the second round, and 0.961 (95% CI 0.929–0.980, p < 0.01) in the third round. The mean intraobserver reliability was 0.851 ± 0.089 in the third validation round. The SITE Score yielded a sensitivity of 97.77% ± 3.87% and a specificity of 95.53% ± 3.87% in the last validation round for the panel treatment decision. CONCLUSIONS The SITE scoring concept showed statistically meaningful reliability parameters. Hopefully, this effort will provide a foundation for a future evidence-based decision aid for treating de novo spinal infections. The SITE Score showed promising inter- and intraobserver reliability. It could serve as a helpful tool to guide physicians’ therapeutic decisions in managing de novo spinal infections and help in comparison studies to better understand disease severity and outcomes.

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Recurrence rate after posterior percutaneous screw fixation without anterior debridement for pyogenic spondylitis compared with conservative treatment: a propensity score-matched analysis

et al. 2023

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Who Needs Surgical Stabilization for Pyogenic Spondylodiscitis? Retrospective Analysis of Non-Surgically Treated Patients

Cited by 7 publications

References 27 publications

The Hamburg Spondylodiscitis Assessment Score (HSAS) for Immediate Evaluation of Mortality Risk on Hospital Admission

The Hamburg Spondylodiscitis Assessment Score (HSAS) for Immediate Evaluation of Mortality Risk on Hospital Admission

A novel scoring system concept for de novo spinal infection treatment, the Spinal Infection Treatment Evaluation Score (SITE Score): a proof-of-concept study

Recurrence rate after posterior percutaneous screw fixation without anterior debridement for pyogenic spondylitis compared with conservative treatment: a propensity score-matched analysis

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