When and how to operate on spondylodiscitis: a report of 13 patients View Full Text


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Article Info

DATE

2015-07-20

AUTHORS

Andreas F. Mavrogenis, Vasilis Igoumenou, Konstantinos Tsiavos, Panayiotis Megaloikonomos, Georgios N. Panagopoulos, Christos Vottis, Efthymia Giannitsioti, Antonios Papadopoulos, Konstantinos C. Soultanis

ABSTRACT

PurposeConflicting reports exist regarding the surgical indications, timing, approach, staged or not operation, and spinal instrumentation for patients with spondylodiscitis. Therefore, we performed this study to evaluate the outcome of a series of patients with spondylodiscitis aiming to answer when and how to operate on these patients.Materials and methodsWe retrospectively studied the files of 153 patients with spondylodiscitis treated at our institution from 2002 to 2012. The approach included MR imaging of the infected spine, isolation of the pathogen with blood cultures and/or biopsy, and further conservative or surgical treatment. The mean follow-up was 6 years (range 1–13 years). We evaluated the indications, timing (when), and methods (how) for surgical treatment, and the clinical outcome of these patients.ResultsOrthopedic surgical treatment was necessary for 13 of the 153 patients (8.5 %). These were patients with low access to healthcare systems because of low socioeconomic status, third-country migrants, prisoners or intravenous drug use, patients in whom a bacterial isolate documentation was necessary, and patients with previous spinal operations. The most common pathogen was Mycobacterium tuberculosis. The surgical indications included deterioration of the neurological status (11 patients), need for bacterial isolate (10 patients), septicemia due to no response to antibiotics (five patients), and/or spinal instability (three patients). An anterior vertebral approach was more commonly used. Nine of the 13 patients had spinal instrumentation in the same setting. Improvement or recovery of the neurological status was observed postoperatively in all patients with preoperative neurological deficits. Postoperatively, two patients deceased from pulmonary infection and septicemia, and heart infarction. At the last follow-up, patients who were alive were asymptomatic; ten patients were neurologically intact, and one patient experienced paraparesis. Imaging showed spinal fusion, without evidence of recurrent spondylodiscitis. Complications related to the spinal instrumentation were not observed in the respective patients.ConclusionsConservative treatment is the standard for spondylodiscitis. Physicians should be alert for Mycobacterium tuberculosis spondylitis because of the low access to healthcare systems of patients with low social and economic status. Surgical indications include obtaining tissue sample for diagnosis, occurrence or progression of neurological symptoms, failure of conservative treatment, large anterior abscesses, and very extensive disease. Thorough debridement of infected tissue and spinal stability is paramount. The anterior approach provides direct access and improved exposure to the most commonly affected part of the spine. Spinal instrumentation is generally recommended for optimum spinal stability and fusion, without any implant-related complications. More... »

PAGES

31-40

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00590-015-1674-6

DOI

http://dx.doi.org/10.1007/s00590-015-1674-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1012825516

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/26190644


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    "description": "PurposeConflicting reports exist regarding the surgical indications, timing, approach, staged or not operation, and spinal instrumentation for patients with spondylodiscitis. Therefore, we performed this study to evaluate the outcome of a series of patients with spondylodiscitis aiming to answer when and how to operate on these patients.Materials and methodsWe retrospectively studied the files of 153 patients with spondylodiscitis treated at our institution from 2002 to 2012. The approach included MR imaging of the infected spine, isolation of the pathogen with blood cultures and/or biopsy, and further conservative or surgical treatment. The mean follow-up was 6\u00a0years (range 1\u201313\u00a0years). We evaluated the indications, timing (when), and methods (how) for surgical treatment, and the clinical outcome of these patients.ResultsOrthopedic surgical treatment was necessary for 13 of the 153 patients (8.5\u00a0%). These were patients with low access to healthcare systems because of low socioeconomic status, third-country migrants, prisoners or intravenous drug use, patients in whom a bacterial isolate documentation was necessary, and patients with previous spinal operations. The most common pathogen was Mycobacterium tuberculosis. The surgical indications included deterioration of the neurological status (11 patients), need for bacterial isolate (10 patients), septicemia due to no response to antibiotics (five patients), and/or spinal instability (three patients). An anterior vertebral approach was more commonly used. Nine of the 13 patients had spinal instrumentation in the same setting. Improvement or recovery of the neurological status was observed postoperatively in all patients with preoperative neurological deficits. Postoperatively, two patients deceased from pulmonary infection and septicemia, and heart infarction. At the last follow-up, patients who were alive were asymptomatic; ten patients were neurologically intact, and one patient experienced paraparesis. Imaging showed spinal fusion, without evidence of recurrent spondylodiscitis. Complications related to the spinal instrumentation were not observed in the respective patients.ConclusionsConservative treatment is the standard for spondylodiscitis. Physicians should be alert for Mycobacterium tuberculosis spondylitis because of the low access to healthcare systems of patients with low social and economic status. Surgical indications include obtaining tissue sample for diagnosis, occurrence or progression of neurological symptoms, failure of conservative treatment, large anterior abscesses, and very extensive disease. Thorough debridement of infected tissue and spinal stability is paramount. The anterior approach provides direct access and improved exposure to the most commonly affected part of the spine. Spinal instrumentation is generally recommended for optimum spinal stability and fusion, without any implant-related complications.", 
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36 schema:description PurposeConflicting reports exist regarding the surgical indications, timing, approach, staged or not operation, and spinal instrumentation for patients with spondylodiscitis. Therefore, we performed this study to evaluate the outcome of a series of patients with spondylodiscitis aiming to answer when and how to operate on these patients.Materials and methodsWe retrospectively studied the files of 153 patients with spondylodiscitis treated at our institution from 2002 to 2012. The approach included MR imaging of the infected spine, isolation of the pathogen with blood cultures and/or biopsy, and further conservative or surgical treatment. The mean follow-up was 6 years (range 1–13 years). We evaluated the indications, timing (when), and methods (how) for surgical treatment, and the clinical outcome of these patients.ResultsOrthopedic surgical treatment was necessary for 13 of the 153 patients (8.5 %). These were patients with low access to healthcare systems because of low socioeconomic status, third-country migrants, prisoners or intravenous drug use, patients in whom a bacterial isolate documentation was necessary, and patients with previous spinal operations. The most common pathogen was Mycobacterium tuberculosis. The surgical indications included deterioration of the neurological status (11 patients), need for bacterial isolate (10 patients), septicemia due to no response to antibiotics (five patients), and/or spinal instability (three patients). An anterior vertebral approach was more commonly used. Nine of the 13 patients had spinal instrumentation in the same setting. Improvement or recovery of the neurological status was observed postoperatively in all patients with preoperative neurological deficits. Postoperatively, two patients deceased from pulmonary infection and septicemia, and heart infarction. At the last follow-up, patients who were alive were asymptomatic; ten patients were neurologically intact, and one patient experienced paraparesis. Imaging showed spinal fusion, without evidence of recurrent spondylodiscitis. Complications related to the spinal instrumentation were not observed in the respective patients.ConclusionsConservative treatment is the standard for spondylodiscitis. Physicians should be alert for Mycobacterium tuberculosis spondylitis because of the low access to healthcare systems of patients with low social and economic status. Surgical indications include obtaining tissue sample for diagnosis, occurrence or progression of neurological symptoms, failure of conservative treatment, large anterior abscesses, and very extensive disease. Thorough debridement of infected tissue and spinal stability is paramount. The anterior approach provides direct access and improved exposure to the most commonly affected part of the spine. Spinal instrumentation is generally recommended for optimum spinal stability and fusion, without any implant-related complications.
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42 schema:keywords ConclusionsConservative treatment
43 MR imaging
44 MethodsWe
45 Mycobacterium tuberculosis
46 abscess
47 access
48 anterior abscesses
49 anterior approach
50 antibiotics
51 approach
52 bacterial isolates
53 biopsy
54 blood cultures
55 clinical outcomes
56 common pathogens
57 complications
58 conservative treatment
59 culture
60 debridement
61 deficits
62 deterioration
63 diagnosis
64 direct access
65 disease
66 documentation
67 drug use
68 economic status
69 evidence
70 exposure
71 extensive disease
72 failure
73 files
74 fusion
75 healthcare system
76 heart infarction
77 imaging
78 implant-related complications
79 improvement
80 indications
81 infarction
82 infected spine
83 infected tissues
84 infection
85 instability
86 institutions
87 instrumentation
88 intravenous drug use
89 isolates
90 isolation
91 low access
92 low socioeconomic status
93 materials
94 method
95 migrants
96 neurological deficits
97 neurological status
98 neurological symptoms
99 occurrence
100 operation
101 outcomes
102 paraparesis
103 part
104 pathogens
105 patients
106 physicians
107 preoperative neurological deficits
108 previous spinal operations
109 prisoners
110 progression
111 pulmonary infection
112 recovery
113 report
114 respective patients
115 response
116 same setting
117 samples
118 septicemia
119 series
120 series of patients
121 setting
122 socioeconomic status
123 spinal fusion
124 spinal instability
125 spinal instrumentation
126 spinal operations
127 spinal stability
128 spine
129 spondylitis
130 spondylodiscitis
131 stability
132 standards
133 status
134 study
135 surgical indications
136 surgical treatment
137 symptoms
138 system
139 third-country migrants
140 thorough debridement
141 timing
142 tissue
143 tissue samples
144 treatment
145 tuberculosis
146 tuberculosis spondylitis
147 use
148 years
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