Introduction: Aim of this study is to evaluate the different surgical approaches and the postoperative antibacterial treatment regime for spondylodiscitis.
Methods: We performed a retrospective review of surgically treated patients due to spondylodiscitis between 2006 and 2010.
Results: 113 patients were identified. The mean age at presentation was 65 years, 78 patients were male (69%). Distribution of the inflammation was lumbar in 68 (60%), thoracic in 19 (17%) and cervical in 20 (18%) cases. Six patients (5%) had two concomitant non-contiguous spondylodiscitis in different segments of the spine. 104 patients (92%) had pain. Neurological deficit was found in 51 patients (45%). In the thoracic and lumbar cases, dorsal instrumentation alone was considered sufficient in 26 cases, additional interbody fusion from dorsal was performed in 44 cases. 360 degree instrumentation was performed in 22 cases. In the cervical cases, ventral spondylodesis was performed in 12 , dorsal instrumentation alone in 6 cases and 360 degree instrumentation in 6 cases. Postoperative intravenous antibiotics were administered for 14.4 ± 9.3 days followed by 3.2 ± 0.8 months of oral antibiotics.?Complete healing of the inflammation was achieved in 111 (98%) of cases. Only two patients had a relapse of the inflammation following dorsal instrumentation alone. This was followed by debridment and anterior interbody fusion upon relapse. Two patients died due to septic schock, both with fulminant endocarditis. From the 51 patients with neurological deficit, 23 (45%) had full recovery and 21 (41%) had improved incompletely after surgery.
Conclusions: Staged surgical immobilisation and instrumentation and optimal debridment at the interdiscal space is a reliable approach to achieve complete healing of spinal inflammation. Thereby, a short period of intravenous antibiotics of 1-2 weeks is followed by 3 months of oral antibiotics is appropriate in most cases. The choice of fusion material (autologous bone, Titanium, PEEK) seems less important.
Patient Care: show the different surgical options for spondylodiscitis and Identify an effective postoperative antibacterial treatment regime for spondylodiscitis
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the different surgical options for spondylodiscitis3) Identify an effective postoperative antibacterial treatment regime for spondylodiscitis