Introduction: To describe and discuss the role of surgery in the management of spontaneous spondylodiscitis.
Methods: Retrospective review of the outcome and complications of a cohort of patients undergoing surgery for spontaneous (non postoperative) spondylodiscitis of any spinal level and etiology.
Results: From 1995 to 2014, 83 patients (45% females, median age 66) with spondylodiscitis were treated. Microbiological confirmation was obtained in 67.4%. Forty-four percent of patients presented with neurological defect. The most common affected level was thoracic (54.2%). The most frequent isolations were Mycobacterium tuberculosis (22,9%), Staphyloccocus aureus (20.5%) and MRSA (7.2%). Eighty-one patients underwent surgery: simple laminectomy and/or biopsy (22.2%), debridement and posterior fixation (43.2%) and debridement and anterior fixation (34.5%). Improvement of pain or neurological defect was achieved in 86.7% of the patients; 7 patients stabilized and 3 worsened. Complications occurred in 36% of the cohort, mainly pleural effusion (9), anemia (7) and need for re-debridement (7). Median postoperative stay was 14 days. After a median follow up of 5.6 months, 46 patients were considered completely cured, 10 presented sequels, 22 patients were lost and 5 patients died. No readmissions occurred because of the infectious episode.
Conclusions: Although prolonged and specific antibiotic therapy remains the mainstay of treatment in spontaneous spondylodiscitis, surgery provides samples for microbiological confirmation and hystopathologic study, allows debridement of the infectious foci and stabilizes the spine. The use of internal metallic fixation material accelerates recovery and does not predispose to chronic infection.
Patient Care: It provides a large single institution experience about spinal infection of many etiologies.
Learning Objectives: Describe a large series of spontaneous spondylodiscitis patients. Highlight the importance of spinal debridement and internal fixation in the curative process of the spinal infection. Comment on the helpful use of hystopathologic exam in the diagnosis of this disease.