Skip to main content

Advertisement

SpringerLink
Log in

A retrospective study of 113 consecutive cases of surgically treated spondylodiscitis patients. A single-center experience

  • Clinical Article - Spine
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Recommendations for the operative treatment of spondylodiscitis are still a controversial issue.

Methods

A retrospective review identified 113 consecutive patients who underwent surgical debridement and instrumentation for spondylodiscitis between 2006 and 2010 at our department.

Results

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 foci in different segments of the spine. Epidural abscess was found in 33 patients (29 %). One hundred four patients (92 %) had pain. Neurological deficit was found in 40 patients (35 %). In the thoracic and lumbar cases, dorsal instrumentation alone was considered sufficient in 26 cases; additional interbody fusion from the posterior was performed in 44 cases. A 360° instrumentation was performed in 22 cases. In the cervical cases, only ventral spondylodesis and plating were performed in eight cases, only dorsal instrumentation in five and 360° instrumentation in seven. Postoperative intravenous antibiotics were administered for 14.4 ± 9.3 (mean ± SD) days followed by 3.2 ± 0.8 (mean ± SD) months of oral antibiosis. Complete healing of the inflammation was achieved in 111 (98 %) cases. Two patients died because of septic shock, both with fulminant endocarditis. Pain resolved in all cases. Neurological deficits were completely resolved in 20 patients, and 14 patients had a partial recovery.

Conclusion

The results of our retrospective study show that surgical treatment of spondylodiscitis with a staged surgical approach (if needed) and a short 1-2-week period of intravenous antibiotics followed by 3 months of oral antibiotics is appropriate for most patients in whom conservative treatment has failed or is not advisable. Furthermore, surgical treatment of newly diagnosed spondylodiscitis might be recommended as an initial treatment option in many cases. Thereby the choice of fusion material (autologous bone, titanium, PEEK) seems less important.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Al-Nammari SS, Lucas JD, Lam KS (2007) Hematogenous methicillin-resistant Staphylococcus aureus spondylodiscitis. Spine (Phila Pa 1976) 15:2480–2386

    Article  Google Scholar 

  2. Belzunegui J, Intxausti JJ, De Dios JR, Del Val N, Rodríguez Valverde V, González C, Queiro R, Figueroa M (2000) Haematogenous vertebral osteomyelitis in the elderly. Clin Rheumatol 19:344–347

    Article  CAS  PubMed  Google Scholar 

  3. Bettini N, Girardo M, Dema E, Cervellati S (2009) Evaluation of conservative treatment of non specific spondylodiscitis. Eur Spine J 1:143–150

    Article  Google Scholar 

  4. Brase A, Ringel F, Stüer C, Meyer B, Stoffel M (2010) Debridement and fusion with polyetheretherketone implants in purulent spondylodiscitis: a clinical experience with nine patients. Acta Neurochir 152:2001–2004

    Article  PubMed  Google Scholar 

  5. Carragee EJ (1997) Instrumentation of the infected and unstable spine: a review of 17 cases from the thoracic and lumbar spine with pyogenic infections. J Spinal Disord 10:317–324

    Article  CAS  PubMed  Google Scholar 

  6. Carragee EJ (1997) Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am 79:874–880

    Article  CAS  PubMed  Google Scholar 

  7. Chang CC, Merritt K (1994) Infection at the site of implanted materials with and without preadhered bacteria. J Orthop Res 12:526–531

    Article  CAS  PubMed  Google Scholar 

  8. Cottle L, Riodan T (2008) Infectious spondylodiscitis. J Infect 56:401–412

    Article  PubMed  Google Scholar 

  9. Deininger MH, Unfried MI, Vougioukas VI, Hubbe U (2009) Minimally invasive dorsal percutaneous spondylodesis for the treatment of adult pyogenic spondylodiscitis. Acta Neurochir 151:1451–1457

    Article  PubMed  Google Scholar 

  10. Dimar JR, Carreon LY, Glassman SD, Campbell MJ, Hartman MJ, Johnson JR (2004) Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion. Spine 29:326–332

    Article  PubMed  Google Scholar 

  11. Dufour V, Feydy A, Rillardon L, Redondo A, Le Page L, Bert F, Belmatoug N, Fantin B (2005) Comparative study of postoperative and spontaneous pyogenic spondylodiscitis. Semin Arthritis Rheum 34:766–771

    Article  PubMed  Google Scholar 

  12. Euba G, Narváez JA, Nolla JM, Murillo O, Narváez J, Gómez-Vaquero C, Ariza J (2008) Long-term clinical and radiological magnetic resonance imaging outcome of abscess-associated spontaneous pyogenic vertebral osteomyelitis under conservative management. Semin Arthritis Rheum 38:28–40

    Article  PubMed  Google Scholar 

  13. Eysel P, Hopf C, Vogel I, Rompe JD (1997) Primary stable anterior instrumentation or dorsoventral spondylodesis in spondylodiscitis? Results of a comparative study. Eur Spine J 6:152–157

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Fang D, Cheung KM, Dos Remedios ID, Lee YK, Leong JC (1994) Pyogenic vertebral osteomyelitis: treatment by anterior spinal debridement and fusion. J Spinal Disord 7:173–180

    Article  CAS  PubMed  Google Scholar 

  15. Fukuta S, Miyamoto K, Masuda T, Hosoe H, Kodama H, Nishimoto H, Sakaeda H, Shimizu K (2003) Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine 28:E 302–308

    Google Scholar 

  16. Hadjipavlou AG, Mader JT, Necessary JT, Muffoletto AJ (2000) Hematogenous pyogenic spinal infections and their surgical management. Spine 25:1668–1679

    Article  CAS  PubMed  Google Scholar 

  17. Hanaoka N, Kawasaki Y, Sakai T, Nakamura T, Nanamori K, Nakamura E, Uchida K, Yamada H (2006) Percutaneous drainage and continuous irrigation in patients with severe pyogenic spondylitis, abscess formation, and marked bone destruction. J Neurosurg Spine 4:374–379

    Article  PubMed  Google Scholar 

  18. Hee HT, Majd ME, Holt RT, Pienkowski D (2002) Better treatment of vertebral osteomyelitis using posterior stabilization and titanium mesh cages. J Spinal Disord Tech 15:149–156

    Article  PubMed  Google Scholar 

  19. Heyde CE, Boehm H, El Saghir H, Tschöke SK, Kayser R (2006) Surgical treatment of spondylodiscitis in the cervical spine: a minimum 2-year follow-up. Eur Spine J 15:1380–1387

    Article  PubMed Central  PubMed  Google Scholar 

  20. Hopf C, Meurer A, Eysel P, Rompe JD (1998) Operative treatment of spondylodiscitis—what is the most effective approach? Neurosurg Rev 21:217–225

    Article  CAS  PubMed  Google Scholar 

  21. Hopkinson N, Stevenson J, Benjamin S (2001) A case ascertainment study of septic discitis: clinical, microbiological and radiological features. QJM 94:465–470

    Article  CAS  PubMed  Google Scholar 

  22. Ito M, Abumi K, Kotani Y, Kadoya K, Minami A (2007) Clinical outcome of posterolateral endoscopic surgery for pyogenic spondylodiscitis: results of 15 patients with serious comorbid conditions. Spine 32:200–206

    Article  PubMed  Google Scholar 

  23. Kuklo TR, Potter BK, Bell RS, Moquin RR, Rosner MK (2006) Single-stage treatment of pyogenic spinal infection with titanium mesh cages. J Spinal Disord Tech 19:376–382

    Article  PubMed  Google Scholar 

  24. Karadimas EJ, Bunger C, Lindblad BE, Hansen ES, Høy K, Helmig P, Kannerup AS, Niedermann B (2008) Spondylodiscitis. A retrospective study of 163 patients. Acta Orthop 79:650–659

    Article  PubMed  Google Scholar 

  25. Khan IA, Vaccaro AR, Zlotolow DA (1999) Management of vertebral discitis and osteomyelitis. Orthopedics 22:758–765

    CAS  PubMed  Google Scholar 

  26. Klockner C, Valencia R (2003) Sagittal alignment after anterior debridement and fusion with or without additional posterior instrumentation in the treatment of pyogenic and tuberculous spondylodiscitis. Spine 28:1036–1042

    PubMed  Google Scholar 

  27. Klockner C, Valencia R, Weber U (2001) Sagittal alignment following surgical therapy of destructive spondylodiscitis: ventral or ventrodorsal procedure—a comparison of results. Orthopade 30:965–976

    Article  CAS  PubMed  Google Scholar 

  28. Krödel A, Krüger A, Lohscheidt K, Pfahler M, Refior HJ (1999) Anterior debridement, fusion, and extrafocal stabilization in the treatment of osteomyelitis of the spine. J Spinal Disord 12:17–26

    PubMed  Google Scholar 

  29. Krodel A, Sturz H (1989) Differentiated surgical and conservative treatment of spondylitis and spondylodiscitis. Z Orthop Ihre Grenzgeb 127:589–596

    Article  Google Scholar 

  30. Krodel A, Sturz H, Siebert CH (1991) Indications for and results of operative treatment of spondylitis and spondylodiscitis. Arch Orthop Trauma Surg 110:78–82

    Article  CAS  PubMed  Google Scholar 

  31. Korovessis P, Petsinis G, Koureas G, Iliopoulos P, Zacharatos S (2006) Anterior surgery with insertion of titanium mesh cage and posterior instrumented fusion performed sequentially on the same day under one anesthesia for septic spondylitis of thoracolumbar spine: is the use of titanium mesh cages safe? Spine 31:1014–1019

    Article  PubMed  Google Scholar 

  32. Korovessis P, Repantis T, Iliopoulos P, Hadjipavlou A (2008) Beneficial influence of titanium mesh cage on infection healing and spinal reconstruction in hematogenous septic spondylitis: a retrospective analysis of surgical outcome of twenty-five consecutive cases and review of literature. Spine (Phila Pa 1976) 33:E759–67

    Article  Google Scholar 

  33. Lee JS, Suh KT (2006) Posterior lumbar interbody fusion with an autogenous iliac crest bone graft in the treatment of pyogenic spondylodiscitis. J Bone Joint Surg Br 88:765–770

    Article  CAS  PubMed  Google Scholar 

  34. Linhardt O, Kruger A, Krodel A (2004) First results of anterior versus posterior instrumentation-fusion in the treatment of spondylodiscitis. Z Orthop Ihre Grenzgeb 142:73–78

    Article  CAS  PubMed  Google Scholar 

  35. Mann S, Schütze M, Sola S, Piek J (2004) Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients. Neurosurg Focus 17(6):E3

    Article  PubMed  Google Scholar 

  36. McGuire RA, Eismont FJ (1994) The fate of autogenous bone graft in surgically treated pyogenic vertebral osteomyelitis. J Spinal Disord 7:206–215

    Article  CAS  PubMed  Google Scholar 

  37. Mondorf Y, Gaab MR, Oertel JM (2009) PEEK cage cervical ventral fusion in spondylodiscitis. Acta Neurochir 151:1537–1541

    Article  PubMed  Google Scholar 

  38. Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A (2009) Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum 39:10–17

    Article  CAS  PubMed  Google Scholar 

  39. Nagata K, Ohashi T, Ariyoshi M, Sonoda K, Imoto H, Inoue A (1998) Percutaneous suction aspiration and drainage for pyogenic spondylitis. Spine 23:1600–1606

    Article  CAS  PubMed  Google Scholar 

  40. O’Daly BJ, Morris SF, O’Rouke SK (2008) Long-term function outcome in pyogenic spinal infection. Spine 33:E246–E253

    Article  PubMed  Google Scholar 

  41. Ogden AT, Kaiser MG (2004) Single stage debridement and instrumentation for pyogenic spinal infections. Neurosurg Focus 17:E5,1–5

    Article  Google Scholar 

  42. Pavlov PW, Meijers H, van Limbeek J, Jacobs WC, Lemmens JA, Obradov-Rajic M, de Kleuver M (2004) Good outcome and restoration of lordosis after anterior lumbar interbody fusion with additional posterior fixation. Spine 29:1893–1900

    Article  PubMed  Google Scholar 

  43. Pee YH, Park JD, Choi YG, Lee SH (2008) Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage. J Neurosurg Spine 8:405–412

    Article  PubMed  Google Scholar 

  44. Pigrau C, Almirante B, Flores X, Falco V, Rodríguez D, Gasser I, Villanueva C, Pahissa A (2005) Spontaneous pyogenic vertebral osteomyelitis and endocarditis: incidence, risk factors, and outcome. Am J Med 118:1287

    Article  PubMed  Google Scholar 

  45. Przybylski GJ, Sharan AD (2001) Single-stage autogenous bone grafting and internal fixation in the surgical management of pyogenic discitis and vertebral osteomyelitis. J Neurosurg Spine 94:1–7

    Article  CAS  Google Scholar 

  46. Quiñones-Hinojosa A, Jun P, Jacobs R, Rosenberg WS, Weinstein PR (2004) General principles in the medical and surgical management of spinal infections: a multidisciplinary approach. Neurosurg Focus 17:E1,1–15

    Google Scholar 

  47. Rath SA, Neff U, Schneider O, Richter HP (1996) Neurosurgical management of thoracic and lumbar vertebral osteomyelitis and discitis in adults: a review of 43 consecutive surgically treated patients. Neurosurg 38:926–933

    Article  CAS  Google Scholar 

  48. Roblot F, Besnier JM, Juhel L, Vidal C, Ragot S, Bastides F (2007) Optimal duration of antibiotic therapy in vertebral oseomylitis. Semin Arthritis Rheum 36:269–277

    Article  CAS  PubMed  Google Scholar 

  49. Sakkas LI, Davas EM, Kapsalaki E, Boulbou M, Makaritsis K, Alexiou I, Tsikrikas T, Stathakis N (2009) Hematogenous spinal infection in central Greece. Spine (Phila Pa 1976) 34:E513–518

    Article  Google Scholar 

  50. Schinkel C, Gottwald M, Andress HJ (2003) Surgical treatment of spondylodiscitis. Surg Infect 4:387–391

    Article  Google Scholar 

  51. Sindern E, Gläser E, Bötel U, Malin JP (1993) Spondylodiscitis with spinal and radicular deficits. Limits of conservative treatment. Nervenarzt 64:801–805

    CAS  PubMed  Google Scholar 

  52. Valancius K, Hansen ES, Høy K, Helmig P, Niedermann B, Bünger C (2012) Failure modes in conservative and surgical management of infectious spondylodiscitis. Eur Spine J 22:1837–1844

    Article  PubMed  Google Scholar 

  53. Walter J, Kuhn SA, Reichart R, Kalff R, Ewald C (2010) PEEK cages as a potential alternative in the treatment of cervical spondylodiscitis: a preliminary report on a patient series. Eur Spine J 19:1004–1009

    Article  PubMed Central  PubMed  Google Scholar 

  54. Zarrouk V, Feydy A, Sallès F, Dufour V, Guigui P, Redondo A (2007) Imaging does not predict the clinical outcome of bacterial vertebral osteomyelitis. Rheumatology (Oxford) 46:292–295

    Article  CAS  Google Scholar 

Download references

Conflicts of interest

The authors declare that they have no conflict of interest affecting this study. The study was completely financed by the Department of Neurosurgery.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Ehab Shiban, Insa Janssen, Maria Wostrack, Sandro M Krieg, Florian Ringel, Bernhard Meyer & Michael Stoffel

  2. Department of Neurosurgery, Helios Klinikum, Krefeld, Germany

    Michael Stoffel

Authors
  1. Ehab Shiban
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Insa Janssen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Wostrack
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sandro M Krieg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Florian Ringel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bernhard Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael Stoffel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ehab Shiban.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shiban, E., Janssen, I., Wostrack, M. et al. A retrospective study of 113 consecutive cases of surgically treated spondylodiscitis patients. A single-center experience. Acta Neurochir 156, 1189–1196 (2014). https://doi.org/10.1007/s00701-014-2058-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-014-2058-0

Keywords

Search

Navigation