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Operative Therapie der bakteriellen Spondylodiszitis

Eine retrospektive Untersuchung

Operative therapy of bacterial spondylodiscitis

A retrospective study

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Zusammenfassung

Einleitung

Die bakterielle Spondylodiszitis ist ein seltenes Problem in der Wirbelsäulenchirurgie. Mit dieser Studie möchten wir die Ergebnisse nach Operation unter besonderer Berücksichtigung von Ursachen, Vorgeschichte, Operation und Krankheitsverlauf untersuchen.

Methoden

Es handelt sich um eine retrospektive Studie über 53 Patienten basierend auf den Krankenakten, inklusive der laborchemischen und mikrobiologischen Befunde.

Ergebnisse

Unter neurologischen Ausfällen verschiedener Schweregrade vom umschriebenen sensiblen Defizit (n=1) bis hin zur Paraplegie (n=6) litten 29 Patienten. In Abhängigkeit von der befallenen Höhe und vom Ausmaß der Infektion wurde die Operation in 16 Fällen als reine Dekompression durchgeführt bzw. als ein- oder zweizeitige Dekompression mit ventraler oder dorsoventraler Stabilisierung. Staphylococcus aureus war der häufigste Erreger (n=23). Nach einem medianen Follow-up von 11,25 Monaten waren 3 Patienten verstorben. In 22 Fällen blieben die Patienten wegen Schmerzen oder neurologischer Ausfälle eingeschränkt.

Schlussfolgerung

Bleibende neurologische Defizite und mögliche letale Komplikationen machen die Spondylodiszitis weiterhin zu einem Problem. Die Behandlung umfasst die gezielte antibiotische Therapie sowie die Operation in ausgewählten Fällen.

Abstract

Objective

Bacterial spondylodiscitis is a rare entity in spinal surgery. This study analyses the postoperative results of 53 patients, focusing on the history, the treatment, and the course of the disease.

Material and Methods

This retrospective study is based on the patients’ medical charts, including the laboratory and microbiological data.

Results

Twenty-nine patients suffered from different neurological deficits ranging from isolated mild hypaesthesia (n=1) to complete paraplegia (n=6). Depending on the affected area and the extension of the infection, surgery was done either as simple decompression in 16 cases or as decompression combined with a ventral or dorsoventral stabilization in 37 patients. Staphylococcus aureus was the most important triggering organism (n=23). After a median follow-up of 11.25 months, three patients had died, and 22 patients were still disabled because of persisting pain or neurological disturbances.

Conclusion

Because of persistent neurological deficits and possible lethal complications, spondylodiscitis remains a severe problem. Management comprises targeted antibiotic therapy and surgery in selected cases.

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Authors and Affiliations

  1. Klinik für Neurochirurgie, Klinikum der Friedrich Schiller-Universität, Erlanger Allee 101, 07747, Jena, Deutschland

    C. Ewald, J. Gartemann, S.A. Kuhn, J. Walter & R. Kalff

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  1. C. Ewald
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  2. J. Gartemann
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  3. S.A. Kuhn
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  4. J. Walter
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  5. R. Kalff
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Correspondence to C. Ewald.

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Ewald, C., Gartemann, J., Kuhn, S. et al. Operative Therapie der bakteriellen Spondylodiszitis. Orthopäde 38, 248–255 (2009). https://doi.org/10.1007/s00132-009-1415-9

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  • DOI: https://doi.org/10.1007/s00132-009-1415-9

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