European Spine Journal

, Volume 27, Supplement 2, pp 229–236 | Cite as

Multidisciplinary management of pyogenic spondylodiscitis: epidemiological and clinical features, prognostic factors and long-term outcomes in 207 patients

  • Enrico Pola
  • F. Taccari
  • G. Autore
  • F. Giovannenze
  • V. Pambianco
  • R. Cauda
  • G. Maccauro
  • M. Fantoni
Original Article



Pyogenic spondylodiscitis (PS) is a potentially life-threatening infection burdened by high morbidity rates. Despite the rising incidence, the proper management of PS is still controversial. Aim of this study was to describe the clinical features of PS and to evaluate the prognostic factors and the long-term outcomes of a large population of patients.


207 cases of PS treated from 2008 to 2016 with a 2-year follow-up were enrolled. Clinical data from each patient were recorded. The primary outcome was the rate of healing without residual disability. Secondary outcomes included length of stay, healing from infection, death, relapse, and residual disability. Binomial logistic regression and multivariate analysis were used to evaluate prognostic factors.


Median diagnostic delay was 30 days and the rate of onset neurological impairment was 23.6%. Microbiological diagnosis was established in 155 patients (74.3%) and the median duration of total antibiotic therapy was 148 days. Orthopedic treatment was conservative for 124 patients and surgical in 47 cases. Complete healing without disability was achieved in 142 patients (77.6%). Statistically confirmed negative prognostic factors were: negative microbiological culture, neurologic impairment at diagnosis and underlying endocarditis (p ≤ 0.05). Healing from infection rate was 90.9%, while residual disabilities occurred in 23.5%. Observed mortality rate was 7.8%.


The microbiological diagnosis is the main predictive factor for successful treatment. Early diagnosis and multidisciplinary management are also needed to identify underlying aggressive conditions and to avoid neurological complications associated with poorer long-term outcomes. Despite high healing rates, PS may lead to major disabilities still representing a difficult challenge.

Graphical abstract

These slides can be retrieved under Electronic Supplementary material.


Spondylodiscitis Prognostic factors Outcomes Antibiotic therapy Orthopedic treatment 



The authors declare that they received no grants or funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2018_5598_MOESM1_ESM.pptx (159 kb)
Supplementary material 1 (PPTX 158 kb)


  1. 1.
    Grammatico L, Baron S, Rusch E, Lepage B, Surer N, Desenclos JC, Besnier JM (2008) Epidemiology of vertebral osteomyelitis (VO) in France: analysis of hospital-discharge data 2002–2003. Epidemiol Infect 136:653–660. CrossRefPubMedGoogle Scholar
  2. 2.
    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. CrossRefPubMedGoogle Scholar
  3. 3.
    Fantoni M, Trecarichi EM, Rossi B, Mazzotta V, Di Giacomo G, Nasto LA, Di Meco E, Pola E (2012) Epidemiological and clinical features of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):2–7PubMedGoogle Scholar
  4. 4.
    Skaf GS, Domloj NT, Fehlings MG, Bouclaous CH, Sabbagh AS, Kanafani ZA, Kanj SS (2010) Pyogenic spondylodiscitis: an overview. J Infect Public Health 3:5–16. CrossRefPubMedGoogle Scholar
  5. 5.
    Hopkinson N, Patel K (2016) Clinical features of septic discitis in the UK: a retrospective case ascertainment study and review of management recommendations. Rheumatol Int 36:1319–1326. CrossRefPubMedGoogle Scholar
  6. 6.
    Krogsgaard MR, Wagn P, Bengtsson J (1998) Epidemiology of acute vertebral osteomyelitis in Denmark: 137 cases in Denmark 1978–1982, compared to cases reported to the National Patient Register 1991–1993. Acta Orthop Scand 69:513–517. CrossRefPubMedGoogle Scholar
  7. 7.
    Kehrer M, Pedersen C, Jensen TG, Lassen AT (2014) Increasing incidence of pyogenic spondylodiscitis: a 14-year population-based study. J Infect 68:313–320. CrossRefPubMedGoogle Scholar
  8. 8.
    Akiyama T, Chikuda H, Yasunaga H, Horiguchi H, Fushimi K, Saita K (2013) Incidence and risk factors for mortality of vertebral osteomyelitis: a retrospective analysis using the Japanese diagnosis procedure combination database. BMJ Open 3:e002412. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Lora-Tamayo J, Euba G, Narváez JA, Murillo O, Verdaguer R, Sobrino B, Narváez J, Nolla JM, Ariza J (2011) Changing trends in the epidemiology of pyogenic vertebral osteomyelitis: the impact of cases with no microbiologic diagnosis. Semin Arthritis Rheum 41:247–255. CrossRefPubMedGoogle Scholar
  10. 10.
    Nasto LA, Colangelo D, Rossi B, Fantoni M, Pola E (2012) Post-operative spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):50–57PubMedGoogle Scholar
  11. 11.
    Duarte RM, Vaccaro AR (2013) Spinal infection: state of the art and management algorithm. Eur Spine J 22:2787–2799. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kulowski J (1936) The Orr treatment of pyogenic osteomyelitis. Ann Surg 103:613–624CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Berbari EF, Kanj SS, Kowalski TJ, Darouiche RO, Widmer AF, Schmitt SK, Hendershot EF, Holtom PD, Huddleston PM 3rd, Petermann GW, Osmon DR (2015) Infectious Diseases Society of America. 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clin Infect Dis 61:e26–e46. CrossRefPubMedGoogle Scholar
  14. 14.
    Pola E, Autore G, Formica VM, Pambianco V, Colangelo D, Cauda R, Fantoni M (2017) New classification for the treatment of pyogenic spondylodiscitis: validation study on a population of 250 patients with a follow-up of 2 years. Eur Spine J 26(Suppl 4):479–488. CrossRefPubMedGoogle Scholar
  15. 15.
    Jean M, Irisson JO, Gras G, Bouchand F, Simo D, Duran C, Perronne C, Mulleman D, Bernard L, Dinh A (2017) Diagnostic delay of pyogenic vertebral osteomyelitis and its associated factors. Scand J Rheumatol 46:64–68. CrossRefPubMedGoogle Scholar
  16. 16.
    Leone A, Dell’Atti C, Magarelli N, Colelli P, Balanika A, Casale R, Bonomo L (2012) Imaging of spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):8–19PubMedGoogle Scholar
  17. 17.
    Ramadani N, Dedushi K, Kabashi S, Mucaj S (2017) Radiologic Diagnosis of Spondylodiscitis, Role of Magnetic Resonance. Acta Inform Med 25:54–57. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Lee IS, Lee JS, Kim SJ, Jun S, Suh KT (2009) Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography imaging in pyogenic and tuberculous spondylitis: preliminary study. J Comput Assist Tomogr 33:587–592. CrossRefPubMedGoogle Scholar
  19. 19.
    Bernard L, Dinh A, Ghout I, Simo D, Zeller V, Issartel B, Le Moing V, Belmatoug N, Lesprit P, Bru JP, Therby A, Bouhour D, Dénes E, Debard A, Chirouze C, Fèvre K, Dupon M, Aegerter P, Mulleman D (2015) Duration of Treatment for Spondylodiscitis (DTS) study group (2015) Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial. Lancet 385:875–882. CrossRefPubMedGoogle Scholar
  20. 20.
    Park KH, Cho OH, Lee JH, Park JS, Ryu KN, Park SY, Lee YM, Chong YP, Kim SH, Lee SO, Choi SH, Bae IG, Kim YS, Woo JH, Lee MS (2016) Optimal duration of antibiotic therapy in patients with hematogenous vertebral osteomyelitis at low risk and high risk of recurrence. Clin Infect Dis 62:1262–1269. CrossRefPubMedGoogle Scholar
  21. 21.
    Roblot F, Besnier JM, Juhel L, Vidal C, Ragot S, Bastides F, Le Moal G, Godet C, Mulleman D, Azaïs I, Becq-Giraudon B, Choutet P (2007) Optimal duration of antibiotic therapy in vertebral osteomyelitis. Semin Arthritis Rheum 36:269–277CrossRefPubMedGoogle Scholar
  22. 22.
    Grados F, Lescure FX, Senneville E, Flipo RM, Schmit JL, Fardellone P (2007) Suggestions for managing pyogenic (non-tuberculous) discitis in adults. Joint Bone Spine 74:133–139CrossRefPubMedGoogle Scholar
  23. 23.
    Pola E, Logroscino CA, Gentiempo M, Colangelo D, Mazzotta V, Di Meco E, Fantoni M (2014) Medical and surgical treatment of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):35–49Google Scholar
  24. 24.
    Nasto LA, Colangelo D, Mazzotta V, Di Meco E, Neri V, Nasto RA, Fantoni M, Pola E (2014) Is posterior percutaneous screw-rod instrumentation a safe and effective alternative approach to TLSO rigid bracing for single-level pyogenic spondylodiscitis? Results of a retrospective cohort analysis. Spine J 14:1139–1146. CrossRefPubMedGoogle Scholar
  25. 25.
    Turel MK, Kerolus M, Deutsch H (2017) The role of minimally invasive spine surgery in the management of pyogenic spinal discitis. J Craniovertebr Junction Spine 8:39–43. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Enrico Pola
    • 1
  • F. Taccari
    • 2
  • G. Autore
    • 1
  • F. Giovannenze
    • 2
  • V. Pambianco
    • 1
  • R. Cauda
    • 2
  • G. Maccauro
    • 3
  • M. Fantoni
    • 2
  1. 1.Division of Spine Surgery, Department of Orthopaedics and Traumatology, “A. Gemelli” University HospitalCatholic University of RomeRomeItaly
  2. 2.Department of Infectious Diseases, “A. Gemelli” University HospitalCatholic University of RomeRomeItaly
  3. 3.Department of Orthopaedics and Traumatology, “A. Gemelli” University HospitalCatholic University of RomeRomeItaly

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