Spondylodiscitis: experience of surgical management of complicated cases after failed antibiotic treatment

Abdullah Mohammed Kamal, Mohammad M El-Sharkawi, Moataz El-Sabrout, Mohammad Gamal Hassan, Abdullah Mohammed Kamal, Mohammad M El-Sharkawi, Moataz El-Sabrout, Mohammad Gamal Hassan

Abstract

Introduction: The term Spondylodiscitis (SD) involves infection of the vertebra (Spondylitis), infection of the intervertebral disc (Discitis), or both (Spondylodiscitis). SD represents a diagnostic and therapeutic challenge to any spine surgeon. Any delay in its diagnosis or management may cause serious long-term morbidity or even lead to mortality. In this study, we report the experience of our Institution in the management of severe and complicated cases of SD.

Methods: Over a period of 1 year, 39 patients with the diagnosis of SD were surgically treated in Assiut University Hospital, Assiut, Egypt. The management processes were tailored according to the clinical condition, radiological and lab studies of each case; and patients were then prospectively followed-up until they were cured (for a minimum of 6 months). The outcomes were analyzed, to be able to give recommendations while aiming to improve the overall outcome of such dangerous health issue.

Results: In this series, patients were managed surgically by drainage and debridement of the infection site with/without instrumented fusion. Results included: satisfactory fusion was achieved in 97.3% of patients (confidence interval [CI] = 0.6856-1.3421). Neurological Improvement Rate (NIR) was 71.5% (Statistically significant improvement P-value = 0.014) and reoperation rate was 5% (CI = 0.00621-0.18525). Mortality rate was 7.7% (CI = 0.016-0.209). Several aspects were analyzed in each case.

Conclusion: Surgical management of severe and complicated cases of SD allows for effective debridement and rapid cure of inflammation, earlier patient mobilization and significantly shorter duration of antibiotic usage.

Keywords: multi-disciplinary approach; pseudarthrosis; spinal fusion; spinal infection; spondylodiscitis.

© The Authors, published by EDP Sciences, 2020.

Figures

Figure 1
Figure 1
Flow diagram for follow-up.
Figure 1
Figure 1
Flow diagram for follow-up.
Figure 2
Figure 2
SD C3–4 in a 62-year-old male. (a) Preoperative CT scan showing C3–4 SD with significant local kyphosis. (b) Preoperative lateral X-rays after traction for 2 weeks. (c and d) Postoperative X-rays anteroposterior and lateral views showing corpectomy of C3 and C2–4 fusion using titanium cage and cervical locked H-shaped plate. (e) Six months follow-up lateral X-rays showing solid fusion.
Figure 2
Figure 2
SD C3–4 in a 62-year-old male. (a) Preoperative CT scan showing C3–4 SD with significant local kyphosis. (b) Preoperative lateral X-rays after traction for 2 weeks. (c and d) Postoperative X-rays anteroposterior and lateral views showing corpectomy of C3 and C2–4 fusion using titanium cage and cervical locked H-shaped plate. (e) Six months follow-up lateral X-rays showing solid fusion.
Figure 3
Figure 3
SD D6–7 in a 47-year-old male. (a) Preoperative sagittal MRI veiws. (b and c) Immediate postoperative X-rays showing cropectomy of D6 and fusion D5–7 using titanium cage and plate via anterior approach. (d and e) Follow-up X-rays after 6 months.
Figure 3
Figure 3
SD D6–7 in a 47-year-old male. (a) Preoperative sagittal MRI veiws. (b and c) Immediate postoperative X-rays showing cropectomy of D6 and fusion D5–7 using titanium cage and plate via anterior approach. (d and e) Follow-up X-rays after 6 months.
Figure 4
Figure 4
SD D8–9 in a 58-year-old female. (a and b) Preoperative lateral X-rays and MRI sagittal veiws. (c and d) Immediate postoperative X-rays showing partial corpectomy D8–9 with interbody fusion using bone garft and long segment pedicular screw fixation from D6–11 (Posterior approach). (e and f) Follow-up X-rays after 6 months.
Figure 4
Figure 4
SD D8–9 in a 58-year-old female. (a and b) Preoperative lateral X-rays and MRI sagittal veiws. (c and d) Immediate postoperative X-rays showing partial corpectomy D8–9 with interbody fusion using bone garft and long segment pedicular screw fixation from D6–11 (Posterior approach). (e and f) Follow-up X-rays after 6 months.

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