- •Operative intervention was associated with lower 30-day mortality and 1-year mortality compared to conservative treatment.
- •Increased mFI was associated with higher short-term mortality.
- •mFI > 3 trended higher mortality regardless of intervention.
Investigate outcomes in a spondylodiscitis (SD) patient cohort undergoing operative and medical treatment or medical treatment alone, accounting for frailty status at presentation.
Patients >18 years old undergoing treatment for SD were retrospectively analyzed. The diagnosis of SD was made through a combination of clinical findings, MRI/CT findings, and blood/tissue cultures. Those who failed to respond to antibiotics, had deteriorating markers, or developed neurologic compromise were considered operative candidates. Patients were stratified based on operative (Op, operative plus medical management) or conservative (Cons, medical only) treatment. Univariate analyses identified differences in outcome measures across treatment groups. Conditional forward regression equations, controlling for patient age, identified predictors of increased mortality and inferior outcomes.
116 patients with SD were included. 73 underwent Cons treatment and 43 were Op. Op patients were significantly younger (62.9vs70.7yrs; p < 0.001) and less frail (1.09vs1.85; p < 0.006) than Cons patients, with significantly higher WCC and ESR. Cons pts had higher rates of isolated SD, but Op pts had higher rates of SD with associated SEA, VOM, psoas abscess, and para-vertebral abscess (all p < 0.05). Op pts had significantly lower 30-day mortality than Cons pts (2.3%vs17.8%, p = 0.016), and trended lower 1Y mortality (11.6%vs20.5%, p = 0.310) with similar SD recurrence rates (11.6%vs16.4%, p = 0.592). Patients with an mFI > 3 had significantly higher 30-day mortality (30.4% vs 7.5%, p = 0.003) and trended higher 1-year mortality regardless of intervention.
Operative intervention was associated with lower 30-day mortality significantly and 1-year mortality compared to conservative treatment, while an increased mFI was associated with higher short-term mortality.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Clinical Neuroscience
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The epidemiology of vertebral osteomyelitis in the united states from 1998 to 2013.Clin Spine Surg. 2018; 31: E102-E108https://doi.org/10.1097/BSD.0000000000000597
- A staged treatment algorithm for spinal infections.J Neurol Surg Part A Cent Eur Neurosurg. 2013; 74: 087-095https://doi.org/10.1055/s-0032-1320022
- Changing trends in the epidemiology of vertebral osteomyelitis in Marseille, France.New Microbes New Infect. 2015; 7: 1-7https://doi.org/10.1016/j.nmni.2015.04.008
- Epidemiology microbiological diagnosis, and clinical outcomes in pyogenic vertebral osteomyelitis: a 10-year retrospective cohort study.Open Forum Infect Dis. 2018; 5https://doi.org/10.1093/ofid/ofy037
- Clinical characteristics, treatments, and outcomes of hematogenous pyogenic vertebral osteomyelitis, 12-year experience from a tertiary hospital in central Taiwan.J Microbiol Immunol Infect. 2018; 51: 235-242https://doi.org/10.1016/j.jmii.2017.08.002
- Adult osteomyelitis.Infect Dis Clin North Am. 2005; 19: 765-786https://doi.org/10.1016/j.idc.2005.07.009
- Anatomic basis for the pathogenesis and radiologic features of vertebral osteomyelitis and its differentiation from childhood discitis. A microarteriographic investigation.Acta Radiol Diagn (Stockh). 1985; 26: 137-143
- Spondylodiscitis: update on diagnosis and management.J Antimicrob Chemother. 2010; 65: iii11-iii24https://doi.org/10.1093/jac/dkq303
- Pyogenic vertebral column osteomyelitis in adults: analysis of risk factors for 30-day and 1-year mortality in a single center cohort study.Asian Spine J. 2019; https://doi.org/10.31616/asj.2018.0295
- Presentation and outcomes after medical and surgical treatment versus medical treatment alone of spontaneous infectious spondylodiscitis: a systematic literature review and meta-analysis.Glob Spine J. 2018; 8: 49S-58Shttps://doi.org/10.1177/2192568218799058
- Cervical spondylodiscitis: presentation, timing, and surgical management in 59 patients.World Neurosurg. 2017; 103: 664-670https://doi.org/10.1016/j.wneu.2017.04.119
- Outcome-related co-factors in 105 cases of vertebral osteomyelitis in a tertiary care hospital.Infection. 2014; 42: 503-510https://doi.org/10.1007/s15010-013-0582-0
- Early detection of spinal sepsis.J Clin Neurosci. 2010; 17: 59-63https://doi.org/10.1016/j.jocn.2009.02.005
- Bacteraemia and subsequent vertebral osteomyelitis: a retrospective review of 125 patients.QJM. 2011; 104: 201-207https://doi.org/10.1093/qjmed/hcq178
- Spinal infections in patients with compromised immune Systems.Clin Orthop Relat Res. 2006; 443: 73-82https://doi.org/10.1097/01.blo.0000201176.87635.f3
- Risk factors for surgical site infection in elective routine degenerative lumbar surgeries.Spine J. 2016; 16: 1377-1383https://doi.org/10.1016/j.spinee.2016.08.018
- Fat thickness as a risk factor for infection in lumbar spine surgery.Orthopedics. 2016; 39: e1124-e1128https://doi.org/10.3928/01477447-20160819-05
- Surgical treatment of spondylodiscitis.Surg Infect (Larchmt). 2003; 4: 387-391https://doi.org/10.1089/109629603322761445
- Increased short- and long-term mortality among patients with infectious spondylodiscitis compared with a reference population.Spine J. 2015; 15: 1233-1240https://doi.org/10.1016/j.spinee.2015.02.021
- Microbiological and therapeutic challenges in infectious spondylodiscitis: a cohort study of 100 cases, 2006–2011.Scand J Infect Dis. 2013; 45: 417-424https://doi.org/10.3109/00365548.2012.753160
- Spondylodiscitis. A retrospective study of 163 patients.Acta Orthop. 2008; 79: 650-659https://doi.org/10.1080/17453670810016678
- Management of spinal infection: a review of the literature.Acta Neurochir (Wien). 2018; 160: 487-496https://doi.org/10.1007/s00701-018-3467-2
- 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. 2014; 14: 1139-1146https://doi.org/10.1016/j.spinee.2013.07.479
- Early surgery with antibiotics treatment had better clinical outcomes than antibiotics treatment alone in patients with pyogenic spondylodiscitis: a retrospective cohort study.BMC Musculoskelet Disord. 2017; 18: 175https://doi.org/10.1186/s12891-017-1533-1
- Hematogenous pyogenic spinal infections and their surgical management.Spine (Phila Pa 1976). 2000; 25: 1668-1679
Published online: March 12, 2020
Accepted: March 2, 2020
Received: October 22, 2019
© 2020 Published by Elsevier Ltd.