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. 2018 Jan;41(1):141-147.
doi: 10.1007/s10143-017-0829-9. Epub 2017 Feb 27.

Primary Acquired Spondylodiscitis Shows a More Severe Course Than Spondylodiscitis Following Spine Surgery: A Single-Center Retrospective Study of 159 Cases

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Free PMC article

Primary Acquired Spondylodiscitis Shows a More Severe Course Than Spondylodiscitis Following Spine Surgery: A Single-Center Retrospective Study of 159 Cases

Anja Tschugg et al. Neurosurg Rev. .
Free PMC article

Abstract

Spondylodiscitis may arise primarily via hematogenous spread or direct inoculation of virulent organisms during spine surgery. To date, no comparative data investigating the differences between primary and postoperative spondylodiscitis is available. Thus, the purpose of this retrospective study was to investigate differences between these two etiologies. One hundred fifty-nine patients that were treated at our department were included in the retrospective analysis. The patients were categorized into two groups based on the etiology of spondylodiscitis: group NS, primary spondylodiscitis without prior spinal surgery; group S, spondylodiscitis following spinal surgery. Evaluation included magnetic resonance imaging (MRI), laboratory values, clinical outcome, and operative or conservative management. Preoperative MRI showed higher rates of epidural and paraspinal abscess in patients with primary spondylodiscitis (p < 0.005). Vertebral bone destruction was more severe in group NS (p < 0.05). Survival rate in group S (98.2%) was higher than in group NS (87.5%, p = 0.024). The extent of the operative procedure in patients who were surgically treated (n = 116) differed between the two groups (p < 0.005). In conclusion, spondylodiscitis is a life-threatening and serious disease and requires long-term treatment. Primary spondylodiscitis is frequently associated with epidural and paraspinal abscess, vertebral bone destruction and has a higher mortality rate than postoperative spondylodiscitis. Therefore, primary spondylodiscitis shows a more severe course than spondylodiscitis following spine surgery.

Keywords: Discitis; Epidural abscess; Postoperative spondylodiscitis; Primary spondylodiscitis; Spinal infection.

Conflict of interest statement

Funding

The study did not receive any external funding.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

According to the local institutional review board, for this type of retrospective study, ethics approval is not required.

Informed consent

According to the local institutional review board, for this type of retrospective study, informed consent is not required.

Figures

Fig. 1
Fig. 1
Flow chart on the treatment in all patients with primary (NS) and secondary acquired spondylodiscitis (S). n number of patients, c conservatively treated, s surgically treated
Fig. 2
Fig. 2
Preoperative magnetic resonance imaging finding in all patients. S secondary acquired spondylodiscitis, NS primary acquired spondylodiscitis, p significance
Fig. 3
Fig. 3
Overall pain on numeric rating scale (NRS) in a surgically (sS, sNS) and b conservatively treated patients (cS, cNS). S secondary acquired spondylodiscitis, NS primary acquired spondylodiscitis, c conservatively treated, s surgically treated. ★★ƒ: differences in follow-up: p < 0.005, ★★: differences between groups: p < 0.005. a FD first diagnosis, A day of admission, 3d third postoperative day, D discharge, 3m and 12m 6m and 12 months follow-up. b FD first diagnosis, d days after the first diagnosis, m months after the first diagnosis
Fig. 4
Fig. 4
Inflammatory blood value in a surgically (sS, sNS) and b conservatively treated patients (cS, cNS). CRP C-reactive protein, S secondary acquired spondylodiscitis, NS primary acquired spondylodiscitis, c conservatively treated, s surgically treated. ★★ƒ: differences in follow-up: p < 0.005, ★ƒ: differences in follow-up: p < 0.05, ★: differences between groups: p < 0.05. a FD first diagnosis, A day of admission, 3d third postoperative day, D discharge, 3m and 12m 6 and 12 months follow-up. b FD first diagnosis, d days after the first diagnosis, m months after the first diagnosis

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References

    1. Tsiodras S, Falagas ME. Clinical assessment and medical treatment of spine infections. Clin Orthop Relat Res. 2006;444:38–50. doi: 10.1097/01.blo.0000203454.82264.cd. - DOI - PubMed
    1. Adam D, Papacocea T, Hornea I, Croitoru R. Postoperative spondylodiscitis. A review of 24 consecutive patients. Chirurgia (Bucur) 2014;109:90–94. - PubMed
    1. Kehrer M, Pedersen C, Jensen TG, Hallas J, Lassen AT. Increased short- and long-term mortality among patients with infectious spondylodiscitis compared with a reference population. Spine J. 2015;15:1233–1240. doi: 10.1016/j.spinee.2015.02.021. - DOI - PubMed
    1. Leone A, Dell'Atti C, Magarelli N, Colelli P, Balanika A, Casale R et al (2012) Imaging of spondylodiscitis. Eur Rev Med Pharmacol Sci 16 Suppl 2:8–19 - PubMed
    1. Stratton A, Gustafson K, Thomas K, James MT. Incidence and risk factors for failed medical management of spinal epidural abscess: a systematic review and meta-analysis. J Neurosurg Spine. 2016;16:1–9. - PubMed
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