Quality of Life Following Surgical and Conservative Therapy of Pyogenic Spinal Infection: A Study of Long-term Outcome in 210 Patients

Abstract

Object The management and recommendations for treatment strategies of pyogenic spinal infection are still a highly controversial issue. The purpose of this study was to evaluate patient's quality of life (QoL) after surgical and conservative treatment of spinal infection.

Materials and Methods We conducted a retrospective, single-center study. All patients treated between 2009 and 2016 were included in this study. For evaluation of QoL, we recorded each patient's satisfaction according to the 36-Item Short Form Health Survey (SF-36) questionnaire. Scores were compared with a U.S. standard population.

Results Two hundred and ten adult patients with spondylodiskitis were identified. Of these, 155 (74%) underwent surgery and 55 (26%) were treated conservatively. The mean overall age was 68.6 (23–98) years. Seventy-two patients were females and 138 patients were males. The mean outcome values in the surgical group did not reach the level of the normative sample in one of eight items, whereas the conservative group revealed a reduced QoL in all items. Intergroup comparison revealed significant differences in all items (p < 0.05).

Conclusion In the patient population we investigated, QoL in surgically treated patients was better than that in conservatively managed patients.

Keywords

spondylodiskitis - quality of life - surgery - conservative treatment

Publikationsverlauf

Eingereicht: 09. März 2020

Angenommen: 08. Juni 2020

Artikel online veröffentlicht:
09. März 2021

• References

• 1 Acosta Jr FL, Chin CT, Quiñones-Hinojosa A, Ames CP, Weinstein PR, Chou D. Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine. Neurosurg Focus 2004; 17 (06) E2
• 2 Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother 2010; 65 (Suppl. 03) iii11-iii24
• 3 Jensen AG, Espersen F, Skinhøj P, Rosdahl VT, Frimodt-Møller N. Increasing frequency of vertebral osteomyelitis following Staphylococcus aureus bacteraemia in Denmark 1980-1990. J Infect 1997; 34 (02) 113-118
• 4 Karadimas EJ, Bunger C, Lindblad BE. et al. Spondylodiscitis. A retrospective study of 163 patients. Acta Orthop 2008; 79 (05) 650-659
• 5 Kehrer M, Pedersen C, Jensen TG, Lassen AT. Increasing incidence of pyogenic spondylodiscitis: a 14-year population-based study. J Infect 2014; 68 (04) 313-320
• 6 Skaf GS, Domloj NT, Fehlings MG. et al. Pyogenic spondylodiscitis: an overview. J Infect Public Health 2010; 3 (01) 5-16
• 7 Sampath P, Rigamonti D. Spinal epidural abscess: a review of epidemiology, diagnosis, and treatment. J Spinal Disord 1999; 12 (02) 89-93
• 8 Calderone RR, Larsen JM. Overview and classification of spinal infections. Orthop Clin North Am 1996; 27 (01) 1-8
• 9 Deininger MH, Unfried MI, Vougioukas VI, Hubbe U. Minimally invasive dorsal percutaneous spondylodesis for the treatment of adult pyogenic spondylodiscitis. Acta Neurochir (Wien) 2009; 151 (11) 1451-1457
• 10 Gasbarrini A, Boriani L, Nanni C. et al. Spinal infection multidisciplinary management project (SIMP): from diagnosis to treatment guideline. Int J Immunopathol Pharmacol 2011; 24 (1 Suppl 2): 95-100
• 11 Gessler F, Mutlak H, Tizi K. et al. Postoperative patient-controlled epidural analgesia in patients with spondylodiscitis and posterior spinal fusion surgery. J Neurosurg Spine 2016; 24 (06) 965-970
• 12 Guerado E, Cerván AM. Surgical treatment of spondylodiscitis. An update. Int Orthop 2012; 36 (02) 413-420
• 13 Hopf C, Meurer A, Eysel P, Rompe JD. Operative treatment of spondylodiscitis--what is the most effective approach?. Neurosurg Rev 1998; 21 (04) 217-225
• 14 Lin C-P, Ma H-L, Wang S-T, Liu C-L, Yu W-K, Chang M-C. Surgical results of long posterior fixation with short fusion in the treatment of pyogenic spondylodiscitis of the thoracic and lumbar spine: a retrospective study. Spine 2012; 37 (25) E1572-E1579
• 15 Bydon M, De la Garza-Ramos R, Macki M. et al. Spinal instrumentation in patients with primary spinal infections does not lead to greater recurrent infection rates: an analysis of 118 cases. World Neurosurg 2014; 82 (06) e807-e814
• 16 Than KD, Mummaneni PV. Spinal instrumentation in the setting of primary infection. World Neurosurg 2014; 82 (06) e713-e714
• 17 Suppiah S, Meng Y, Fehlings MG, Massicotte EM, Yee A, Shamji MF. How best to manage the spinal epidural abscess? A current systematic review. World Neurosurg 2016; 93: 20-28
• 18 Foreman SC, Schwaiger BJ, Gempt J. et al. MR and CT imaging to optimize CT-guided biopsies in suspected spondylodiscitis. World Neurosurg 2017; 99: 726-734.e7
• 19 Bernard L, Dinh A, Ghout I. et al; Duration of Treatment for Spondylodiscitis (DTS) study group. Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial. Lancet 2015; 385 (9971): 875-882
• 20 McHorney CA, Ware Jr JE, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 1993; 31 (03) 247-263
• 21 Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum 2009; 39 (01) 10-17
• 22 Madhavan K, Vanni S, Williams SK. Direct lateral retroperitoneal approach for the surgical treatment of lumbar discitis and osteomyelitis. Neurosurg Focus 2014; 37 (02) E5
• 23 Valancius K, Hansen ES, Høy K, Helmig P, Niedermann B, Bünger C. Failure modes in conservative and surgical management of infectious spondylodiscitis. Eur Spine J 2013; 22 (08) 1837-1844
• 24 Woertgen C, Rothoerl RD, Englert C, Neumann C. Pyogenic spinal infections and outcome according to the 36-item short form health survey. J Neurosurg Spine 2006; 4 (06) 441-446