Abstract
Background and Study Aims Spinal instrumentation for spondylodiskitis (SD) remains highly controversial. To
date, surgical data are limited to relatively small case series with short-term follow-up
data. In this study, we wanted to elucidate the biomechanical, surgical, and neurologic
long-term outcomes in these patients.
Material and Methods A retrospective analysis from two German primary care hospitals over a 9-year period
(2005–2014) was performed. The inclusion criteria were (1) pyogenic lumbar SD, (2)
minimum follow-up of 1 year, and (3) surgical instrumentation. The clinical and radiologic
outcome was assessed before surgery, at discharge, and at a minimum of 12 months of
follow-up. Follow-up included physical examination, laboratory results, CT and MRI
scans, as well as assessment of quality of life (QoL) using short-form health survey
(SF-36) inventory, Oswestry Disability Questionnaire, and visual analog scale (VAS)
spine score.
Results Complete data were available in 70 patients (49 males and 21 females, with an age
range of 67±12.3 years) with a median follow-up of 6.6 ± 4.2 years. Follow-up data
were available in 70 patients after 1 year, in 58 patients after 2 years, and in 44
patients after 6 years. Thirty-five patients underwent posterior stabilization and
decompression alone and 35 patients were operated on in a two-stage 360-degree interbody
fusion with decompression. Pre- and postoperative angles of the affected motion segment
were 17.6 ± 10.2 and 16.1 ± 10.7 degrees in patients with posterior instrumentation
only and 21.0 ± 10.2 and 18.3 ± 10.5 degrees in patients with combined anterior/posterior
fusion. Vertebral body subsidence was seen in 12 and 6 cases following posterior instrumentation
and 360-degree instrumentation, respectively. Nonfusion was encountered in 22 and
11 cases following posterior instrumentation and 360-degree instrumentation, respectively.
The length of hospital stay was 35.0 ± 24.5 days. Surgery-associated complication
rate was 18% (12/70). New neurologic symptoms occurred in 7% (5/70). Revision surgery
was performed in 3% (2/70) due to screw misplacement/hardware failure and in 3% (2/70)
due to intraspinal hematoma. Although patients reported a highly impaired pain deception
and vitality, physical mobility was unaffected and pain disability during daily activities
was moderate.
Conclusion Surgical treatment of SD with a staged surgical approach (if needed) is safe and
provides very good long-term clinical and radiologic outcome.
Keywords
spinal infection - risk factor - surgical approach - diagnostics - functional outcome
- quality of life - biomechanics - vertebral pyogenic osteomyelitis
