Pyogenic Spinal Infection

Pyogenic spinal infection (spondylodiscitis) is a life-threatening medical condition. Over the past three decades, its incidence has increased 15-fold. This is in part due to the aging of the population, increase in immunocompromised patients, and better diagnostic abilities. While we routinely care for these patients, treatment is still not standardized and is mostly done according to local preferences. Moreover, when uttering the words “spinal infection” among medical colleagues, we have come to realize that few practitioners will think of the same clinical picture. Some associated it with postinterventional infectious complications and vertebral osteomyelitis, while others with spinal epidural abscess or spondylodiscitis. In some regions of the world, spinal infections may evoke the suspicion of Pott's disease. In other regions, the pathology is dominated by young patients with habits of intravenous drug abuse, yet again others may refer to frailty-fraught fraction of geriatric patients with diabetes on dialysis. Regardless of regional differences, etiology, and terminology, the disease has been posing a formidable challenge to all involved in its management.

This special issue of the Journal of Neurological Surgery-A presents various aspects of this multifaceted entity.

The role of modern diagnostic modalities in diagnosing spondylodiscitis is recounted in an illustrative and insightful way by Heyde and colleagues. The next article addresses the organisms at the root of spondylodiscitis. In their diligent analysis, Lackermair, Egermann, and Müller made an attempt to associate the type of bacteria with specific groups at risk of spondylodiscitis. The role of surgical treatment remains a hotly debated topic until today for want of class I evidence. A collaborative article from two groups with differing surgical technique compared whether performing diskectomy routinely yielded different outcomes than spinal instrumentation alone. Two studies address the long-term quality of life after surgery. The results show that the severity in terms of both mortality and long-term morbidity of spondylodiscitis remains significant to this day. In a socioeconomic analysis, Abboud et al evaluated the complications of medical and surgical treatment. Moreover, they provide interesting insights into duration of stay and the cost of care. Finally, Abduljawwad et al. put us on the forefront of current developments as they chronicle the development of hospital admissions for spondylodiscitis in the pre- and post-Covid area.

It is our hope that with the content of this special edition, spine surgeons will find several points worth picking up on as we continue to await class-I evidence to guide our treatment strategy.

Publication History

Received: 07 March 2022

Accepted: 23 March 2022

Article published online:
25 July 2022