Operative Therapie der pyogenen Spondylodiszitis – Rationale, Evidenz und strukturiertes Vorgehen

Zusammenfassung

Die pyogene Spondylodiszitis ist eine zunehmend häufige, klinisch heterogene und potenziell lebensbedrohliche Erkrankung. Neben lokaler Destruktion und segmentaler Instabilität drohen neurologische Defizite und systemische Infektionen bis hin zur Sepsis. Während die antibiotische Therapie die biologische Grundlage der Infektkontrolle bildet, zeigen aktuelle Daten, dass eine frühzeitige operative Sanierung in vielen Situationen zu einer deutlichen Reduktion von Mortalität, Rezidiven und Krankenhausverweildauer führt. In diesem Beitrag werden die Rationale und Evidenz für die operative Therapie dargestellt – mit Fokus auf den Stellenwert von Stabilisierung, Dekompression und Debridement sowie auf die Bedeutung einer strukturierten Beurteilung nach dem SNIM-Framework (Stability, Neurology, Infection, Morbidity). Im Sinne der DWG-Diskussionssession wird die konservative Therapie als wichtige Option für stabile, neurologisch unauffällige Patienten anerkannt, gleichzeitig aber gezeigt, dass bei einem großen Teil der heute behandelten, häufig multimorbiden Patientinnen und Patienten die frühzeitige operative Ergänzung der biologischen Therapie entscheidend für das Outcome ist.

Abstract

Pyogenic spondylodiscitis is an increasingly common, clinically heterogeneous, and potentially life-threatening condition. In addition to local destruction and segmental instability, patients are at risk of developing neurological deficits and systemic infections up to septic shock. While antibiotic therapy forms the biological basis of infection control, current evidence demonstrates that early surgical intervention can substantially reduce mortality, recurrence rates, and hospital length of stay in many clinical scenarios.

This article summarizes the rationale and evidence for surgical treatment, with a focus on the roles of stabilization, decompression, and debridement, as well as the importance of structured clinical assessment using the SNIM framework (Stability, Neurology, Infection, Morbidity). In the spirit of the DWG debate session, conservative therapy is acknowledged as an important option for stable patients without neurological compromise; however, it is also emphasized that for a large proportion of today’s often multimorbid patient population, early surgical augmentation of biological therapy is crucial to achieving optimal outcomes.

Schlüsselwörter

pyogene Spondylodiszitis - operative Therapie - Stabilisierung - Dekompression - Debridement

Keywords

pyogenic spondylodiscitis - surgical treatment - stabilization - decompression - debridement

Publication History

Article published online:
02 March 2026

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