Current Concepts in Hematogenous Septic Spondylodiscitis
Abstract
Hematogenous Septic spondyloDiscitis (HSD) is a rare but serious infectious disease which affects in an increasing rate immuno-compromised patients. The most common clinical symptom in HSD is a constant and increasing nocturnal axial spinal pain, while consequently different degrees of residual neurological symptoms from nerve roots and/or spinal cord may appear. The most frequent causative agent is Staphylococcus Aureus followed by the second most common to be Gram(-) bacteria. Since the disease course is chronic and clinical symptoms are not specific, surgeons should be aware that the time between the onset of the infection and final diagnosis is prolonged. MRI is mostly used to investigate HSD, however F-18 FDGPET has been recently proved to be more accurate than MRI in the detection of HSD. A delayed HSD diagnosis potentially increases morbidity and mortality while the final diagnosis is mainly based on biopsy and blood culture results.
Conservative treatment is the mainstay in cases with no residual neurological symptoms consisting of antibiotic therapy and immobilization. Surgical treatment is used in patients with neurological deficit, spinal instability or drug resistance, comprising of conventional open approaches such as anterior, posterior or combined and transcutaneous approaches. The use of metallic implants does not interfere with favorable outcome and recurrence rates. The overall mortality rate ranges from 1.5%-38%. Rates of disability of up to 31% have been reported with residual spinal dysfunction or persistent pain after recovery followed by spinal infection. The outcome of treatment is influenced by the type of infection, age, comorbidities and the degree of neurologic compromise before treatment.
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