Spondylodiscitis: Surgical Treatment And Indications
Keywords:
Spondylodiskitis, treatmentAbstract
Spondylodiscitis is a serious infectious disease affecting the spine, causing inflammation of the vertebral bodies and intervertebral discs. It is caused by a bacterial infection and can lead to significant disability if left untreated. Initial management of the disease is conservative. Aiming to evaluate the indications and the methods of surgical management in patients with spondylodiscitis, a literature review was conducted searching the keywords: “spondylodiscitis” AND (“surgical treatment” OR ‘”surgical management” OR “indications”) on Pubmed database. The search included only prospective studies. Initially, 308 studies were identified after primary search. At last, 26 studies remained for analysis. The study concluded that indications for surgical treatment include neurological deficits, spinal instability, abscess formation and failure of conservative treatment. Surgical management includes debridement of the infected tissues and spinal fusion with instrumentation, through an anterior, a posterior or a combined approach. The choice of material for spinal support and enhancement of spinal fusion does not influence the clinical result.
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References
1. Shousha M, Heyde C, Boehm H. Cervical spondylodiscitis: change in clinical picture and operative management during the last two decades. A series of 50 patients and review of literature. Eur Spine J. 2015;24(3):571-6.
2. Thurnher MM, Post MJ, Jinkins JR. MRI of infections and neoplasms of the spine and spinal cord in 55 patients with AIDS. Neuroradiology. 2000;42(8):551-63.
3. Urrutia J, Zamora T, Campos M. Cervical pyogenic spinal infections: are they more severe diseases than infections in other vertebral locations? Eur Spine J. 2013;22(12):2815-20.
4. Skaf GS, Domloj NT, Fehlings MG et al. Pyogenic spondylodiscitis: an overview. J Infect Public Health. 2010;3(1):5-16.
5. Okay G, Akkoyunlu Y, Bolukcu S et al. Analysis of infectious spondylodiscitis: 7-years data. Pak J Med Sci. 2018;34(6):1445-51.
6. Kucuk A, Karademir M, Tumturk A, et al. Surgical Strategies for Spondylodiscitis due to Lumbar Disc Surgery. Turk Neurosurg. 2017;27(1):95-8.
7. Nasto LA, Colangelo D, Rossi B et al. Post-operative spondylodiscitis. Eur Rev Med Pharmacol Sci. 2012;16 Suppl 2:50-7.
8. Babic M, Simpfendorfer CS. Infections of the Spine. Infect Dis Clin North Am. 2017;31(2):279-97.
9. Nasto LA, Fantoni M, Cipolloni V et al.. A Detailed Analysis of Clinical Features and Outcomes of Patients with Pyogenic Spondylodiscitis Presenting without Axial Back Pain. Trop Med Infect Dis. 2021;6(2).
10. Lawson McLean A, Senft C et al. Management of Lumbar Pyogenic Spondylodiscitis in Germany: A Cross-Sectional Analysis of Spine Specialists. World Neurosurg. 2023 Mar 7.
11. Cottle L, Riordan T. Infectious spondylodiscitis. J Infect. 2008 Jun;56(6):401-12.
12. Gentile L, Benazzo F, De Rosa F et al. A systematic review: characteristics, complications and treatment of spondylodiscitis. Eur Rev Med Pharmacol Sci. 2019;23(2 Suppl):117-28.
13. Gasbarrini A, Boriani L, Salvadori C et al. Biopsy for suspected spondylodiscitis. Eur Rev Med Pharmacol Sci. 2012;16 Suppl 2:26-34.
14. Yagdiran A, Otto-Lambertz C, Lingscheid KM et al. Quality of life and mortality after surgical treatment for vertebral osteomyelitis (VO): a prospective study. Eur Spine J. 2021;30(6):1721-31.
15. Asamoto S, Doi H, Kobayashi N et al. Spondylodiscitis: diagnosis and treatment. Surg Neurol. 2005;64(2):103-8; discussion 8.
16. Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother. 2010;65 Suppl 3:iii11-24.
17. Zarghooni K, Röllinghoff M, Sobottke R. Treatment of spondylodiscitis. Int Orthop. 2012;36(2):405-11.
18. Giampaolini N, Berdini M, Rotini M et al. Non-specific spondylodiscitis: a new perspective for surgical treatment. Eur Spine J. 2022;31(2):461-72.
19. Mavrogenis AF, Igoumenou V, Tsiavos K, et al. When and how to operate on spondylodiscitis: a report of 13 patients. Eur J Orthop Surg Traumatol. 2016;26(1):31-40.
20. Kamal AM, El-Sharkawi MM, El-Sabrout M, et al. Spondylodiscitis: experience of surgical management of complicated cases after failed antibiotic treatment. SICOT J. 2020;6:5.
21. Tschöke SK, Fuchs H, Schmidt O et al. Single-stage debridement and spinal fusion using PEEK cages through a posterior approach for eradication of lumbar pyogenic spondylodiscitis: a safe treatment strategy for a detrimental condition. Patient Saf Surg. 2015;9:35.
22. Kandwal P, Garg B, Upendra B et al. Outcome of minimally invasive surgery in the management of tuberculous spondylitis. Indian J Orthop. 2012;46(2):159-64.
23. Mann S, Schütze M, Sola S et al. Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients. Neurosurg Focus. 2004;17(6):E3.
24. Schömig F, Li Z, Perka L et al. Georg schmorl prize of the German spine society (DWG) 2021: Spinal Instability Spondylodiscitis Score (SISS)-a novel classification system for spinal instability in spontaneous spondylodiscitis. Eur Spine J. 2022;31(5):1099-106.
25. Kitov B, Kehayov I, Davarski A et al. Outcome of Surgical Treatment of Spontaneous Spinal Epidural Abscesses for a 10-year Period. Folia Med (Plovdiv). 2020;62(3):482-9.
26. Bhojraj S, Nene A. Lumbar and lumbosacral tuberculous spondylodiscitis in adults. Redefining the indications for surgery. J Bone Joint Surg Br. 2002;84(4):530-4.
27. van Ooij A, Beckers JM, Herpers MJ et al. Surgical treatment of aspergillus spondylodiscitis. Eur Spine J. 2000;9(1):75-9.
28. Appalanaidu N, Shafafy R, Gee C, et al. Predicting the need for surgical intervention in patients with spondylodiscitis: the Brighton Spondylodiscitis Score (BSDS). Eur Spine J. 2019 Apr;28(4):751-61.
29. Lee BH, Park JO, Kim HS et al. Transpedicular curettage and drainage versus combined anterior and posterior surgery in infectious spondylodiscitis. Indian J Orthop. 2014;48(1):74-80.
30. Cingöz İ D. Role of Surgery in Brucella Spondylodiscitis: An Evaluation of 28 Patients. Cureus. 2023;15(1):e33542.
31. Griffith-Jones W, Nasto LA, Pola E et al. Percutaneous suction and irrigation for the treatment of recalcitrant pyogenic spondylodiscitis. J Orthop Traumatol. 2018;19(1):10.
32. Joerger AK, Shiban E, Krieg S et al. Carbon-fiber reinforced PEEK instrumentation for spondylodiscitis: a single center experience on safety and efficacy. Sci Rep. 2021;11(1):2414.
33. Homagk L, Homagk N, Klauss JR et al. Spondylodiscitis severity code: scoring system for the classification and treatment of non-specific spondylodiscitis. Eur Spine J. 2016;25(4):1012-20.
34. Banse X, Kaminski L, Irda N et al. PMMA-cement anterior column reconstruction in surgical treatment of spondylodiscitis. Brain Spine. 2022;2:101186.
35. Masuda T, Miyamoto K, Hosoe H et al. Surgical treatment with spinal instrumentation for pyogenic spondylodiscitis due to methicillin-resistant Staphylococcus aureus (MRSA): a report of five cases. Arch Orthop Trauma Surg. 2006;126(5):339-45.
36. Chen IC, Chiu YC, Yang SC et al. Single Posterior Approach for Circumferential Debridement and Anterior Reconstruction Using Fibular Allograft in Patients With Skipped Multifocal Pyogenic Spondylodiscitis. World Neurosurg. 2023;170:e639-e44.
37. Zhou B, Kang YJ, Chen WH. Continuous Epidural Irrigation and Drainage Combined with Posterior Debridement and Posterior Lumbar Inter-Body Fusion for the Management of Single-Segment Lumbar Pyogenic Spondylodiscitis. Surg Infect (Larchmt). 2020;21(3):262-7.
38. Pola E, Nasto LA, Cipolloni V et al. 10-Year Clinical, Functional, and X-ray Follow-Up Evaluation of a Novel Posterior Percutaneous Screw-Rod Instrumentation Technique for Single-Level Pyogenic Spondylodiscitis. Trop Med Infect Dis. 2021;6(3).
39. Blizzard DJ, Hills CP, Isaacs RE et al.. Extreme lateral interbody fusion with posterior instrumentation for spondylodiscitis. J Clin Neurosci. 2015 ;22(11):1758-61.
40. Hassan K, Elmorshidy E. Anterior versus posterior approach in surgical treatment of tuberculous spondylodiscitis of thoracic and lumbar spine. Eur Spine J. 2016;25(4):1056-63.
41. Hempelmann RG, Mater E, Schön R. Septic hematogenous lumbar spondylodiscitis in elderly patients with multiple risk factors: efficacy of posterior stabilization and interbody fusion with iliac crest bone graft. Eur Spine J. 2010;19(10):1720-7.
42. Kim J, Lee SY, Jung JH et al. The outcome following spinal instrumentation in haemodialyzed patients with pyogenic spondylodiscitis. Bone Joint J. 2019;101-B(1):75-82.
43. Vinay Jain K, Ravikumar TV. Surgical Management of Thoracolumbar Spondylodiscitis in End-Stage Renal Disease. Indian J Orthop. 2021;55(Suppl 1):176-81.
2. Thurnher MM, Post MJ, Jinkins JR. MRI of infections and neoplasms of the spine and spinal cord in 55 patients with AIDS. Neuroradiology. 2000;42(8):551-63.
3. Urrutia J, Zamora T, Campos M. Cervical pyogenic spinal infections: are they more severe diseases than infections in other vertebral locations? Eur Spine J. 2013;22(12):2815-20.
4. Skaf GS, Domloj NT, Fehlings MG et al. Pyogenic spondylodiscitis: an overview. J Infect Public Health. 2010;3(1):5-16.
5. Okay G, Akkoyunlu Y, Bolukcu S et al. Analysis of infectious spondylodiscitis: 7-years data. Pak J Med Sci. 2018;34(6):1445-51.
6. Kucuk A, Karademir M, Tumturk A, et al. Surgical Strategies for Spondylodiscitis due to Lumbar Disc Surgery. Turk Neurosurg. 2017;27(1):95-8.
7. Nasto LA, Colangelo D, Rossi B et al. Post-operative spondylodiscitis. Eur Rev Med Pharmacol Sci. 2012;16 Suppl 2:50-7.
8. Babic M, Simpfendorfer CS. Infections of the Spine. Infect Dis Clin North Am. 2017;31(2):279-97.
9. Nasto LA, Fantoni M, Cipolloni V et al.. A Detailed Analysis of Clinical Features and Outcomes of Patients with Pyogenic Spondylodiscitis Presenting without Axial Back Pain. Trop Med Infect Dis. 2021;6(2).
10. Lawson McLean A, Senft C et al. Management of Lumbar Pyogenic Spondylodiscitis in Germany: A Cross-Sectional Analysis of Spine Specialists. World Neurosurg. 2023 Mar 7.
11. Cottle L, Riordan T. Infectious spondylodiscitis. J Infect. 2008 Jun;56(6):401-12.
12. Gentile L, Benazzo F, De Rosa F et al. A systematic review: characteristics, complications and treatment of spondylodiscitis. Eur Rev Med Pharmacol Sci. 2019;23(2 Suppl):117-28.
13. Gasbarrini A, Boriani L, Salvadori C et al. Biopsy for suspected spondylodiscitis. Eur Rev Med Pharmacol Sci. 2012;16 Suppl 2:26-34.
14. Yagdiran A, Otto-Lambertz C, Lingscheid KM et al. Quality of life and mortality after surgical treatment for vertebral osteomyelitis (VO): a prospective study. Eur Spine J. 2021;30(6):1721-31.
15. Asamoto S, Doi H, Kobayashi N et al. Spondylodiscitis: diagnosis and treatment. Surg Neurol. 2005;64(2):103-8; discussion 8.
16. Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother. 2010;65 Suppl 3:iii11-24.
17. Zarghooni K, Röllinghoff M, Sobottke R. Treatment of spondylodiscitis. Int Orthop. 2012;36(2):405-11.
18. Giampaolini N, Berdini M, Rotini M et al. Non-specific spondylodiscitis: a new perspective for surgical treatment. Eur Spine J. 2022;31(2):461-72.
19. Mavrogenis AF, Igoumenou V, Tsiavos K, et al. When and how to operate on spondylodiscitis: a report of 13 patients. Eur J Orthop Surg Traumatol. 2016;26(1):31-40.
20. Kamal AM, El-Sharkawi MM, El-Sabrout M, et al. Spondylodiscitis: experience of surgical management of complicated cases after failed antibiotic treatment. SICOT J. 2020;6:5.
21. Tschöke SK, Fuchs H, Schmidt O et al. Single-stage debridement and spinal fusion using PEEK cages through a posterior approach for eradication of lumbar pyogenic spondylodiscitis: a safe treatment strategy for a detrimental condition. Patient Saf Surg. 2015;9:35.
22. Kandwal P, Garg B, Upendra B et al. Outcome of minimally invasive surgery in the management of tuberculous spondylitis. Indian J Orthop. 2012;46(2):159-64.
23. Mann S, Schütze M, Sola S et al. Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients. Neurosurg Focus. 2004;17(6):E3.
24. Schömig F, Li Z, Perka L et al. Georg schmorl prize of the German spine society (DWG) 2021: Spinal Instability Spondylodiscitis Score (SISS)-a novel classification system for spinal instability in spontaneous spondylodiscitis. Eur Spine J. 2022;31(5):1099-106.
25. Kitov B, Kehayov I, Davarski A et al. Outcome of Surgical Treatment of Spontaneous Spinal Epidural Abscesses for a 10-year Period. Folia Med (Plovdiv). 2020;62(3):482-9.
26. Bhojraj S, Nene A. Lumbar and lumbosacral tuberculous spondylodiscitis in adults. Redefining the indications for surgery. J Bone Joint Surg Br. 2002;84(4):530-4.
27. van Ooij A, Beckers JM, Herpers MJ et al. Surgical treatment of aspergillus spondylodiscitis. Eur Spine J. 2000;9(1):75-9.
28. Appalanaidu N, Shafafy R, Gee C, et al. Predicting the need for surgical intervention in patients with spondylodiscitis: the Brighton Spondylodiscitis Score (BSDS). Eur Spine J. 2019 Apr;28(4):751-61.
29. Lee BH, Park JO, Kim HS et al. Transpedicular curettage and drainage versus combined anterior and posterior surgery in infectious spondylodiscitis. Indian J Orthop. 2014;48(1):74-80.
30. Cingöz İ D. Role of Surgery in Brucella Spondylodiscitis: An Evaluation of 28 Patients. Cureus. 2023;15(1):e33542.
31. Griffith-Jones W, Nasto LA, Pola E et al. Percutaneous suction and irrigation for the treatment of recalcitrant pyogenic spondylodiscitis. J Orthop Traumatol. 2018;19(1):10.
32. Joerger AK, Shiban E, Krieg S et al. Carbon-fiber reinforced PEEK instrumentation for spondylodiscitis: a single center experience on safety and efficacy. Sci Rep. 2021;11(1):2414.
33. Homagk L, Homagk N, Klauss JR et al. Spondylodiscitis severity code: scoring system for the classification and treatment of non-specific spondylodiscitis. Eur Spine J. 2016;25(4):1012-20.
34. Banse X, Kaminski L, Irda N et al. PMMA-cement anterior column reconstruction in surgical treatment of spondylodiscitis. Brain Spine. 2022;2:101186.
35. Masuda T, Miyamoto K, Hosoe H et al. Surgical treatment with spinal instrumentation for pyogenic spondylodiscitis due to methicillin-resistant Staphylococcus aureus (MRSA): a report of five cases. Arch Orthop Trauma Surg. 2006;126(5):339-45.
36. Chen IC, Chiu YC, Yang SC et al. Single Posterior Approach for Circumferential Debridement and Anterior Reconstruction Using Fibular Allograft in Patients With Skipped Multifocal Pyogenic Spondylodiscitis. World Neurosurg. 2023;170:e639-e44.
37. Zhou B, Kang YJ, Chen WH. Continuous Epidural Irrigation and Drainage Combined with Posterior Debridement and Posterior Lumbar Inter-Body Fusion for the Management of Single-Segment Lumbar Pyogenic Spondylodiscitis. Surg Infect (Larchmt). 2020;21(3):262-7.
38. Pola E, Nasto LA, Cipolloni V et al. 10-Year Clinical, Functional, and X-ray Follow-Up Evaluation of a Novel Posterior Percutaneous Screw-Rod Instrumentation Technique for Single-Level Pyogenic Spondylodiscitis. Trop Med Infect Dis. 2021;6(3).
39. Blizzard DJ, Hills CP, Isaacs RE et al.. Extreme lateral interbody fusion with posterior instrumentation for spondylodiscitis. J Clin Neurosci. 2015 ;22(11):1758-61.
40. Hassan K, Elmorshidy E. Anterior versus posterior approach in surgical treatment of tuberculous spondylodiscitis of thoracic and lumbar spine. Eur Spine J. 2016;25(4):1056-63.
41. Hempelmann RG, Mater E, Schön R. Septic hematogenous lumbar spondylodiscitis in elderly patients with multiple risk factors: efficacy of posterior stabilization and interbody fusion with iliac crest bone graft. Eur Spine J. 2010;19(10):1720-7.
42. Kim J, Lee SY, Jung JH et al. The outcome following spinal instrumentation in haemodialyzed patients with pyogenic spondylodiscitis. Bone Joint J. 2019;101-B(1):75-82.
43. Vinay Jain K, Ravikumar TV. Surgical Management of Thoracolumbar Spondylodiscitis in End-Stage Renal Disease. Indian J Orthop. 2021;55(Suppl 1):176-81.
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2024-03-11
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