Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. General Characteristics of the Patients
3.2. Symptoms and Neurological Status
3.3. Laboratory Findings and Microbiology
3.4. Operative Therapy
3.5. Etiology and Concomitant Infections
3.6. Antibiotic Therapy
3.7. Outcome
3.7.1. Healing of Infection and Recovery of Infection Parameters
3.7.2. Pain Reduction and Neurological Status
3.7.3. Outcome Measurement
4. Discussion
4.1. Conservative vs. Operative Treatment of Spondylodiscitis
4.2. General Characteristics, Neurological Deficits and Mortality
4.3. Value of Measurement of Laboratory Infection Parameters
4.4. Surgical Therapy
4.5. Influence of Concomitant Infections
4.6. Outcome Parameters
4.7. Limitations of the Study
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Patient Characteristics | Number |
---|---|
Overall number of patients (n) | n = 237 (100%) |
Gender | |
Male | 150 (63.3%) |
Mean age (years) | 71.4 (Standard deviation SD ± 12.9) |
Mean follow-up (months) | 31.62 (SD ± 19.5) |
MRI of the spine at follow-up | 125 patients (52.7%) |
Average duration of hospital stay (days) | 14.1 (SD ± 8.2) |
Mortality | |
Death during the initial hospital stay | 21 patients (8.9%) |
Death up to two years following discharge | 5 (2.1%) |
Spine level (n) | |
Cervical | 45 patients (19%) |
Thoracic | 73 (30.8%) |
Lumbosacral | 119 (50.2%) |
Psoas muscle abscess | 35 (14.8%) |
Spinal levels (n) | |
One level | 174 patients (73.4%) |
Two levels | 44 (18.7%) |
Three levels | 7 (3%) |
Four or more levels | 12 (5%) |
Mean number of infected levels (n) | 1.33 (SD: 1.204) |
Epidural empyema (n) | |
Present | 146 (61.6%) |
Absent | 91 (38.4%) |
Mean number of segments of empyema spread (n) | 1.43 (SD 2.165) |
Concomitant diseases | 185 patients (78%) |
Two or more diseases | 155 (65.4%) |
Arterial hypertension | 145 (61.2%) |
Renal insufficiency | 70 (29.5%) |
Lung diseases | 81 (34.2%) |
Diabetes mellitus | 74 (31.2%) |
Malignant primary tumors | 46 (19.4%) |
Obesity | 40 (16.9%) |
History of alcohol abuse | 18 (7.6%) |
Smokers | 26 (11%) |
History of drug abuse | 9 (3.8%) |
Patient Characteristics | Number |
---|---|
Pain preoperative | 225 patients (94.9%) |
Mean preoperative VAS | 8.17 (SD: 2.5). |
Mean postoperative VAS | 2.03 (SD: 0.19), p < 0.001 |
Neurological deficits preoperative | 172 patients (72.6%) |
Motor deficits with paresis of one or more muscles | 63 patients (26.6%) |
Motor deficits with paraparesis | 22 patients (9.3%) |
Motor deficits with tetraparesis | 4 patients (1.7%) |
Sensory deficits | 75 patients (31.6%) |
Ataxia | 30 patients (12.7%) |
Time from onset of symptoms to diagnosis | 17.9 days (range 1–67 days, SD: 14.8). |
Neurological status at follow-up | |
Improved | 101 patients (42.6%), p = 0.002 |
Unchanged | 95 patients (40%) |
Worsened | 15 patients (6.3%) |
Laboratory Findings | Value |
---|---|
Mean leukocyte (WBC) count preoperative (G/L) | 11.66 (SD: 5.28) |
Mean leukocyte (WBC) count postoperative (G/L) | 8. 03 (SD: 4.05), p < 0.001 |
Mean C-reactive protein (CRP) preoperative (mg/L) | 160.8 (SD: 159.52) |
Mean C-reactive protein (CRP) postoperative (mg/L) | 45.44 (SD: 68.85), p < 0.001 |
Microbiological findings | |
Isolation of pathogen in intraoperative specimen (n = 237) No | 57 patients (24%) |
Yes | 180 patients (76%) |
Staphylococcus aureus | 77 |
MRSA | 13 |
Streptococcus spp. | 8 |
Enterococcus spp. | 8 |
Other | 74 |
Isolation of pathogen in blood culture (n = 237) | |
No | 182 patients (76.8%) |
Yes | 55 patients (23.2%) |
Staphylococcus aureus | 26 (11%) |
Pathogens in patients who died during the initial hospital stay | 21 patients |
Staphylococcus aureus | 5 |
MRSA | 2 |
Streptococcus spp. | 1 |
No pathogen isolation | 13 |
Operative Therapy | Number of Patients |
---|---|
Overall number of patients | 237 (100%) |
Cervical spine | 45 |
Ventral discectomy with PEEK (Polyetheretherketon) cage | 31 |
Corpectomy with Titanium expandable cage | 14 |
Additional dorsal stabilization | 23 |
Thoracic and lumbar spine | |
Decompression and empyema evacuation without stabilization | 54 |
Dorsal stabilization | 138 |
Without cage | 36 |
With cage | 102 |
TLIF (Transforaminal interbody fusion) PEEK Cage | 45 |
TLIF Titan Cage | 35 |
XLIF (Extreme lateral interbody fusion) PEEK Cage | 22 |
Dorsal stabilization overall | 161 |
One segment | 25 |
Two segments | 47 |
Three and more segments | 89 |
Single surgery | 122 (51.5%) |
Multiple surgeries | 115 (48.5%) |
Early surgery (within 24 h) | 222 (93.7%) |
Psoas muscle abscess | 35 |
CT-guided punction | 19 |
Conservative therapy | 16 |
Surgical complications | 51 (21.5%) |
Hardware failure | 28 |
Wound healing deficits | 44 |
Concomitant Infections | Patients |
---|---|
Overall number of patients | 237 (100%) |
Present | 89 (37.6%) |
Pneumonia | 48 (20.25%) |
Urinary tract infections | 40 (16.9%) |
Endocarditis | 10 (4.2%) |
Stap aureus | 7 |
MRSA | 1 |
Haemophilus influenzae | 1 |
Pseudomonos aeruginosa | 1 |
Sepsis | 46 (19.4%) |
Antibiotic Therapy | Number (Days) |
---|---|
Mean time of application of empiric IV antibiotic therapy | 9.6 ± 3.4 (SD:11) |
Mean total time of application of IV antibiotic therapy (empiric and tailored) | 20.5 (SD: 22, range 2–297 days) |
Oral antibiotic therapy in cases where pathogens could have been isolated from the intraoperative specimen | 47.4 ± 0.9 (SD:45.2). |
Cummulative oral antibiotic therapy in all cases | 58.9 (SD: 46.3, range 2–462 days) |
Mean time of cummulative application of antibiotic therapy | 73.9 (SD: 54) |
Outcome Parameters | Outcome (n = 237 Patients) | p-Value |
---|---|---|
Significant decline of C-reactive protein, significant decline of VAS score, improved or unchanged neurological status | Favorable (n = 156) | p = 0.005 |
Absence of concomitant infections | Favorable (n = 148) | p = 0.005 |
Completely normalized CRP_value (CRP less than 5 mg/L) | Favorable (n = 96) | p = 0.02 |
Antibiotic therapy longer than 6 weeks | Favorable (n = 91) | p = 0.017 |
Higher preoperative CRP value | Unfavorable (n = 85) | p = 0.009 |
Postoperative spondylodiscitis | Unfavorable (n = 62) | p < 0.02 |
Recurrent spondylodiscitis | Unfavorable (n = 18) | p < 0.01 |
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Pojskić, M.; Carl, B.; Schmöckel, V.; Völlger, B.; Nimsky, C.; Saβ, B. Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis. Brain Sci. 2021, 11, 1019. https://doi.org/10.3390/brainsci11081019
Pojskić M, Carl B, Schmöckel V, Völlger B, Nimsky C, Saβ B. Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis. Brain Sciences. 2021; 11(8):1019. https://doi.org/10.3390/brainsci11081019
Chicago/Turabian StylePojskić, Mirza, Barbara Carl, Vincent Schmöckel, Benjamin Völlger, Christopher Nimsky, and Benjamin Saβ. 2021. "Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis" Brain Sciences 11, no. 8: 1019. https://doi.org/10.3390/brainsci11081019
APA StylePojskić, M., Carl, B., Schmöckel, V., Völlger, B., Nimsky, C., & Saβ, B. (2021). Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis. Brain Sciences, 11(8), 1019. https://doi.org/10.3390/brainsci11081019