[Possibilities and limits of conservative therapy of spondylitis and spondylodiscitis].
OBJECTIVE
For many years the treatment of spondylitis and spondylodiscitis has been discussed controversially. The aim of this study is to report on objective and subjective mid-term results of therapy of spondylitis and to present a differentiated concept of treatment.


METHODS
Between 1988 and 1996, 58 patients were treated with spondylitis or spondylodiscitis. Nine of these patients had to be operated. A biopsy was taken in all of the cases. According to the antibiogram obtained by the biopsy, antibiotics were applied intravenously. The patients were immobilized by a plaster bed for at least 6 weeks and were then treated by a spinal orthosis for another 3 months. Patients were re-examined clinically and radiographically and by a questionnaire (including Roland-Morris score), after 8 years on average.


RESULTS
Patients were diagnosed correctly 4 months after the begin of the disease. Spondylitis was predominantly localized in the lumbar spine. A positive bacteriological culture was derived from one third of the biopsies; none of them was a specific culture. C-reactive protein was revealed as appropriate for diagnosis and follow-up of spondylitis. In 84% of the patients a total or partial bony fusion was demonstrated radiographically. Questionnaire assessment revealed a significant decrease of the Roland-Morris score (17.8-7.4) and a significant relief of pain (8.9-2.5).


CONCLUSIONS
We recommend surgical treatment on patients with major vertebral body destruction, epidural abscess and progressive neurological impairment. These indications for operation can be prevented by a rapid diagnosis, so that spondylitis can be successfully treated by consequent immobilization in a plaster bed and appropriate antibiotics.
Flamme
C H
CH
Orthop. Klinik der MHH im Annastift e.V., Hannover. Flamme@annastift.de
Frischalowski
T
T
Gossé
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001706:Biopsy; D003131:Combined Modality Therapy; D015299:Discitis / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007103:Immobilization; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013166:Spondylitis / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents