Surgical treatment of spondylodiscitis.
BACKGROUND
Spondylodiscitis is a rare bacterial infection of the vertebra and intervertebral discs with an inflammatory, destructive course.


METHODS
To gain further information about the management and clinical course of spondylodiscitis, we retrospectively reviewed 32 patients in 2002 who had surgical interventions between 1992 and 2001.


RESULTS
The mean age of patients was 61 years (29-78 years). The mean hospital stay was 47 days (+/- 5.6 days; 3-121 days), including 28 days (+/- 8.1 days; 2-112 days) in the ICU. In-hospital mortality was 6%. The cervical spine was affected in 20% of patients (6/32), the thoracic spine in 25% (8/32), and the lumbosacral spine in 55% (18/32). Abscesses occurred in 63% of patients (20/32) and destruction of the vertebral body in 71% (23/32). Neurological deficits were present in 17 patients, which improved by surgical intervention in 82% of those affected. Thirty-one patients underwent ventral resection of the focus, spondylodesis with a bone graft or titanium cage, and ventral stabilization with a plate. In 19% of patients (6/32), additional dorsal bridging instrumentation was performed. Complete healing was obtained in 94% (30/32) patients. At follow-up, 50% of patients (16/32) had no complaints.


CONCLUSIONS
Spondylodiscitis requires immediate debridement of the focus, with decompression and stabilization through a ventral approach, when conservative management fails. Otherwise, severe complications occur, such as sepsis, vertebral body destruction, abscess, or neurological deficits.
Schinkel
Christian
C
Department of Surgery, BG Kliniken Bergmannsheil, Ruhr University Bochum, Germany. christian.schinkel@ruhr-uni-bochum.de
Gottwald
Matthias
M
Andress
Hans-Joachim
HJ
D000328:Adult; D000368:Aged; D003646:Debridement; D015299:Discitis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion; D016896:Treatment Outcome