Adjacent segment infection after surgical treatment of spondylodiscitis.
BACKGROUND
This is the first case series to describe adjacent segment infection (ASI) after surgical treatment of spondylodiscitis (SD).


METHODS
Patients with SD, spondylitis who were surgically treated between 1994 and 2012 were included. Out of 1187 cases, 23 (1.94 %) returned to our institution (Zentralklinik Bad Berka) with ASI: 10 males, 13 females, with a mean age of 65.1 years and a mean follow-up of 69 months.


RESULTS
ASI most commonly involved L3-4 (seven patients), T12-L1 (five) and L2-3 (four). The mean interval between operations of primary infection and ASI was 36.9 months. All cases needed surgical intervention, debridement, reconstruction and fusion with longer instrumentation, with culture and sensitivity-based postoperative antimicrobial therapy. At last follow-up, six patients (26.1 %) were mobilized in a wheelchair with a varying degree of paraplegia (three had pre-existing paralysis). Three patients died within 2 months after the ASI operation (13 %). Excellent outcomes were achieved in five patients, and good in eight.


CONCLUSIONS
Adjacent segment infection after surgical treatment of spondylodiscitis is a rare complication (1.94 %). It is associated with multimorbidity and shows a high mortality rate and a high neurological affection rate. Possible explanations are: haematomas of repeated micro-fractures around screw loosening, haematogenous spread, direct inoculation or a combination of these factors. ASI may also lead to proximal junctional kyphosis, as found in this series. We suggest early surgical intervention with anterior debridement, reconstruction and fusion with posterior instrumentation, followed by antimicrobial therapy for 12 weeks.


METHODS
Level IV retrospective uncontrolled case series.
Spine Unit, El Hadara University Hospital, Alexandria, Egypt. doctorezzo@hotmail.com.|Department of Spinal Surgery with Scoliosis Centre, Schön Klinik Vogtareuth, Krankenhausstrasse 20, 83569, Vogtareuth, Germany. doctorezzo@hotmail.com.
Ahmed Ezzat
AE
Siam
Department of Spinal Surgery, Zentralklinik Bad Berka, Bad Berka, Germany.|Spine Unit, El Hadara University Hospital, Alexandria, Egypt.
Hesham
H
El Saghir
Department of Spinal Surgery, Zentralklinik Bad Berka, Bad Berka, Germany.
Heinrich
H
Boehm
D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement / Q000379:methods; D015299:Discitis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000601:surgery; D013997:Time Factors
Adjacent segment disease; Adjacent segment infection; Spinal infection; Spondylitis; Spondylodiscitis