Clinical and microbiological outcomes in haematogenous spondylodiscitis treated conservatively.
Spondylodiscitis refers to infections of the intervertebral disc and the adjacent vertebral body. Although it is still considered a rare condition, its rate is projected to increase. Mortality rate is considered to be low, but an estimated one third of the survivors experience residual disabilities. Literature shows that uncomplicated spondylodiscitis can be adequately treated by early antibiotic therapy and immobilization. The aim of the study is to evaluate the outcome of conservative treatment in patients with haematogenous spondylodiscitis.



All patients with haematogenous spondylodiscitis observed in two orthopaedic centres were retrospectively considered. The medical records, radiologic imaging, bacteriology results, treatment, and complications of all patients were reviewed.



Thirty patients (median age 64 years, range 15-77, females 56.7%) were considered in the study, eight (26.7%) showed residual back pain at median follow-up of 117 weeks (range 104-189). A significant difference in SF-36 physical (P < 0.001), SF-36 mental function (P < 0.002), and Oswestry Disability Index (ODI) (P < 0.001) scores was observed among patients with residual local pain compared to the ones who had not. Methicillin-resistant Staphylococcus aureus (MRSA) infection and symptoms duration before the diagnosis were associated with an increased risk of persistent back pain and permanent disability. The most important negative determinants of SF-36 mental function were the age of patients (ρ = 0.36, P < 0.05), the duration of symptoms before the diagnosis (ρ = 0.44, P < 0.05) and MRSA infection (P = 0.006). Spondylodiscitis sustained by MRSA and the duration of symptoms before the diagnosis influenced negatively the physical status (P = 0.002) and ODI (ρ = 0.36, P < 0.05), respectively.



Conservative approaches are safe and effective for patients without complications. A delayed diagnosis and MRSA infections are related to poor clinical outcome among patients treated by conservative treatment; this must be carried out scrupulously with close patient monitoring.
Department of Infectious Diseases, D. Cotugno Hospital, AORN dei colli, Naples, Italy.
Tiziana
T
Ascione
Department of Public Health, School of Medicine"Federico II" University, Naples, Italy. giovannibalato@gmail.com.
Giovanni
G
Balato
Department of Public Health, School of Medicine"Federico II" University, Naples, Italy.
Sigismondo Luca
SL
Di Donato
Department of Infectious Diseases, D. Cotugno Hospital, AORN dei colli, Naples, Italy.
Pasquale
P
Pagliano
Department of Public Health, School of Medicine"Federico II" University, Naples, Italy.
Francesco
F
Granata
Department of Public Health, School of Medicine"Federico II" University, Naples, Italy.
Gianluca
G
Colella
Department of Public Health, School of Medicine"Federico II" University, Naples, Italy.
Carlo
C
Ruosi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015299:Discitis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
D000900:Anti-Bacterial Agents
Conservative treatment; Haematogenous spondylodiscitis; Outcome; Spine infection