Management of spontaneous pyogenic spondylodiscitis: a descriptive cohort study

IF 0.7 Q4 CLINICAL NEUROLOGY Egyptian journal of neurosurgery Pub Date : 2024-06-04 DOI:10.1186/s41984-024-00299-0
Aly Ibrahim, Khaled Elshazly, Mohamed A. R. AbdelFatah, Abdelrahman El-Gayar, Sameh Hefny
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Abstract

Spontaneous spondylodiscitis (SD) is an inflammation of the vertebral endplate and the intervertebral disc with no prior surgery or intervention. The treatment of spontaneous pyogenic SD mainly consists of systemic antibiotics and rest. Some cases require surgery due to failure of medical treatment or due to neurological compromise. Due to the disease heterogeneity, there are no standardized, widely adopted treatment protocols. We conducted this study to assess the clinical outcome of the different treatment modalities. This is a retrospective analysis of prospectively collected data of patients with spontaneous non-tuberculous spondylodiscitis. Thirty-eight patients were identified, including 14 males and 24 females. The mean age was 49 years. Twenty-three patients underwent surgery from the start while 15 patients received conservative medical treatment. Among the latter, 8 patients showed disease progression and required surgical intervention. The ODI/NDI at 1 year (mean = 8) was significantly better than before treatment (mean = 18). Among 11 patients with motor deficit at presentation, 8 improved and 3 remained stable. There were 14 complications, including 11 minor and 3 major, requiring one revision surgery. Surgical decompression and debridement with or without instrumented fusion for complicated SD cases is a safe and effective treatment modality. Close follow-up is needed in case of conservative treatment for early detection of treatment failure and disease progression. Baseline characteristic variabilities in patients with spontaneous pyogenic SD could predict conservative treatment failure, but this needs to be validated in larger series.
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自发性化脓性脊椎盘炎的治疗:一项描述性队列研究
自发性椎间盘炎(SD)是指椎体终板和椎间盘在未进行手术或干预的情况下发生的炎症。自发性化脓性椎间盘炎的治疗主要包括全身使用抗生素和休息。有些病例因药物治疗无效或神经系统受损而需要手术治疗。由于疾病的异质性,目前还没有标准化的、被广泛采用的治疗方案。我们进行了这项研究,以评估不同治疗方法的临床效果。这是对前瞻性收集的自发性非结核性脊椎盘炎患者数据进行的回顾性分析。研究共确定了 38 名患者,其中男性 14 人,女性 24 人。平均年龄为 49 岁。23名患者一开始就接受了手术治疗,15名患者接受了保守治疗。在后者中,8 名患者的病情出现进展,需要进行手术治疗。1 年后的 ODI/NDI(平均值 = 8)明显优于治疗前(平均值 = 18)。在 11 位发病时有运动障碍的患者中,8 位病情有所改善,3 位病情保持稳定。共有14例并发症,其中11例为轻微并发症,3例为严重并发症,需要进行一次复查手术。对于复杂的 SD 病例,手术减压和清创加或不加器械融合是一种安全有效的治疗方式。保守治疗时需要密切随访,以便及早发现治疗失败和疾病进展。自发性化脓性SD患者的基线特征变异可预测保守治疗的失败,但这需要在更大的系列中进行验证。
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