IS THE DECOMPRESSION ALONE, A VALID TREATMENT FOR SPINAL INFECTIONS?

Abstract

Introduction: Spondylodiscitis is a rare but serious disease due to delay in diagnoses and inadequate treatment. The outcome mainly related to the early diagnosis.

The purpose of our study is to analyze retrospectively our patients, who had received conservative treatment or either posterior or combined approach.

Material and Method: Between 1992 and 2000, 163 patients were hospitalized due to spondylodiscitis; 62 were females and 101 males. The mean age was 56 years (1–83yrs).

The diagnosed was based on clinical examination, cultures, bone histology, X-rays, bone scan and MRI with gadolinium. The location of the infection was in 13 (8%) patients the cervical spine, in 62 (38%) the thorachic, in 10 (6%) the thoracolumbar junction and in 78 (48%) the lumbo-sacral spine. In 95 cases, concomitant diseases were present.

In 67 (41%) patients was not able to detect any microorganism. From the remaining patients, 53 (33%) were infected by staph.aureus and 22 (13%) by mycob tuberculosis.

The patients according to the treatment provided, were divided in three groups:

• Group A: 70 patients, which had conservative treatment with antibiotics and bracing.

• Group B: 56 patients, which, sustained posterior decompression alone

• Group C: 37 patients, which had anterior debridemant and posterior decompression and stabilizations or anterior stabilization.

Results: The 12 months follow up reveals that 8 patients (11.4%) of group-A were operated. On the other hand 24 (42.9%) of the group-B were revised, as well as 6 (16.2%) patients from the group C.

The group A patients had not neurological symptoms. In group B, 11 had altered neurology and the operation was beneficial for 5 of them (45.5%), 4 remained unchanged and in 2 was deteriorate. In group C, 11 patients had altered neurology, from which 9 (81.8%) were improved and 2 remained unchanged.

The in-hospital complications were: 2 pulmonary embolism, 2 post operative haematomas, 1 persistent anaimia, 1 diafragm paralysis, 2 atelectasia and 1 cerebral thrombosis. In addition 3 patients had residual psoas abscess, 2 pancreas abscess, 1 cerebelum abscess and 3 lung infection.

The in-hospital mortality was 3 patients, other 17 patients died during the follow up

Conclusion: Spondylodiscitis is a valid diagnose for persisting back pain. Bacterial isolation is still difficult no matter the improved techniques, but in the majority of the cases is Staph.Aureus.

The conservative management in selected patients is effective up to 89%. From the operations performed the decompression alone had unacceptable high re-operation rate and also, it wasn’t so beneficial regarding the neurological improvement. If it is combined with anterior reconstruction and posterior stabilization provides better results.