Conservative versus surgical management of spondylodiscitis: a systematic review

Abstract

Spinal infections can be described etiologically as pyogenic, granulomatous (tuberculous, brucellar, fungal) and parasitic. Pyogenic spinal infections include: spondylodiscitis, a term encompassing vertebral osteomyelitis, spondylitis and discitis, which are considered different manifestations of the same pathological process; epidural abscess, which can be primary or secondary to spondylodiscitis. The incidence of non-specific spondylodiscitis is about 1:250000, corresponding to about 3% to 5% of all cases of osteomyelitis.Although diagnostic and therapeutic possibilities have drastically improved during the past decades, pyogenic spondylodiscitis remains a diagnostic and therapeutic challenge. Since it is often a complication of a distant process causing bacteremia. Spondylodiscitis remains a life threatening disease with a mortality rate of 2% to 20 %. Although some therapeutic guidelines are available, treatment of spondylodiscitis is certainly not standardized and is mostly based on local preferences resulting in physician related variability. The essential elements for successful treatment of spondylodiscitis include: fixation of the affected section of the spinal column, antibiotic therapy, debridement and decompression of the spinal canal. Conservative treatment can be considered if the clinical symptoms and destruction are relatively mild or the risk of operation appears to be too great. The objectives of surgery in spondylodiscitis are to remove the septic focus and to stabilize the infected section of the spinal column, followed by formation of fused vertebrae. Many fundamental aspects of the treatment of pyogenic spondylodiscitis are still a matter of debate. Therefore, the aim of this study was to systematically review the currently available literature to determine the outcome in patients with pyogenic spondylodiscitis after the different antibiotic and/or surgical treatments. Electronic search of databases for articles regarding treatment of spondylodiscitis that were published since 2000. Stepwise procedure to identify relevant studies was used. Details regarding treatment strategy (for example: antibiotics, bracing or surgery) and outcome parameters (treatment duration, required additional surgery, treatment failure, relapse, and mortality) were assessed.