Multidisciplinary management of pyogenic spondylodiscitis: epidemiological and clinical features, prognostic factors and long-term outcomes in 207 patients

  • Enrico Pola
  • F. Taccari
  • G. Autore
  • F. Giovannenze
  • V. Pambianco
  • R. Cauda
  • G. Maccauro
  • M. Fantoni
Original Article

Abstract

Purpose

Pyogenic spondylodiscitis (PS) is a potentially life-threatening infection burdened by high morbidity rates. Despite the rising incidence, the proper management of PS is still controversial. Aim of this study was to describe the clinical features of PS and to evaluate the prognostic factors and the long-term outcomes of a large population of patients.

Methods

207 cases of PS treated from 2008 to 2016 with a 2-year follow-up were enrolled. Clinical data from each patient were recorded. The primary outcome was the rate of healing without residual disability. Secondary outcomes included length of stay, healing from infection, death, relapse, and residual disability. Binomial logistic regression and multivariate analysis were used to evaluate prognostic factors.

Results

Median diagnostic delay was 30 days and the rate of onset neurological impairment was 23.6%. Microbiological diagnosis was established in 155 patients (74.3%) and the median duration of total antibiotic therapy was 148 days. Orthopedic treatment was conservative for 124 patients and surgical in 47 cases. Complete healing without disability was achieved in 142 patients (77.6%). Statistically confirmed negative prognostic factors were: negative microbiological culture, neurologic impairment at diagnosis and underlying endocarditis (p ≤ 0.05). Healing from infection rate was 90.9%, while residual disabilities occurred in 23.5%. Observed mortality rate was 7.8%.

Conclusion

The microbiological diagnosis is the main predictive factor for successful treatment. Early diagnosis and multidisciplinary management are also needed to identify underlying aggressive conditions and to avoid neurological complications associated with poorer long-term outcomes. Despite high healing rates, PS may lead to major disabilities still representing a difficult challenge.

Graphical abstract

These slides can be retrieved under Electronic Supplementary material.

Keywords

Spondylodiscitis Prognostic factors Outcomes Antibiotic therapy Orthopedic treatment 

Notes

Acknowledgements

The authors declare that they received no grants or funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2018_5598_MOESM1_ESM.pptx (159 kb)
Supplementary material 1 (PPTX 158 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Enrico Pola
    • 1
  • F. Taccari
    • 2
  • G. Autore
    • 1
  • F. Giovannenze
    • 2
  • V. Pambianco
    • 1
  • R. Cauda
    • 2
  • G. Maccauro
    • 3
  • M. Fantoni
    • 2
  1. 1.Division of Spine Surgery, Department of Orthopaedics and Traumatology, “A. Gemelli” University HospitalCatholic University of RomeRomeItaly
  2. 2.Department of Infectious Diseases, “A. Gemelli” University HospitalCatholic University of RomeRomeItaly
  3. 3.Department of Orthopaedics and Traumatology, “A. Gemelli” University HospitalCatholic University of RomeRomeItaly

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