Pyogenic spondylodiscitis

The quest towards a clinical-radiological classification

Pyogene Spondylodiszitis

Die Suche nach einer klinisch-radiologischen Klassifikation

Abstract

Background

Pyogenic spondylodiscitis (PS) is a debilitating condition laden with orthopedic and neurological complications. The choice of the best step in management is often delayed due to the controversy encompassing its multiple facets. Several classification systems were proposed in the literature to define optimal management; however, consensus was not achieved.

Objective

The aim of this study was to review the literature and critically appraise the classification systems of PS and the rationale behind the classification criteria.

Methods

A literature search was conducted in PubMed. Titles and abstracts of articles were searched using different synonyms of spondylodiscitis and its classification. No restrictions regarding language of publication or date of publication were applied.

Results

A total of 43 papers with 5 encompassing 3 main classifications were found in the literature. These classifications were overlapping but different. They encompassed neurologic deficits, abscess formation and segmental instability, laboratory parameters and morphological changes in magnetic resonance imaging (MRI) as the most important factors used to classify PS, assess the severity and guide treatment.

Conclusion

The current classification schemes overlap and encompass the most clinically relevant factors; however, some could be too complex for interdisciplinary clinical practice and do not adequately address unique entities, such as PS of the cervical spine, anterolisthesis and retrolisthesis. Most importantly, some criteria must be utilized in concert with recently published guidelines and should be re-assessed for validity and reliability. A uniform orthopedic parlance is required to optimize the management of this debilitating and life-threatening condition.

Zusammenfassung

Hintergrund

Die pyogene Spondylodiszitis (PS) ist eine lebensbedrohliche Erkrankung mit zahlreichen orthopädischen und neurologischen Komplikationen. Die Wahl des besten Therapieschrittes wird aufgrund der facettenreichen Darstellung des Krankheitsbilds häufig verzögert. In der Literatur wurden mehrere Klassifikationssysteme zur Entscheidungsfindung vorgeschlagen, um ein optimales Therapie-Management zu definieren. Ein Konsens wurde jedoch nicht erreicht.

Fragestellung

Das Ziel dieser Studie ist es, die Literatur bezüglich der vorhandenen Klassifikationen der PS zu überprüfen und die Klassifizierungsparameter kritisch zu bewerten.

Methoden

Eine Literaturrecherche wurde mit PubMed durchgeführt. Titel und Abstracts von Artikeln wurden mit verschiedenen Synonymen der Spondylodiszitis und ihrer Klassifikation durchsucht. Sowohl die Veröffentlichungssprache als auch das Veröffentlichungsdatum stellten kein Ausschlusskriterium dar.

Ergebnisse

Iinsgesamt wurden 43 Artikel gefunden, von denen 5 Arbeiten 3 verschiedene Klassifikationen aufwiesen. Diese Klassifikationen überschneiden sich, auch wenn sie sich zum Teil unterscheiden. Sie umfassen die wichtigsten Parameter wie das neurologische Defizit, die Abszessbildung und die segmentale Instabilität sowie Laborparameter und morphologische Veränderungen in der Magnetresonanztomographie (MRT) zur Klassifizierung der PS, zur Einschätzung des Schweregrades und zur therapeutischen Entscheidungsfindung.

Schlussfolgerungen

Die aktuell publizierten Klassifikationen zeigen bezüglich des Aufbaus Überlappungen und umfassen die klinisch relevantesten Parameter. Einige dieser Klassifikationen könnten jedoch für die interdisziplinäre klinische Praxis zu komplex und im klinischen Alltag schwere zu handhaben sein. Auch werden einzelne Entitäten wie z. B. die PS der Halswirbelsäule, die Antero- und die Retrolisthese nicht adressiert. Am wichtigsten ist, dass einige der enthaltenen Kriterien in Übereinstimmung mit den kürzlich veröffentlichten Leitlinien verwendet werden müssen und auf ihre Validität und Reliabilität überprüft werden sollten. Eine einheitliche orthopädische Klassifikation ist erforderlich, um das Management dieser lebensbedrohlichen Erkrankung zu optimieren.

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Abbreviations

ASIA:

American Spinal Injury Association

CRP:

C‑reactive protein

CT:

Computed tomography

ESR:

Erythrocyte sedimentation rate

HRQoL:

Health-related quality of life

IDSA:

Infectious Disease Society of America

MRI:

Magnetic resonance imaging

PS:

Pyogenic spondylodiscitis

ROM:

Range of motion

SEA:

Spinal epidural abscess

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Correspondence to M. Akbar MD.

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Conflict of interest

H. Almansour, W. Pepke and M. Akbar declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Almansour, H., Pepke, W. & Akbar, M. Pyogenic spondylodiscitis. Orthopäde 49, 482–493 (2020). https://doi.org/10.1007/s00132-019-03836-0

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Keywords

  • Vertebral osteomyelitis classification
  • Surgery
  • Neurologic deficits
  • Epidural abscess
  • Segmental instability

Schlüsselwörter

  • Klassifikation
  • Operative Therapie
  • Neurologische Defizite
  • Epiduraler Abszess
  • Segmentale Instabilität