Abstract
Purpose
Spondylodiscitis represents a condition with significant heterogeneity. A significant proportion of patients are managed without surgical intervention, but there remains a group where surgery is mandated. The aim of our study was to create a scoring system to guide clinicians as to which patients with spondylodiscitis may require surgery.
Methods
A retrospective analysis of patients presenting to our institution with a diagnosis of spondylodiscitis between 2005 and 2014 was performed. Data for 35 variables, characterised as potential risk factors for requiring surgical treatment of spondylodiscitis, were collected. Logistic regression analysis was performed to evaluate the predictability of each. A prediction model was constructed, and the model was externally validated using a second series of patients from 2014 to 2015 meeting the same standards as the first population. The predicted odds were calculated for every patient in the data set. Receiver operating characteristic (ROC) curves were created, and the area under curve (AUC) was determined.
Results
Sixty-five patients were identified. Surgery was deemed necessary in 21 patients. Six predictors: distant site infection, medical comorbidities, the immunocompromised patient, MRI findings, anatomical location and neurology, were found to be the most consistent risk factors for surgical intervention. An internally validated scoring system with an AUC of 0.83 and an Akaike information criterion (AIC) of 115.2 was developed. External validation using a further 20 patients showed an AUC of 0.71 at 95% confidence interval of 0.50–0.88.
Conclusions
A new scoring system has been developed which can help guide clinicians as to when surgical intervention may be required. Further prospective analyses are required to validate this proposed scoring system.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Similar content being viewed by others
References
Zimmerli W (2010) Clinical practice. Vertebral osteomyelitis. N Engl J Med 362(11):1022–1029
Skaf GS et al (2010) Pyogenic spondylodiscitis: an overview. J Infect Public Health 3(1):5–16
Zarghooni K, Röllinghoff M, Sobottke R, Eysel P (2012) Treatment of spondylodiscitis. Int Orthop 36(2):405–411
Digby JM, Kersley JB (1979) Pyogenic non-tuberculous spinal infection: an analysis of thirty cases. J Bone Joint Surg Br 61(1):47–55
Beronius M, Bergman B, Andersson R (2001) Vertebral osteomyelitis in Göteborg, Sweden: a retrospective study of patients during 1990–95. Scand J Infect Dis 33(7):527–532
Cheung WY, Luk KD (2012) Pyogenic spondylitis. Int Orthop 36(2):397–404
Duarte RM, Vaccaro AR (2013) Spinal infection: state of the art and management algorithm. Eur Spine J 22(12):2787–2799
Cervan AM, JeD Colmenero, Del Arco A, Villanueva F, Guerado E (2012) Spondylodiscitis in patients under haemodyalisis. Int Orthop 36(2):421–426
Rutges JP, Kempen DH, van Dijk M, Oner FC (2016) Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review. Eur Spine J 25(4):983–999
Sobottke R, Seifert H, Fätkenheuer G, Schmidt M, Gossmann A, Eysel P (2008) Current diagnosis and treatment of spondylodiscitis. Dtsch Arztebl Inl 105(10):181–187
Guerado E, Cerván AM (2012) Surgical treatment of spondylodiscitis. An update. Int Orthop 36(2):413–420
Gouliouris T, Aliyu SH, Brown NM (2010) Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother 65(3):11–24
de Graeff JJ, Paulino Pereira NR, van Wulfften Palthe OD, Nelson SB, Schwab JH (2017) Prognostic factors for failure of antibiotic treatment in patients with osteomyelitis of the spine. Spine (Phila Pa 1976) 42(17):1339–1346
Roßbach BP et al (2014) Surgical treatment of patients with spondylodiscitis and neurological deficits caused by spinal epidural abscess (SEA) is a predictor of clinical outcome. J Spinal Disord Tech 27(7):395–400
Kothari MK, Shah KC, Tikoo A, Nene AM (2016) Surgical management in elderly patients with tuberculous spondylodiscitis: ten year mortality audit study. Asian Spine J 10(5):915–919
Linhardt O, Matussek J, Refior HJ, Krödel A (2007) Long-term results of ventro-dorsal versus ventral instrumentation fusion in the treatment of spondylitis. Int Orthop 31(1):113–119
Ozturk C, Aydinli U, Vural R, Sehirlioglu A, Mutlu M (2007) Simultaneous versus sequential one-stage combined anterior and posterior spinal surgery for spinal infections (outcomes and complications). Int Orthop 31(3):363–366
Pee YH, Park JD, Choi YG, Lee SH (2008) Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage. J Neurosurg Spine 8(5):405–412
Si M, Yang ZP, Li ZF, Yang Q, Li JM (2013) Anterior versus posterior fixation for the treatment of lumbar pyogenic vertebral osteomyelitis. Orthopedics 36(6):831–836
Lee BH, Park JO, Kim HS, Lee HM, Cho BW, Moon SH (2014) Transpedicular curettage and drainage versus combined anterior and posterior surgery in infectious spondylodiscitis. Indian J Orthop 48(1):74–80
Lin TY et al (2014) Comparison of two-stage open versus percutaneous pedicle screw fixation in treating pyogenic spondylodiscitis. BMC Musculoskelet Disord 15:443
Schomacher M et al (2014) Application of titanium and polyetheretherketone cages in the treatment of pyogenic spondylodiscitis. Clin Neurol Neurosurg 127:65–70
Včelák J, Chomiak J, Toth L (2014) Surgical treatment of lumbar spondylodiscitis: a comparison of two methods. Int Orthop 38(7):1425–1434
Pola E et al (2018) Multidisciplinary management of pyogenic spondylodiscitis: epidemiological and clinical features, prognostic factors and long-term outcomes in 207 patients. Eur Spine J 27(2):229–236
Sapico FL, Montgomerie JZ (1979) Pyogenic vertebral osteomyelitis: report of nine cases and review of the literature. Rev Infect Dis 1(5):754–776
Shetty AP, Viswanathan VK, Kanna RM, Shanmuganathan R (2017) Tubercular spondylodiscitis in elderly is a more severe disease: a report of 66 consecutive patients. Eur Spine J 26(12):3178–3186
Shah K, Kothari M, Nene A (2018) Role of frailty scoring in the assessment of perioperative mortality in surgical management of tuberculous spondylodiscitis in the elderly. G Spine J 1:1–5
Akiyama T, Chikuda H, Yasunaga H, Horiguchi H, Fushimi K, Saita K (2013) Incidence and risk factors for mortality of vertebral osteomyelitis: a retrospective analysis using the Japanese diagnosis procedure combination database. BMJ Open 3(3):1–6
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None of the authors has any potential conflict of interest.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Appalanaidu, N., Shafafy, R., Gee, C. et al. Predicting the need for surgical intervention in patients with spondylodiscitis: the Brighton Spondylodiscitis Score (BSDS). Eur Spine J 28, 751–761 (2019). https://doi.org/10.1007/s00586-018-5775-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-018-5775-x