Abstract
Background Surgery for pyogenic Spondylodiscitis as an adjunct to antibiotic therapy is an established
treatment. However, the technique and extent of surgical debridement remains a matter
of debate. Some propagate diskectomy in all cases. Others maintain that stand-alone
instrumentation is sufficient.
Methods We reviewed charts of patients who underwent instrumentation for pyogenic Spondylodiscitis
with a minimum follow-up of 1 year. Patients were stratified according to whether
they underwent diskectomy plus instrumentation or posterior instrumentation alone.
Outcome measures included the need for surgical revision due to recurrent epidural
intraspinal infection, wound revision, and construct failure.
Results In all, 257 patients who underwent surgery for pyogenic Spondylodiscitis were identified.
Diskectomy and interbody procedure (group A) was performed in 102 patients, while
155 patients underwent instrumentation surgery for Spondylodiscitis without intradiskal
debridement (group B). The mean age was 67 ± 12 years, and 102 patients (39.7%) were
females. No significant differences were found in the need for epidural abscess recurrence
therapy (group A [2.0%] and 5 cases in group B [3%; p = 0.83]) and construct failure (p = 0.575). The need for wound revisions showed a tendency toward higher rates in the
posterior instrumentation–only group, which failed to reach significance (p = 0.078).
Conclusions Overall, intraspinal relapse of surgically treated pyogenic diskitis was low in our
retrospective series. The choice of surgical technique was not associated with a significant
difference. However, a somewhat higher rate of wound infections requiring revision
in the group where no diskectomy was performed has to be weighed against a longer
duration of surgery in an already ill patient population.
Keywords
spine Instrumentation - Spondylodiscitis - spine surgery - spinal fusion - vertebral
osteomyelitis
