Abstract
Background and Study Aim Spinal pyogenic infections occur frequently in today's neurosurgical routine. Conservative
therapy often proves to be insufficient against an aggressive disease that affects
patients who tend to be elderly and debilitated with complex comorbidity. Treatment,
or lack of treatment, carries risks of persistent disability, sepsis, and death. In
this study, we propose a tailored and staged algorithm for treating such spinal infections
and present results of this approach.
Patients and Methods We retrospectively analyzed 52 patients (33 male, 19 female; median age: 68 years)
who had undergone cervical, thoracic, or lumbar surgery for spinal infections according
to the proposed staged treatment algorithm.
Results Most of the 52 patients were severely disabled (35% with quadri- or paraparesis,
31% with sepsis and catecholamine dependency, 17% with a single motor deficit, and
10% with meningitis). We surgically treated multilevel and multisegmental spinal infections
via 23 nonstabilizing and 57 stabilizing ventral or dorsal approaches to the cervical,
thoracic, or lumbar spine. The mean follow-up time was 24 months. Overall mortality
was 19%. Surgery-related complications occurred in 11.5% of patients; recurrence of
infection occurred in 3.8%. Motor function improved in 61.7%; bladder and sphincter
dysfunction remitted completely in 50.0%.
Conclusions Depending on the patient's health status and neurological condition, surgery in complex
spinal infections provides a good outcome in most cases. Nevertheless, indication
must be individualized; for this, the proposed algorithm seems to be an excellent
tool. We find that surgery should be discussed as a treatment of first choice for
today's often complex spinal infections.
Keywords
spinal infections - septic osteomyelitis - elderly patients - comorbidity - spinal
stabilization
