Abstract
Background The incidence of pyogenic spondylodiscitis is increasing; however, the source of
infection often remains obscure. We analyzed predisposing factors, pathogens, and
outcome of patients undergoing surgical and/or conservative treatment of spondylodiscitis
with a focus on the diagnostic work-up including a comprehensive maxillofacial assessment.
Patients The analysis of prognostic factors comprised comorbidities, nicotine dependence,
symptom duration, and oral cavity peculiarities. After a standardized diagnostic work-up,
a detailed examination of the oral cavity was also performed. The outcome analysis
included assessment of the patients' clinical status.
Results Forty-one patients with pyogenic spondylodiscitis were investigated of whom 24% had
undergone spinal surgery within 4 weeks before the infection. A total of 29% of patients
were found to have a concomitant bacterial oral cavity disease, and in 22% the definitive
source of infection remained unidentified. Among the 12 patients with oral cavity
infections, 10 patients had periodontitis; 8, root canal pathologies; 6, periapical
lesions, and another 8 patients, caries. In 25% of these patients, typical oral cavity
pathogens were found in the intervertebral disk. The prevalence of oral cavity infections
was associated with a history of nicotine dependence (p = 0.003). All other analyzed comorbidities did not differ compared with patients
without an oral cavity focus.
Conclusion Oral cavity infections appear to be a frequent source of pyogenic spondylodiscitis,
with smoking its most relevant associated risk factor. In case of an unidentified
infection focus, a detailed diagnostic work-up including a mandatory maxillofacial
assessment is strongly recommended.
Keywords
pyogenic spondylodiscitis - oral cavity infection - bacteria - nicotine dependence
- maxillofacial assessment
