Abstract
Study design Retrospective analysis of a single-center cohort of patients with pyogenic vertebral osteomyelitis. The purpose of the study was to review risk factors for perioperative complications and recurrences in patients diagnosed with hematogenous pyogenic vertebral osteomyelitis. Material and methods 141 inpatient records of hematogenous pyogenic vertebral osteomyelitis were reviewed at the Regional Clinical Hospital No. 2, Tyumen. Patients who developed complications, neurological deficits and recurrences were assigned to A group (n = 66), and those who did not included in B group (n = 75). Results Perioperative complications, recurrences, risk factors and neurological disorders that could develop with different treatment methods were explored. There was a greater risk of recurrences and a lower rate of neurological complications seen in chronic cases and drug addicts. There was a lower risk of intra- and postoperative complications seen in thoracic spine involvement, a greater risk of neurological deficit with involved cervical spine and a lower risk in the lumbar spine involvement. There was a lower risk of neurological disorders in type A and type B disorders, and a greater risk in type C disorders as categorized by E. Pola. There were no differences in recurrence rates among different types of involvement. HIV did not increase the risk of complications and relapses. Surgical site infection developed in 8.1 % cases of transpedicular fixation and in 6.9 % following ventral interventions. No correlation was observed between the recurrence and complication rate and the surgical methods used. Overall, recovery or stable remission was achieved in 88.6 % of cases after treatment of relapses. Conclusion Recurrences and complications were primarily caused by delayed diagnosis, co-morbidities and neurological deficits. No correlation was observed between the recurrence and complication rate and the surgical methods used. There was a greater risk of recurrences and a lower rate of neurological complications seen in chronic cases and drug addicts. Neurological disorders are common for cervical spine disorders. The risk of complications was dependent on the type of involvement as categorized by E. Pola. There was a lower risk of neurological disorders in type A and B disorders and a statistically greater risk in type C disorders.
Highlights
Hematogenous osteomyelitis of the spine (HOS) is a disease that requires a multidisciplinary approach at all stages of treatment, from diagnosis to rehabilitation of patients
Neurological deficiency occurs in 18.5-75 % with the risk of the complication being higher with involvement in the cervical spine and with a disease caused by Staphylococcus aureus [5, 10, 11]
There were no significant differences in the risk of recurrence and complications depending on the type of surgical intervention
Summary
Hematogenous osteomyelitis of the spine (HOS) is a disease that requires a multidisciplinary approach at all stages of treatment, from diagnosis to rehabilitation of patients. The rare and severe pathology is associated with perioperative risk factors of recurrences and complications. This is supported by a number of factors. Neurological deficiency occurs in 18.5-75 % with the risk of the complication being higher with involvement in the cervical spine and with a disease caused by Staphylococcus aureus [5, 10, 11]. The complication rate is twice as high in patients older than 65 years after surgical treatment being 40.6 % including long-term results and mortality, and 21.9 % after conservative therapy. Conservative treatment is a safe and effective for patients with early diagnosis, absence of significant bone destruction and neurological deficit and can be the method of choice for patients with decompensated concomitant pathology [14]
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