Abstract
BACKGROUND CONTEXTSpinal infection (SI) is a life-threatening condition and its treatment remains challenging. Recent studies have supported early and aggressive surgery, but mortality still reaches 5% to 10% and it remains unclear, if an aggressive surgical strategy also applies for severely sick patients. PURPOSEThe aim of this analysis was to generate an assessment score to predict mortality of SI in order to facilitate decision-making. STUDY DESIGNRetrospective risk factor analysis. PATIENT SAMPLETwo hundred fifty-two patients were retrospectively analyzed. OUTCOME MEASURESPhysiologic measures, functional measures. METHODSDiagnosis was based on clinical presentation, imaging findings and inflammatory markers. Factors associated with mortality were identified by multivariate analysis, weighted according to their relative risk ratio (RR) and included in the novel assessment score. RESULTSEight parameters were included: (1) BMI, (2) ASA score, (3) presence of sepsis, (4) age-adjusted Charlson Comorbidity Index, (5) presence and degree of renal failure, (6) presence of hepatopathy, (7) neurological deficits and (8) CRP levels at diagnosis. Each parameter was assigned a certain range of points, resulting in a maximum total score of 20. The mortality in spinal infection (MSI-20) score - indicating poorer status with higher values - was obtained for each patient and correlated with mortality. CONCLUSIONAn MSI-20 score of 11 or more points seems to identify the small group of patients being “too sick to undergo surgery,” while early surgery can be recommended in the remainder (MSI-20 ≤10). Our results need to be confirmed in prospective studies, but may give guidance for indicating surgery even in rather sick and comorbid patients.
Highlights
Spinal infection (SI) is a life-threatening condition and is defined as an infectious disease affecting the spine and/or the paravertebral tissues [1]
Factors associated with mortality Two hundred fifty-two patients with complete data records were identified and evaluated retrospectively
The occurrence of spinal epidural and/or paraspinal abscesses was slightly higher in the deceased patient group but failed to reach statistical significance
Summary
Spinal infection (SI) is a life-threatening condition and is defined as an infectious disease affecting the spine and/or the paravertebral tissues [1]. SI can arise primarily through hematogenous spread, or secondarily, as a result of prior spinal surgery or trauma [2,3]. The incidence of SI has been increasing in the last decades, which may be explained by an aging population with serious comorbidities and rising numbers of spinal interventions. FDA device/drug status: Not applicable Author disclosures: SL: Nothing to disclose. SH: reports personal fees from Johnson& Johnson/ depuy Synthes, personal fees from Icotec, outside the submitted work. CT: reports grants from BrainLab, DePuySynthes, Intrinsic Therapeutics, Pfizer, Signus Medical, TETEC, personal fees from BrainLab, DePuySynthes, Icotec, Intrinsic Therapeutics, Medtronic, Nuvasive, Pfizer, Siemens, Signus Medical, Zeiss, outside the submitted work
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