Decompression alone versus fusion for pyogenic spondylodiscitis

Abstract

Background ContextA spinal infection is a serious problem for a spine surgeon, and there is currently much debate regarding how best to treat pyogenic spondylodiscitis using antibiotics and the instrumentations that have been developed to date. PurposeThe purpose of this study was to determine which method is better for treating pyogenic spondylodiscitis. Study DesignA retrospective chart review was performed. Patient SampleThirty-one patients with pyogenic spondylodiscitis underwent surgical treatment between 2000 and 2016 at the authors' institution. Outcome MeasuresClinical outcomes were assessed using a visual analog scale (VAS). We measured translation and rotation on flexion and extension X-rays to identify instability. MethodsPatients were divided into two groups: Group I, decompression group; Group II, decompression plus fusion group. Group I exhibited no instability according to a preoperative radiographic study, whereas Group II exhibited instability. Both groups were compared with respect to demographics and laboratory findings, including tests to determine C-reactive protein (CRP) levels and erythrocyte sedimentation rates (ESR), organisms, and the total duration of antibiotic treatment after the operation. We compared the results of the preoperative, postoperative, and last follow-up radiographic examinations of the sagittal alignment of the infected segment. This study was supported by a clinical research fund (4,500 dollars) from the National Health Insurance Service, Ilsan Hospital. ResultsA total of 31 patients were included; 22 (71%) were in Group I and 9 (29%) were in Group II. On radiological examination, the mean preoperative translation and rotation values in Group I were 2.45±1.22 mm and 5.64±1.98°, and in Group II were 5.35±1.65 mm and 12.01±4.22°. At the last follow-up, the mean translation and rotation values in Group I were 1.95±1.75 mm and 2.69±1.61°, and in Group II were 1.77±1.02 mm and 3.44±2.07°. Both Groups I and II exhibited stability after the operation. No differences were detected in preoperative ESR and CRP levels between the two groups. Group I, compared with Group II, experienced a shorter duration of treatment with antibiotics and normalization of ESR and CRP levels after the operation and a shorter hospitalization period. ConclusionsIf the appropriate antibiotics are administered quickly when there is no instability, decompression alone is effective; however, if instability is detected, decompression plus fusion can be used to achieve stability.