Abstract
PurposeIn patients with pyogenic spondylodiscitis, surgery is considered the treatment of choice to conduct proper debridement, stabilise the spine and avoid extended bed rest, which in turn is a risk factor for complications such as deep vein thrombosis and pulmonary embolism.MethodsWe conducted a retrospective clinical study with analysis of a group of 99 patients who had undergone treatment for pyogenic discitis at our institution between June 2012 and August 2017. Included parameters were age, sex, disease pattern, the presence of deep vein thrombosis, resuscitation, in-hospital mortality, present anticoagulation, preexisting comorbidities, tobacco abuse, body mass index, microbiological germ detection and laboratory results.ResultsAmong the analysed cohort, 12% of the treated patients for pyogenic spondylodiscitis suffered from a radiologically confirmed pulmonary embolism. Coronary heart disease (p < 0.01), female sex (p < 0.01), anticoagulation at admission (p < 0.01) and non-O blood type (p < 0.001) were associated with development of pulmonary embolism. Pulmonary embolism was significantly associated with resuscitation (p < 0.005) and deep vein thrombosis (p < 0.001). Neurosurgery was not associated with increased risk for pulmonary embolism compared to conservative-treated patients (p > 0.05).ConclusionSurgery for pyogenic spondylodiscitis was not associated with an elevated risk of pulmonary embolism in our analysis. However, we describe several risk factors for pulmonary embolism in this vulnerable cohort. Prospective studies are necessary to improve prevention and postoperative management in patients with pyogenic spondylodiscitis.
Highlights
Pyogenic spondylodiscitis is a rare disease with high morbidity and consecutive long-term sequelae [1]
Two patients were excluded from the study due to a pre-existing hemostaseological burden and Incidence, risk factors and clinical course of pyogenic spondylodiscitis patients with
A total of 99 patients with pyogenic spondylodiscitis were included in the analysis
Summary
Pyogenic spondylodiscitis is a rare disease with high morbidity and consecutive long-term sequelae [1]. The bacterial infection is usually of hematogenic origin and transmitted from the oral cavity, the respiratory tract or the skin [2, 3]. The primary site of infection is the avascular disc, the infection may spread continually into the vertebral body and up into the subligamentous paravertebral area, epidural space and contiguous vertebral bodies. Treatment concepts of pyogenic spondylodiscitis include either a conservative or a surgical management and should be evaluated individually. The currently available therapeutic guidelines are not standardised and based on individual preferences resulting in a high variability of outcome with conflicting results [6,7,8]
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