Radiographic evaluation of single-level infective lumbar spondylodiscitis following conservative compared to surgical treatment: A retrospective cohort study

Abstract

Study designRetrospective cohort study. PurposeSpondylodiscitis is the most common infectious disease of the spine which can be treated either conservative or surgery. Nowadays, there are only a few studies on radiographic outcomes. The purpose of this study was to investigate the long-term radiographic outcomes of conservative treatment compared with surgical treatment in single-level infective spondylodiscitis patients. MethodsPatients diagnosed with single-level infective spondylodiscitis in lumbar vertebrae during July 2009 to September 2019 were eligible for inclusion. Radiographic evaluation comprising lumbar lordotic angle, segmental kyphotic angle, and foraminal height of was performed on lumbar lateral view before treatment and at the 1-year follow-up. ResultsA total of 116 patients (mean age; 60 years; 53 males) were included. Except for length of hospital stay, which was significantly longer in the surgical group, there were no significant differences for any of the other demographic or clinical characteristics between groups. All pre-treatment radiographic parameters in the surgical group were worse than in the conservative group. At the 1-year follow-up, conservative treatment patients demonstrated significantly worse segmental kyphosis (p ​< ​0.01), In contrast, surgical treatment was shown to improve the segmental kyphotic angle. Concerning the surgical approach, the combined surgical approach resulted in a significantly improved segmental kyphotic angle at the 1-year follow-up (p ​= ​0.013); however, there was no significant change in the segmental kyphotic angle via the anterior or posterior approach (p ​= ​0.511 and p ​= ​0.475, respectively). ConclusionIn patients with single level infective lumbar spondylodiscitis, surgical treatment can significantly improve segmental kyphotic angle, and the result is more favorable than conservative treatment. The combined surgical approach was found to be superior to the anterior and posterior approaches for improving regional spinal alignment.