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. 2021 Jun;15(3):591-599.
doi: 10.14444/8080. Epub 2021 May 13.

Management of Pyogenic Spondylodiscitis Following Nonspinal Surgeries: A Tertiary Care Center Experience

Ghazwan A Hasan  1 , Hayder Q Raheem  2 , Ahmed Qutub  3 , Yasameen Bani Wais  4 , Mustafa Hayder Katran  2 , Gautam M Shetty  5   6
Affiliations

Management of Pyogenic Spondylodiscitis Following Nonspinal Surgeries: A Tertiary Care Center Experience

Ghazwan A Hasan et al. Int J Spine Surg. 2021 Jun.

Abstract

Background: The literature is lacking on the incidence and management of pyogenic spondylodiscitis (PS) following routine elective surgical procedures. This study aimed to analyze the presentation and treatment outcome in patients with PS following nonspinal surgeries at a tertiary care center with a minimum follow-up of 12 months.

Methods: The demographic, clinical-radiologic features, and treatment outcomes in 40 patients with a diagnosis of PS following nonspinal surgical procedures were retrospectively reviewed and analyzed.

Results: The mean age at presentation was 36.4 ± 11.8 years, with 80% of patients being female. The common surgical procedures associated with PS were cesarean delivery (30%), gastric sleeve surgery (12.5%), and dilatation and curettage (12.5%). The tissue biopsy culture was positive in 82.5% of patients. A total of 26 patients (65%) were treated with conservative management and 14 patients (35%) were treated surgically. The mean pretreatment Core Outcome Measure Index score significantly decreased at 12 months (P < .0001) after treatment. The mean pretreatment erythrocyte sedimentation rate (P < .0001) and C-reactive protein (P < .0001) levels significantly decreased at 12 months after treatment.

Conclusions: With most patients with PS following nonspinal surgeries treated with conservative management, excellent clinical outcomes were achieved in all patients at 12 months after treatment. The diagnosis of PS should be considered in patients presenting with low back pain (LBP) with a recent history of undergoing a nonspinal surgical procedure. Patients who undergo surgical procedures are an important "at-risk" patient population, and early diagnosis and treatment can help achieve excellent clinical outcomes. Further studies are required to determine risk factors and possible perioperative precautions that can be taken to prevent PS in patients who undergo nonspine surgeries.

Level of evidence: 3.

Clinical relevance: Pyogenic spondylodiscitis should be suspected in patients presenting with LBP after a recent non-spinal surgical procedure. Early diagnosis and treatment can help achieve excellent clinical outcomes in these patients.

Keywords: infection; outcome; pyogenic spondylodiscitis; spinal infections; surgery.

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Conflict of interest statement

Disclosures and COI: No benefits or funds were received in support of this study by any of the authors. This study has been approved by an Institutional Review Board and ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Figures

Figure 1
Figure 1
Example of grade I pyogenic spondylodiscitis (PS) at C3 to C4 level (arrow) on magnetic resonance imaging (MRI; left), grade II PS at L4 to L5 level (arrow) on MRI (center), and grade III PS at L3 to L4 level (arrow) on computed tomography scan (right).
Figure 2
Figure 2
Preoperative cervical spine magnetic resonance image of a patient with grade III pyogenic spondylodiscitis at the C4 to C6 levels (left) and cervical spine lateral radiograph of the same patient at 12 months after anterior cervical corpectomy and fusion surgery (right).
Figure 3
Figure 3
Mean Core Outcome Measure Index (COMI) scores at 6 weeks, 3 months, 6 months, and 12 months after treatment.
Figure 4
Figure 4
Mean erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels at 6 weeks, 3 months, 6 months, and 12 months after treatment.
See this image and copyright information in PMC

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