Epidemiological trends of pyogenic spondylodiscitis in Germany: an EANS Spine Section Study

Abstract

Pyogenic spondylodiscitis presents significant diagnostic and therapeutic challenges. In Germany, a comprehensive understanding of its epidemiology and inpatient management outcomes is limited, hindering the optimisation of therapeutic strategies. This study aimed to characterise the evolving epidemiological trends of pyogenic spondylodiscitis in Germany, and concurrently evaluate inpatient management strategies and outcomes. We performed a retrospective population-based study of spondylodiscitis cases in Germany from 2005 to 2021, utilising data from the German Federal Statistical Office database. The parameters assessed were incidence trends, demographic characteristics, inpatient management strategies, and inpatient mortality. The study found a significant rise in the population-adjusted incidence of spondylodiscitis in Germany from 2005 to 2021, increasing by 104% from 5.4 to 11.0 cases per 100,000 individuals (p < 0.001). The highest number of diagnoses was recorded in 2019. Age group-adjusted data revealed the largest relative changes in the "90 + " age group, followed by the "80-89" and "70-79" age groups. These increases were not solely attributable to population changes but were also confirmed after calculating the age-group-adjusted incidence rates. Additionally, our statistical analysis demonstrated that both age and year significantly influenced the incidence of spondylodiscitis. Over the same period, inpatient mortality also surged significantly by 347% (p < 0.001), with the highest increase recorded in the 90 + age group, observing a 2450% rise (p < 0.001). The mean length of inpatient stay decreased by 15% (p < 0.05). Concurrently, there was a significant increase in surgical interventions using spinal stabilisation procedures (p < 0.001), which might suggest a shift in the treatment paradigm for spondylodiscitis. The results underscore a concerning rise in spondylodiscitis incidence and mortality in Germany, particularly affecting the ageing population. A notable shift towards surgical intervention was observed. The data highlights the urgent necessity for high-level evidence studies comparing surgical versus conservative treatment, thereby guiding optimised therapeutic strategies.

Figure 1

This area chart visually represents the number of spondylodiscitis diagnoses (categorized by ICD-10 codes: M46.2, M46.3, M46.4) in Germany from 2005 to 2021. The distinct color layers correspond to different age groups, illustrating the distribution of these diagnoses across age groups. The vertical axis represents the number of diagnoses per 100,000 of the general German population, while the horizontal axis spans the years under observation.

Figure 2

The presented line plots elucidate the age-adjusted incidence rates of spondylodiscitis (ICD-10: M46.2, M46.3, M46.4) in Germany spanning the years 2005 to 2021, distinctly represented for various age groups. Panel (A) utilizes a linear scale, making evident the absolute changes over the years, while Panel (B) employs a logarithmic scale, emphasizing the rate of change across age categories. The black dashed line in both panels symbolizes the cumulative incidence rate across all age groups, offering a consolidated view of the disease’s prevalence each year.

Figure 3

The depicted line chart illustrates the progression of diagnosed spondylodiscitis cases (ICD-10: M46.2, M46.3, M46.4) treated with surgical interventions between 2005 and 2021. The treatments are classified into three specific surgical categories: spinal fusion (OPS-2023: 5-836), vertebral body replacement (OPS-2023: 5-837), and complex spinal reconstruction (OPS-2023: 5-838). A prominent red dashed line signifies the cumulative total of these interventions, providing an encompassing view of the surgical treatment trends over the years.

Figure 4

Displayed is a line chart delineating the distinct types of patient discharges after being hospitalised for spondylodiscitis (ICD-10: M46.2, M46.3, M46.4) spanning the years 2005 through 2021. The types of discharges include those discharged against medical advice, transferred to rehabilitation or care homes/hospice, instances of death, regular discharges, and transfers to other medical institutions. This representation offers a comprehensive perspective on patient outcomes and trends for those diagnosed with spondylodiscitis over the 16-year period.