Conservative or surgical treatment of pyogenic spinal infection. A retrospective multicenter binational retrospective cohort study
Rattachement africain : de, gb. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Introduction: The optimal treatment of patients with spinal infections remains a controversial topic. Within Europe, fundamentally different therapeutic concepts are found. Therefore, the aim of this study was to compare the outcome of patients who received surgical vs. antibiotic treatment alone for primary pyogenic spondylodiscitis in an international cohort analysis. Materials and Methods: The retrospectively compiled databases of tertiary high-volume spine centers served as the baseline for this study. All documented cases of primary spondylodiscitis treated surgically and conservatively in the period of 2017-2022 were included and grouped according to the therapeutic concept: conservative vs. surgical treatment. Independent investigators collected the relevant clinical and radiological data. The primary endpoint of this study was mortality rate; secondary endpoints were relapse rate and persisting neurological deficit. Results: A total of 392 patients were included in the analysis (155 females with a mean age of 68 years). Of these, 95 cases were treated conservatively (CoT) and 297 cases were treated surgically (SuT). There was no significant difference (p<0.01) related to patient’s disease characteristics: Lumbar was the main location (n=240, CoT 58/ SuT 182, p=0.97) followed by thoracic (n=70, CoT 24/ SuT 46, p=0,03) and cervical (n=47, CoT 7/ SuT 40, p=0.11) region. A multilocular spinal infection was present in 32 patients (CoT 3/ SuT 29, p=0.04). 181 cases (CoT 36/ SuT 145, p=0.06) presented with an epidural abscess. Neurological deficits were recorded in 100 cases (CoT 26/ SuT 74, p=0.63), and septic conditions in 88 cases (CoT 26/ SuT 62, p=0.19). Pre-existing conditions like Diabetes (p=0.57), renal failure (p= 0.97), hepatopathy (p= 0.15), malignoma (p=0.39) or i.v. drug abuse (p=0.93) did also not differ between the groups. The mortality rate of all conservatively treated was 24.2% (23 cases) and 6.7% (20 cases) in all surgically treated patients (p<0.001). A follow-up of ≥ 6 weeks was available in 289 cases (CoT 83, SuT 206 ). In this subset of patients relapse of infection occurred in six (7.2%) and 23 (11.2%) cases in the conservative and early surgical treatment group, respectively (p=0.69). Persisting neurological deficit was recorded in 21 (25.3%) of conservatively treated and 51 (24.8%) of surgically treated cases (p=0.92). Conclusion: Whereas relapse rates and persisting neurological deficit were not found to differ significantly, the results of this international data analyses, with their respective limitations, clearly support the growing evidence of a significantly reduced mortality rate after surgical therapy for primary pyogenic spondylodiscitis when compared to conservative treatment regimen.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Conservative or surgical treatment of pyogenic spinal infection. A retrospective multicenter binational retrospective cohort study
- Date Crossref
- 01/01/2023
- Éditeur
- Elsevier BV
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
-
Berufsgenossenschaftliche Unfallklinik Frankfurt am Main pays non établi dans la noticeÉtablissement de santé
-
Johannes Gutenberg University Mainz pays non établi dans la noticeUniversité ou école supérieure
-
TUM Klinikum pays non établi dans la noticeÉtablissement de santé
-
University of Cambridge Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
-
Technical University of Munich Klinikum rechts der Isar pays non établi dans la noticeUniversité ou école supérieure
-
University Hospital Augsburg Neurosurgery pays non établi dans la noticeÉtablissement de santé
-
NHS Lothian pays non établi dans la noticeÉtablissement de santé
-
Center for Spinal Surgery and Neurotraumatology pays non établi dans la noticeInstitution
-
Johannes Gutenberg University of Mainz Department of Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
-
Department of Neurosurgery pays non établi dans la noticeInstitution
-
Division of Clinical Neurosciences Department of Neurosurgery pays non établi dans la noticeÉtablissement de santé
Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Johannes Gutenberg University Mainz et TUM Klinikum, avec 8 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.