[Therapy of Spondylodiscitis by Severity]

Area of Science:

• Spine surgery
• Infectious diseases
• Clinical pathway development

Background:

• Spondylodiscitis, a rare spinal infection, presents treatment challenges due to limited specific recommendations.
• Current management relies on immobilization and antibiotics, often with delayed diagnosis and treatment initiation.

Purpose of the Study:

• To optimize spondylodiscitis therapy through a novel classification system and electronically based clinical pathways.
• To establish severity-adapted treatment recommendations for improved patient care.

Main Methods:

• A classification system (SponDT) was developed, grading spondylodiscitis severity based on vertebral destruction and neurological status.
• Electronically based clinical pathways were implemented, incorporating severity-adapted surgical care, antibiotics, and physical therapy.
• Data from 296 patients treated between 1998 and 2013 were analyzed.

Main Results:

• Significant reduction in pain intensity (6.0 to 3.1 NRS) and C-reactive protein levels (119.2 to 46.7 mg/dl).
• Mean age of patients increased to 67.3 years, with 34.3% developing spontaneous spondylodiscitis.
• Time from admission to surgical treatment reduced to under 3 days, though time from symptom onset to surgery remained unchanged.

Conclusions:

• A severity-adapted clinical pathway, guided by the SponDT classification, effectively optimizes spondylodiscitis treatment.
• The electronic pathway facilitates timely and specific interventions, improving key clinical markers.
• This approach offers a structured framework for managing this complex spinal infection.