Minimally invasive management of cervical spondylodiscitis. A multicenter experience

The urgent etiological diagnosis represents the main management objective of cervical spondylodiscitis (CSD) to start as soon as possible antibiotic treatment to prevent neurological deterioration. The present study aimed to evaluate a multicenter experience implementing a minimally invasive surgical approach (MISA) to manage CSD such pathology vs the most complex and aggressive surgical strategies currently used.This retrospective multicenter study used a database of 70 patients from five European neurosurgical centers. Patients with primary CSD underwent MISA via a limited funnel shaped cervical microdiscectomy with 4-mm anterior and 6-mm posterior longitudinal ligaments incision, PUS drainage, and extensive washing of the interbody and epidural space without fusion. Diagnosis was confirmed by clinical, imaging, laboratory, and perioperative histopathology and bacteriology.Of the 70 patients, 41 were men (58,5%), with an average age of 47.67 years. Severe neck pain affected 45 patients, while 51 had single-level cervical spondylodiscitis, 14 had double-level, and 5 had triple-level involvement. Staphylococcus aureus was identified in 49 cases. Each patient received a mean of three months of antibiotics. Inflammatory markers (C-reactive protein) were moderate for four weeks, then normalized by 8-12 weeks, except in one recurrence. After an average 48-month follow-up, all patients fully recovered without neurological deficit, spinal instability, or kyphotic deformity. Radiological exams confirmed bony fusion, with no recurrences of infection. MISA treatment offers a valuable, stable, and less invasive option for treating CSD, effectively identifying causative microorganisms and decompressing the spinal cord, leading to excellent patient outcomes.