Key Predictors of Treatment Failure in Conservatively Managed Spondylodiscitis: A Long-Term Retrospective Cohort...

Area of Science:

• Spinal Surgery
• Infectious Diseases
• Radiology

Background:

• Conservative treatment for pyogenic spinal infections is common but often fails despite antibiotics.
• Treatment failure necessitates identifying predictive factors for better patient-specific management.

Purpose of the Study:

• To evaluate predictors of treatment failure in pyogenic spinal infections.
• To facilitate individualized therapy and improve treatment success rates.

Main Methods:

• Retrospective analysis of 245 patients (2012-2023) with pyogenic spinal infections.
• Assessment of medical data, comorbidities (Charlson Comorbidity Index - CCI), and radiological findings (CT/MRI).
• Analysis of treatment failure and readmission rates, comparing conservative vs. surgical groups.

Main Results:

• Treatment failure occurred in 40% of conservative cases versus 4% in surgical cases (p < 0.001).
• Progression of vertebral body lesions (average 32% destruction) correlated with treatment failure.
• Significant predictors of failure included advanced age (p=0.007), cervical discitis (p=0.018), and high CCI scores (p=0.001).

Conclusions:

• Age, cervical spine involvement, and high CCI scores are significant predictors of treatment failure in spinal infections.
• These factors are linked to increased bone destruction and osteolysis.
• Early surgical intervention may prevent complications like chronic pain and the need for complex revision surgeries.