Risk Factor Analysis of Simple Drainage Followed by Instrumented Fusion in Patients with Pyogenic Spinal Infection

The first-line treatment for pyogenic spondylitis is conservative management with immobilization and systemic antibiotic therapy. However, in cases where conservative treatment fails or neurological deficits and spinal instability are present, surgical intervention is required. Surgical treatment helps manage spondylitis by decompressing neural structures through abscess drainage and maintaining spinal stability. It includes simple decompression via abscess removal, debridement of inflamed and necrotic tissues, and reconstruction with fixation. This study aims to analyze the risk factors associated with clinical outcomes in patients undergoing simple drainage followed by instrumented fusion.

We retrospectively evaluated patients who underwent surgical treatment with intravenous antibiotics for pyogenic spondylitis at our hospital between March 2010 and November 2021. We categorized the study group into a group that underwent simple decompression and drainage and a group that was followed up until fusion. We compared the basic demographics, laboratory data, and radiological findings between the two groups.

Overall, 88 patients (50 males and 38 females) with a mean age of 63.8 years were included in this study. Of the 88 patients, 71 underwent simple abscess drainage and 17 underwent instrumented fusion. In the univariate logistic regression analysis based on demographic data, longer duration of antibiotic use (p=0.021), body signal change (p=0.001), facet inflammation (p=0.003), disc abscess (p<0.001), psoas abscess (p=0.003), disc space bone erosion (p=0.006), and hypertension (p=0.024) were significant risk factors for necessitation of fusion surgery after decompression and drainage surgery. Multivariate logistic regression analysis based on these risk factors revealed that the longer the period of total antibiotic use after decompression and drainage (p=0.019), the higher the risk of fusion surgery, as well as a higher risk of body signal change.

When planning surgical treatment for pyogenic spondylitis, close observation is required because the necessity for instrumented fusion surgery increases when antibiotic use is prolonged or body signal changes are confirmed on magnetic resonance imaging.