Postoperative spondylodiscitis: Five-year, single-center retrospective analysis. Is it really postoperative?

Area of Science:

• Infectious Diseases
• Spinal Surgery
• Radiology

Background:

• Postoperative spondylodiscitis (POSD) is a significant complication following spinal surgery.
• The incidence of POSD ranges from 0.21% to 3.6%, necessitating effective diagnostic and treatment strategies.
• This study investigates the clinical presentation, diagnostic methods, and therapeutic outcomes for POSD.

Purpose of the Study:

• To analyze the clinical findings, diagnostic approaches, and treatment responses in patients with POSD.
• To evaluate the effectiveness of empirical antibiotic therapy and identify alternative causative agents when treatment fails.
• To determine the optimal treatment duration for different etiologies of POSD.

Main Methods:

• A retrospective study of 37 patients with POSD treated between September 2017 and October 2022.
• Data collected included symptoms, physical examination, contrast-enhanced spinal MRI, laboratory tests (CRP, PPD, QuantiFERON TB-Gold), and blood cultures.
• Treatment regimens, including empirical antibiotics and anti-tuberculosis therapy, were evaluated for clinical and radiological response.

Main Results:

• C-reactive protein (CRP) was the most significant laboratory marker for POSD diagnosis.
• Empirical treatment with teicoplanin and ciprofloxacin led to clinical and radiological improvement in 24 patients.
• Thirteen patients required a change in treatment to anti-tuberculosis therapy due to lack of response, achieving recovery with a mean treatment duration of 9.5 months, compared to 3.5 months for pyogenic POSD.

Conclusions:

• In refractory POSD cases, consider uncommon pathogens like Mycobacterium tuberculosis.
• Diagnostic challenges may necessitate a treatment-based approach to identify the causative agent.
• Prompt initiation of appropriate anti-tuberculosis therapy is crucial for patients with tuberculous POSD.