Operative and antibiotic treatment of cervical spondylodiscitis: a retrospective bicentric outcome analysis

Cervical spondylodiscitis is a rare but complex disease due to its potential for severe neurological impairments and post-infectious deformity. The reported mortality rate ranges from 5 to 10%. Radical surgical treatment is usually followed by antibiotic therapy. There is, however, no uniform treatment guideline. Implant choice, extent of fusion and duration of treatment vary across centers. The aim of this study is to analyze a decade of treatment of patients suffering from primary cervical spondylodiscitis to gain insights for improving existing treatment strategies.

This is a retrospective analysis of surgically treated patients suffering from cervical spondylodiscitis between January 2014 and December 2024 in two academic spine centers. Following ethical approval, pre- and postoperative imaging and clinical course were evaluated. Outcome analysis included assessment of implant complications, corrections of sagittal and coronal profiles, complication rates, length of hospital stay, neurological deficits, pain intensity, and 1-year survival. Clinical and radiological reassessments were performed at or shortly after completion of antibiotic therapy.

The study included 33 patients (52% males) with a median age at diagnosis of 68 years (IQR 59-76 years). The most common pathogen was staphylococcus aureus (39%). All patients underwent surgical debridement, predominantly by ventral decompression and fusion (90%). Following surgery, a significant number of patients showed an improvement in cervical radiculopathy and neck pain (n = 24/33, p < 0.0001). One patient required revision surgery due to screw misplacement during the same hospital stay. The average inpatient stay was 23 days (21 days), with 15 patients requiring postoperative treatment in the intensive care unit. Within a median clinical follow-up of three months there was radiological evidence of implant-loosening in five (15%) patients. Three (9%) patients died within one year because of sepsis, all of whom were older than 75 years and had significant comorbidities (ASA score > 3).

Our study supports the effectiveness of surgical treatment for cervical spondylodiscitis in short to medium-term outcome analysis, particularly through ventral decompression and fusion. The significant improvement in radiculopathy and pain reduction post-surgery underscores the treatment benefits. However, 1-year mortality is still high in geriatric patients with relevant comorbidities. Future studies should focus on long-term outcomes and complications to further optimize the treatment strategy for this dangerous condition.