Surgical Treatment of Pyogenic Spondylodiscitis: Is Intradiscal Debridement Necessary?

Study DesignRetrospective Cohort Study.ObjectivesTo investigate the role of intradiscal debridement and fusion in the surgical treatment of pyogenic spondylodiscitis.MethodsPertinent clinical and imaging data were retrospectively analyzed for 147 consecutive patients who underwent surgery for primary pyogenic spondylodiscitis with (DF) vs. without discectomy/fusion (noDF) between 2016 and 2023.Results84/129 (65.1%) patients with mono-site infections (cervical: 21, thoracic: 38, lumbosacral: 70) underwent DF surgery, whereas 45 (34.9%) had noDF surgery. DF and noDF patients did not differ significantly with respect to age, sex, septic presentation, ASA score, admission KPS and MRC grade, or paravertebral abscess. DF patients had a higher incidence of epidural empyema (p = 0.005), and DF surgery was more often performed in cases with severe vertebral body destruction and for non-thoracic spondylodiscitis (statistical trends only). (Antibiotic) treatment duration, hospital stay, mortality, and complication rates did not differ significantly between the DF and noDF groups. 18 patients had multi-site infections. Treatment duration, complication rates, and outcomes did not vary with the surgical strategy. Complications requiring revision surgery occurred in 19.7% of patients. CTCAE grade ≥3 medical complications were seen in 19.0%. There were 9 (6.1%) in-hospital deaths, and 3-month mortality was 15/140 (10.7%).ConclusionsTreatment duration, outcomes and complication rates did not vary significantly between DF and noDF patients, while the respective patient cohorts were relatively well balanced with respect to many clinical characteristics. These data suggest that surgery without routine intradiscal debridement may be a reasonable option in carefully selected patients with spondylodiscitis.