Early surgery may lower mortality in patients suffering from severe spinal infection
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ORIGINAL ARTICLE - INFECTION
Early surgery may lower mortality in patients suffering from severe spinal infection Sara Lener 1
&
Christoph Wipplinger 1 & Anna Stocsits 1 & Sebastian Hartmann 1 & Anja Hofer 1 & Claudius Thomé 1
Received: 20 March 2020 / Accepted: 20 July 2020 # The Author(s) 2020
Abstract Purpose Spinal infection (SI) is a life-threatening condition and treatment remains challenging. Numerous factors influence the outcome of SI and both conservative and operative care can be applied. As SI is associated with mortality rates between 2 and 20% even in developed countries, the purpose of the present study was to investigate the occurrence and causes of death in patients suffering from SI. Methods A retrospective analysis was performed on 197 patients, categorized into two groups according to their outcome: D (death) and S (survival). The diagnosis was based on clinical and imaging (MRI) findings. Data collected included demographics, clinical characteristics, comorbidities, infection parameters, treatment details, outcomes, and causes of death. Results The number of deaths was significantly higher in the conservative group (n = 9/51, 18%) compared with the operative counterpart (n = 8/146, 6%; p = 0.017). Death caused by septic multiorgan failure was the major cause of fatalities (n = 10/17, 59%) followed by death due to cardiopulmonary reasons (n = 4/17, 24%). The most frequent indication for conservative treatment in patients of group D included “highest perioperative risk” (n = 5/17, 29%). Conclusion We could demonstrate a significantly higher mortality rate in patients solely receiving conservative treatment. Mortality is associated with number and type of comorbidities, but also tends to be correlated with primarily acquired infection. As causes of death are predominantly associated with a septic patient state or progression of disease, our data may call for an earlier and more aggressive treatment. Nevertheless, prospective clinical trials will be mandatory to better understand the pathogenesis and course of spinal infection, and to develop high quality, evidence-based treatment recommendations. Keywords Spinal infection . Spondylodiscitis . Mortality . Infection . Morbidity
Background Spinal infection (SI) is a life-threatening condition and defined as an infectious disease affecting the spine and/or the paravertebral tissues [20]. SI may arise primarily by hematogenous spread, or secondarily as a result of spinal surgery or trauma [3, 29]. The incidence of SI has been increasing as a result of an aging population with serious comorbidities and the rising number of spinal interventions in the last few decades. Additionally, improved diagnostic capabilities have led This article is part of the Topical Collection on Infection * Sara Lener [email protected] 1
Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
to an earlier and more accurate diagnosis [6, 28]. To date, SI represents 2 to 7% of all musculoskeletal infections [27]. Early dia
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