Surgical Management of Spontaneous Pyogenic Spondylodiscitis: Clinical and Radiological Outcome

Background: Spontaneous Pyogenic Spondylodiscitis is a spectrum of diseases involving the bone, discs and or ligaments .It represents a challenge to spine surgeons due to the frequent serious sequelae resulting in acute neurological deterioration and require a combination of surgical and medical treatments. Objective: This is a prospective study analyzing the postoperative clinical and radiological outcome of nineteen patients with spontaneous pyogenic spondylodiscitis operated upon in the Neurosurgery Department, Cairo University Hospital. Patients and Methods: Patient selection: Nineteen patients with spontaneous pyogenic spondylodiscitis were operated upon and followed up clinically and radiologically for six months. Operation: surgical debridement in eight cases and debridement and stabilization with instrumentation in eleven patients. Results: Between Jan 2011 and December 2014, nineteen pa􀆟ents (mean age 43.8) with spontaneous pyogenic spondylodiscitis underwent surgical management .Back/neck pain (84.2% of patients), motor weakness (79% of patients) and fever (57.9%) were the most common symptoms on admission. Surgical debridement and instrumentation were performed in eleven patients (57.9%) while debridement was only done in eight patients 42.1%).Out of nineteen patients with spontaneous pyogenic spondylodiscitis, fitieen patients improved (79%),two patients (10.3%) remained stable, one patient (5.3%) worsened and one patient (5.3%)died. Outcomes were assessed as good outcome (Frankel D and E) in thirteen patients (68.4%) and poor outcome (Frankel A,B,C and dead patient) was encountered in six patients (31.6%). No recurrence or residual infection was encountered. Conclusion: Accurate diagnosis of spontaneous pyogenic spondylodiscitis patients and adequate surgical treatment with effective antibiotics in proper timing manner is critical for preventing severe neurological injury and decrease the rate of mortality.