gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

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Spondylodiscitis by multiresistent bacteria – a single center experience of 15 cases

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  • E. Shiban - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • I. Janssen - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • M. Stoffel - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • B. Meyer - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • F. Ringel - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.08.07

doi: 10.3205/12dgnc073, urn:nbn:de:0183-12dgnc0733

Published: June 4, 2012

© 2012 Shiban et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The treatment of spondylodiscitis is still a controversially discussed issue. To date there are no guidelines for surgical treatment and treatment strategies of pyogenic spinal infections with multiresistant bacteria.

Methods: We performed a retrospective review of patients presenting with spondylodiscitis due to multiresistant bacteria between 2006 and 2010.

Results: 15 patients were found (13 MRSA, 2 ESBL). The mean age at presentation was 63 year, 10 patients were male (69%). All patients presented with pain. Neurological deficit was found in 6 (40%) cases. Epidural abscess was found in 6 (40%) cases. Mean duration of hospital stay was 30 ± 13 days. Distribution of the inflammation: lumbar in 6 (40%), thoracic in 4 (27%) and cervical in 3 (20%) cases. Two patients (13%) had two concomitant non-contiguous spondylodiscitis in different segments of the spine. C-reactive protein was elevated in all cases with a mean of 10.3 ± 7.7 mg/dl. Leukocyte count was elevated in 6 (46%) cases. The main source of inflammation was previous spine surgery (53%). All patients in this series underwent surgical debridement with instrumentation of the spine. Postoperative intravenous antibiotics were administered for 19 ± 8 days followed by 3.1 ± 0.3 months of oral antibiotics. At three months complete healing of the inflammation was achieved in 14 (93%) of cases. One patient had a relapse of the inflammation following dorsal instrumentation, only. This was followed by an anterior debridement and interbody fusion upon relapse. Out of the 6 patients with neurological deficit, two had full recovery and two had improved incompletely after surgery.

Conclusions: Staged surgical immobilisation and instrumentation and debridement within the disc space is a reliable approach to achieve complete healing of spinal inflammation with multiresistant bacteria. Even with multiresistent bacteria, a relatively short period of intravenous antibiotics of 3 weeks is followed by a 3 months of oral antibiotics is appropriate in most cases.