Pola E, et al. - Researchers wanted to define the clinical features of pyogenic spondylodiscitis (PS) and assess the prognostic factors and long-term outcomes. For successful treatment, the microbiological diagnosis was the main predictive factor. In order to identify underlying aggressive conditions and to avoid neurological complications linked to poorer long-term outcomes, early diagnosis and multidisciplinary management are needed. PS could lead to major disabilities, regardless of high healing rates, which remain a difficult challenge.

Methods

• Authors enrolled 207 cases of PS treated from 2008 to 2016 with a 2-year follow-up.
• The rate of healing without residual disability was the primary outcome.
• The length of stay, healing from infection, death, relapse, and residual disability were the secondary outcomes.
• Prognostic factors were evaluated via binomial logistic regression and multivariate analysis were used.

Results

• The rate of onset neurological impairment was 23.6% and 30 days was the median diagnostic delay.
• As per data, microbiological diagnosis was established in 155 patients (74.3%) and the median length of total antibiotic therapy was 148 days.
• For 124 patients, orthopedic treatment was conservative and for 47 cases it was surgical.
• Ultimately 142 patients (77.6%) achieved complete healing without disability.
• Negative microbiological culture, neurologic impairment at diagnosis and underlying endocarditis (p ≤ 0.05) were statistically confirmed negative prognostic factors.
• Authors noted 90.9% healed from infection, while residual disabilities were seen in 23.5%.
• They found the observed mortality rate to be 7.8%.