Management of Patients with Spondylodiscitis: An Overview
European Journal of Molecular & Clinical Medicine,
2021, Volume 8, Issue 3, Pages 3023-3034
Abstract
Background:Spinal infections can be described etiologically as pyogenic, granulomatous (tuberculous, brucellar, fungal) and parasitic spondylodiscitis, a term encompassing vertebral osteomyelitis, spondylitis and discitis, which are considered different manifestations of the same pathological process; epidural abscess, which can be primary or secondary to spondylodiscitis and facet joint arthropathy.When infection affects the intervertebral disc, the term to describe this condition is usually spondylodiscitis. If invades the endplates or the vertebral body, the infection is more correctly designated for vertebral osteomyelitis or spondylitis. However, at the time of diagnosis in many cases, the infection has already compromised these two structures; therefore, both terms are frequently used.Conservative treatment is the standard of care for patients with spondylodiscitis, using multidisciplinary approaches involving microbiologists, infectious disease consultants, anaesthetists, intensivists and geriatricians, with public health physicians for contact tracing. The morbidity and mortality of patients with spondylodiscitis treated conservatively has fallen from 56% to 25% over the last 15 years.However, careful selection of patients who need surgical treatment is necessary. Surgical treatment is absolutely indicated in patients with spinal cord or cauda equina compression with progressive neurological deficits. Relative surgical indications include spinal instability due to extensive bone destruction, significant deformity or conservative treatment failure
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