DIAGNOSTIC AND TREATMENT OF SPINAL INFECTIONS IN SURGICALLY-

TREATED PATIENTS WITH SPONDILODISCITIS

Authors: Diana Plescan, Andrian Ciobanu, Sorin Cristea, Teodor Jipa, Alexandru Radulescu,
Georgiana Nedelea.

Department of Orthopaedic Surgery, Clinical Hospital of Orthopaedics and Traumatology “Foișor”, Bucharest,
Romania

INTRODUCTION

Spondilodiscitis is a pathology with an increase in incidence and a more and more complex
etiology. With the use of antibiotics on a large scale and the advances made in this field of
interest, the incidence of spinal infections has decreased nowadays.

These infections can affect patients of all ages, although most of them were older than 40
years. Most patients were of male gender, with a male/female ratio of 1,5.

The risk factors believed to have influence on the pathophysyology and epidemiology of
spondilodiscitis are elderly males, immunocompromising diseases and IV drug abuse [1] . The
anatomy and histology of the spinal elements are important in understanding the spinal
infections. The metaphyses with its rich arterial anastomosis and the cartilaginous end plates
are considered to be the starting points of spinal infection, when hematogenous spread is
involved [2] .

PURPOSE

The aim of this study is to analyze the infecting organisms and their sensitivity to antibiotics
in several infections of the spine in patients with early onset of neurological deficits.

MATERIAL AND METHODS

This study analyzes 124 cases of spondilodiscitis, treated between January 1, 2010 and
September 30, 2017 who had neurological deficits as a presenting complaint. The
neurological deficit was quantified using the Medical Research Council scale for peripheral
muscle strenght (5 - normal strenght, 4 - active movement against gravity and resistance, 3 -
weak contraction against gravity, 2 - active movement with gravity eliminated, 1 - minimal
contraction, 0 – complete paralysis) .

All cases were thoroughly examined, anteroposterior and lateral radiographs of the involved
area of the spine were acquired and magnetic resonance imaging was used to determine the
full extent of the spinal infection. Laboratory tests including c-reactive protein (CRP),
erythrocyte sedimentation rate (ESR), complete blood count (CBC) with white blood cell
(WBC) count and urine cultures were also used to assess all patients.

After being informed about the benefits and risks of the procedure, all patients signed an
informed consent. Because of the present neurological symptoms, every patient benefited
from surgery with pedicle screw fixation. During surgery, samples from the infected area were
taken for microbiological examination, in order to identify the etiological agent. Where
possible, the antibiotic therapy was avoided before certain identification of an organism.
Immediately following the biopsy of the infected area and in the first 48 hours from surgery,
patients received broad-spectrum antibiotic therapy. The antimicrobial treatment administered
afterwards was tailored according to the cultures that identified the infecting organisms and
their sensitivity to antibiotics. During hospitalization iv antibiotics were used, followed by
oral antibiotics for at least 6 weeks or until resolution.

RESULTS

One hundred and twenty-four patients including forty-nine women and seventy-five men,
with a mean age of 51.3 years, were included.

Most patients included were between 51-60 years and 61-70 years old.
Gender distribution

39.52% F
M
60.48%

Age distribution

12.10% 12.10%
11 – 20
4.84% 21 – 30
9.68% 31 – 40
23.39% 41 – 50
51 – 60
61 – 70
71- 80
14.52%
23.39%

The surgical indication was the presence of neurological deficit at the time of hospital
admission quantified using the Medical Research Council scale for peripheral muscle
strenght. Patients benefited from surgery with pedicle screw fixation. The samples used for
identifying the etiological agent were carefully examined with pathological confirmation.
 spp probe
Ethiological agents

Contaminated
sppspp
1

Salmonella
1

Acinetobacter
Staphylococcus
1

+ Pseudomonas
Bacilli/Mycobacterium-
3

-E.Coli
2
16

Mycobacterium
6

Coagulase
Mycobacterium
58
36

Rare
0 10 20 30 40 50 60 70

Over 50% of all cases were with Mycobacterium, strenghtening the idea that tuberculosis was
and remains the primary cause for spondilodiscitis. The second most frequently isolated
organism was coagulase + Staphylococcus, with more than ????(75%) resistant strains to
penicillin of the organism.

Less frequent was the Pseudomonas spp. and the Escherichia coli etiology. Rare cases
presented with Acinetobacter spp. and Salmonella spp.
1. A. Vaccaro, pg 212-213.

2. Campbell, pg 1965

3. textbook of operative spine surgery pg 1553