J Korean Orthop Assoc.  2018 Aug;53(4):332-340. 10.4055/jkoa.2018.53.4.332.

Comparison of the Results between Conservative and Operative Treatments for Pyogenic Spondylitis

• Hong CH
• Lee S
• Kim WJ
• Soh J

• KMID: 2419469
• DOI: http://doi.org/10.4055/jkoa.2018.53.4.332

Abstract

PURPOSE
With advancements in antibiotics, the ability to treat pyogenic spondylitis is increasing. This study aimed to compare and analyze the outcomes between conservative and operative treatments.
MATERIALS AND METHODS
Sixty patients (28 males and 32 females) with pyogenic spondylitis, who were hospitalized and treated between February 2008 and June 2016, were enrolled. Patients were divided according to the following: type of treatment - conservative or operative treatment, method of surgery, radiographic parameters, location of the affected spine. Clinical parameters as durations of hospital stay, intravenous antibiotics use, normalization in laboratory findings, and residual symptoms were analyzed. For statistical evaluation, independent-sample t-test, Mann-Whitney U-test, Pearson's chi-square test, one-way ANOVA, and Spearman correlation analysis were performed retrospectively.
RESULTS
There was no significant difference in the duration of hospital stay, intravenous antibiotics use, normalization in laboratory findings, and residual symptoms between the conservative and operative treatment groups.
CONCLUSION
In treating pyogenic spondylitis, conservative treatment can be considered as the first choice, and operative treatment can be chosen in refractory cases.

Keyword

spine; pyogenic spondylitis; conservative treatment; operative treatment

MeSH Terms

Anti-Bacterial Agents
Humans
Length of Stay
Male
Methods
Retrospective Studies
Spine
Spondylitis*
Anti-Bacterial Agents

Figure

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  Figure 1 A 77-year-old female developed T8–9 pyogenic spondylitis. (A) Initial thoracic spine anteroposterior (AP) and lateral radiographs show severe disc space narrowing and end-plate destruction on T8–9. (B) Magnetic resonance imaging shows low-density signal changes in T8 and T9 in a T1-weighted image and enhancement in T8 and T9 along with inflammatory changes in the paraspinal soft tissue and epidural abscess. (C) Immediate postoperative thoracic spine AP and lateral radiographs. (D) Thoracic spine AP and lateral radiographs taken 12 months after operative treatment show no significant changes compared with the postoperative radiographs.

• 

  Figure 2 A 62-year-old female developed T10–11 pyogenic spondylitis. (A) Initial thoracolumbar spine anteroposterior (AP) and lateral radiographs show moderate disc space narrowing and end-plate destruction on T10–11. (B) Magnetic resonance imaging shows low-density signal changes in T10 and T11 in a T1-weighted image and enhancement in T10 and T11 with anterior epidural inflammatory thickening. (C) Thoracolumbar spine AP and lateral radiographs taken 12 months after conservative treatment demonstrate no significant changes compared with the initial radiographs.

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