Dorsolumbar Spinal infection: Surgery versus Conservative Treatment

Abstract

Background: The spinal infection is defined as infection accompanied by the destruction of the vertebral bodies, starting at the endplate with secondary involvement of the intervertebral disks. Patients with spinal infection experience back pain with or without fever. Aim of the Work: The aim of the current study was to compare the results for both surgical interference and conservative methods in managing dorsolumbar spinal infections. Patients and Methods: This was a prospective study that included 30 patients with dorsolumbar spinal infection. They were admitted and managed at the Neurosurgery Department, Al-Azhar University hospitals and Health Insurance hospitals through the period of 2015 to 2020. Result: The disease was more common in males. Patient age ranged from 29 to 65 years. Diabetes mellitus was the most common reported comorbidity. The most affected region was the thoracic region followed by the lumbar region. Diagnosis was established bacteriologically for 32%. The average erythrocyte sedimentation rate [ESR] in the first hour was 84.5 mm/hr, elevated in the second hour to 94mm/hr. C-reactive protein [CRP] level was greater than 10mg/L in all cases with an average of 55.8mg/L. All patients received more than 4 weeks of antibiotic therapy. The outcome was excellent to good outcome among 60% and 73.3%. Fair outcome was 13.3% and 20%, poor outcome, was 20% and 6.7%, and patients died was 6.7% and 0%, in conservative and surgical groups, respectively. Relapse developed in 10% of patients. Conclusion: ESR and CRP were very important in both diagnosis and follow-up [with CRP superior to ESR]. Surgery is superior than conservative treatment.

Keywords

• spinal infection
• vertebral osteomyelitis
• disk space infection
• spondylodiscitis
• epidural abscess