Management of Severe Pyogenic Spinal Infections: The 2SICK Study by the EANS Spine Section

• Published in: The spine journal 2024-12
• Main Authors: Kramer, Andreas, Thavarajasingam, Santhosh G., Neuhoff, Jonathan, Lange, Felipa, Ponniah, Hariharan Subbiah, Lener, Sara, Thomé, Claudius, Stengel, Felix C., Fischer, Gregor, Hostettler, Isabel C., Stienen, Martin N., Jemna, Maxim, Gousias, Konstantinos, Nedeljkovic, Aleksandra, Grujicic, Danica, Nedeljkovic, Zarko, Poluga, Jasmina, Schär, Ralph T., Urbanski, Wiktor, Sousa, Carla, Casimiro, Carlos Daniel Oliveira, Harmer, Helena, Ladisich, Barbara, Matt, Matthias, Simon, Matthias, Pai, Delin, Doenitz, Christian, Mongardi, Lorenzo, Lofrese, Giorgio, Buchta, Melanie, Grassner, Lukas, Trávníček, Pavel, Hosszú, Tomáš, Wissels, Maarten, Bamps, Sven, Hamouda, Waeel, Panico, Flavio, Garbossa, Diego, Barbato, Marcello, Barbarisi, Manlio, Pantel, Tobias, Gempt, Jens, Kasula, Tharaka Sai, Desai, Sohum, Vitowanu, Julius Mautin, Rovčanin, Bekir, Omerhodzic, Ibrahim, Demetriades, Andreas K., Davies, Benjamin, Shiban, Ehab, Ringel, Florian
• Format: Article
• Language: English
• Subjects: Conservative Stabilization; Mortality Rates; Pyogenic Spondylodiscitis; Severe Spinal Infection; Surgical Timing
• ISSN: 1529-9430; 1878-1632; 1878-1632
• DOI: 10.1016/j.spinee.2024.12.018

Spondylodiscitis management presents significant clinical challenges, particularly in critically ill patients, where the risks and benefits of surgical intervention must be carefully balanced. The optimal timing of surgery in this context remains a subject of debate. This study aims to evaluate the effectiveness of early surgery versus delayed surgery or conservative management in critically ill patients with de novo pyogenic spondylodiscitis. This is an international, multicenter retrospective cohort study involving 24 centers, primarily in Europe. The study included 192 critically ill patients (65.63% male) with a median age of 69 years, all severely affected by pyogenic spondylodiscitis characterized by an initial CRP level >200 mg/l or the presence of two out of four Systemic Inflammatory Response Syndrome criteria upon admission. The primary outcome was 30-day mortality. Secondary outcomes included length of ICU stay, length of hospital stay, and relapse rates of spondylodiscitis. Patients were divided into three groups: early surgery (within three days of admission), delayed surgery (after three days of admission), and conservative therapy. Propensity score matching and multivariate regression analyses were performed to adjust for baseline differences and assess the impact of treatment modalities on mortality and other clinical outcomes. Delayed surgery was associated with significantly lower 30-day mortality (4.05%) compared to early surgery (27.85%) and conservative therapy (27.78%) (p