Outcome following surgical treatment of pyogenic spondylodiscitis

Background: Pyogenic spondylodiscitis (PS) is a rare and life-threatening condition. Traditional treatment is surgical debridement followed by antibiotic therapy. Objective: To investigate risk factors, bacteriological features, treatment methods and clinical, laboratory, and radiological findings and surgical outcomes in patients with PS. Material and Method: Twenty-one patients who underwent treatment for PS at Siriraj Hospital during the January 2012 to October 2015 study period were included. All patients received surgical debridement followed by antibiotic therapy. Results: Five patients had complete cord PS. Infection was found in the following spinal regions: cervical (12), thoracic (2), lumbar (4), and multiple regions (3). The most common presenting symptom was spinal pain. All patients had elevated ESR and CRP. The most common isolated bacterium was Staphylococcus spp. Clinical improvement after surgical debridement was observed in all patients, except in two who died because of other complications. Conclusion: There should be a high index of clinical suspicion for PS in patients who have increased inflammatory markers in the blood and local tenderness or pain in the spinal region. In cases with severe neurological deficit, surgical debridement followed by antibiotic therapy is the most effective treatment.