Spondylodiszitis

Zusammenfassung

Die Spondylodiszitis bezeichnet eine Infektion der Wirbelsäule, welche zuerst die Wirbelabschlussplatten betrifft („Spondylitis“) und sekundär auf die benachbarte Bandscheibe übergreift [1]. Die Spondylodiszitis ist eine potenziell lebensbedrohliche systemische Erkrankung, die einer raschen und nicht selten chirurgischen Behandlung bedarf. Die große Mehrheit der Spondylodiszitiden heilt jedoch unter konservativer Therapie aus.

Abstract

Spondylodiscitis is an infection of the spine that first affects the vertebral endplates (“spondylitis”) and then spreads to the adjacent intervertebral disc (“spondylodiscitis”). As it is a potentially life-threatening systemic disease rapid, often surgical treatment is required. Due to the multimorbidity of the patients and the complexity of the therapy, a multidisciplinary approach is essential. The vast majority of the cases heals under conservative therapy. An absolute indication for surgical therapy is given for acute septic courses or if there are new relevant neurological deficits. In addition, urgent surgical treatment is required for epidural abscesses that can be diagnosed by means of magnetic resonance imaging. In developed countries, over 90% of all spondylodiscitis cases come to a complete recovery.

Schlüsselwörter

Wirbelsäulenchirurgie - Bandscheibe - Abszesschirurgie - septischer Verlauf

Key words

Spine surgery - intervertebral disc - abscess surgery - septic course

• Literatur

• 1 Rudert M, Tillmann B. Lymph and blood supply of the human intervertebral disc. Acta Orthop Scand 1993; 64: 37-40
• 2 Stoltze D, Böhm H, Harms J. Operative Behandlung bei bakterieller Spondylitis und Spondylodiszitis. In: Rahmanzadeh R, Meißner A. Hrsg. Fortschritte in der Unfallchirurgie. Berlin, Heidelberg: Springer; 1992
• 3 Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother 2019; 65 (Suppl. 03) iii11-iii24
• 4 Lerner T, Hackenberg L, Rösler S. et al. Operative Therapie der unspezifischen und spezifischen Spondylodiszitis. Z Orthop Grenzgebiete 2005; 143: 204-212 doi:10.1055/s-2005-836455
• 5 Maeda Y, Izawa K, Nabeshima T. et al. Tuberculous spondylitis in elderly Japanese patients. J Orthop Sci 2008; 13: 16-20
• 6 Akbar M, Lehner B, Doustdar S. et al. Pyogene Spondylodiszitis der Brust- und Lendenwirbelsäule: Eine neue Klassifikation zur Entscheidungsfindung bei der Wahl der operativen Therapie. Orthopäde 2011; 40: 614-623
• 7 Skaf GS, Domloj NT, Fehlings MG. et al. Pyogenic spondylodiscitis: an overview. J Infect Public Health 2010; 3: 5-16
• 8 Zarghooni K, Rollinghoff M, Sobottke R. et al. Treatment of spondylodiscitis. Int Orthop 2012; 36: 405-411
• 9 Lehner B, Akbar M, Rehnitz C. et al. Standards der mikrobiologischen Diagnostik der Spondylodiszitis. Orthopäde 2012; 41: 702-710
• 10 Isenberg J, Jubel A, Hahn U. et al. Die mehrzeitige Spondylodese: Behandlungskonzept der destruierenden Spondylodiszitis bei kritisch reduziertem Allgemeinzustand. Orthopäde 2005; 34: 159-166
• 11 Klöckner C, Valencia R, Weber U. Die Einstellung des sagittalen Profils nach operativer Therapie der unspezifischen destruierenden Spondylodiszitis: ventrales oder ventrodorsales Vorgehen – Ein Ergebnisvergleich. Orthopäde 2001; 30: 965-976
• 12 Sur A, Tsang K, Brown M. et al. Management of adult spontaneous spondylodiscitis and its rising incidence. Ann R Coll Surg Engl 2015; 97: 451-455
• 13 Kehrer M, Pedersen C, Jensen TG. et al. Increasing incidence of pyogenic spondylodiscitis: a 14- year population-based study. J Infect 2014; 68: 313-320
• 14 Mylona E, Samarkos M, Kakalou E. et al. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum 2009; 39: 10-17
• 15 Nickerson EK, Sinha R. Vertebral osteomyelitis in adults: an update. Br Med Bull 2016; 117: 121-138
• 16 Sobottke R, Seifert H, Fatkenheuer G. et al. Current diagnosis and treatment of spondylodiscitis. Dtsch Arztebl Int 2008; 105: 181-187
• 17 Peronne C, Saba J, Behloul Z. et al. Pyogenic and tuberculous spondylodiskitis (vertebral osteomyelitis) in 80 adult patients. Clin Infect Dis 1994; 19: 746-750
• 18 Batson OV. The vertebral vein system. Caldwell lecture, 1956. Am J Roentgenol Radium Ther Nucl Med 1957; 78: 195212
• 19 Arko LT, Quach E, Nguyen V. et al. Medical and surgical management of spinal epidural abscess: a systematic review. Neurosurg Focus 2014; 37: E4
• 20 Turunc T, Demiroglu YZ, Uncu H. et al. A comparative analysis of tuberculous, brucellar and pyogenic spontaneous spondylodiscitis patients. J Infect 2007; 55: 158-163
• 21 Kumar K. A clinical study and classification of posterior spinal tuberculosis. Int Orthop 1985; 9: 147-152
• 22 Colmenero JD, Jimenez-Mejias ME, Sanchez-Lora FJ. et al. Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases. Ann Rheum Dis 1997; 56: 709-715
• 23 Digby JM, Kersley JB. Pyogenic non-tuberculous spinal infection. J Bone Joint Surg 1979; 61: 47-55
• 24 Krödel A, Stürz H. Differenzierte operative versus konservative Therapie der Spondylitis und Spondylodiscitis. Z Orthop 1989; 127: 587-596
• 25 Kemp HBS, Jackson JW, Jeremiah JD. et al. Pyogenic infections occuring primarily in intervertebral discs. J Bone Joint Surg Br 1973; 55: 698-714
• 26 Hsieh PC, Liu JC, Wang MY. Introduction: vertebral osteomyelitis and spinal epidural abscess. Neurosurg Focus 2014; 37: 1p preceding E1
• 27 Jeong DK, Lee HW, Kwon YM. Clinical value of procalcitonin in pa- tients with spinal infection. J Korean Neurosurg Soc 2015; 58: 271-275
• 28 Nolla JM, Ariza J, Gomez-Vaquero C. et al. Spontaneous pyogenic vertebral osteomyelitis in nondrug users. Semin Arthritis Rheum 2002; 31: 271-278
• 29 Nam KH, Song GS, Han IH. et al. Diagnostic value of biopsy techniques in lumbar spondylodiscitis: percutaneous needle biopsy and open biopsy. Korean J Spine 2011; 8: 267-271
• 30 Sheik AF, Khosvari AD, Goodarzi H. et al. Pathogen identification in suspected cases of pyogenic spondylodyscitis. Front Cell Infect Microbiol 2017; 7: 60-69
• 31 Delogu G, Zumbo A, Fadda G. Microbiological and immunological diagnosis of tuberculous spondylodiscitis. Eur Rev Med Pharmacol Sci 2012; 1 (Suppl. 02) 73-78
• 32 Valancius K, Hansen ES, Hoy K. et al. Failure modes in conservative and surgical management of infectious spondylodiscitis. Eur Spine J 2013; 22: 1837-1844
• 33 Ewald C, Gartemann J, Kuhn S A. et al. Operative Therapie der bakteriellen Spondylodiszitis: Eine retrospektive Untersuchung. Orthopäde 2009; 38: 248-255
• 34 Frangen TM, Kalicke T, Gottwald M. et al. Die operative Therapie der Spondylodiszitis. Eine Analyse von 78 Patienten. Unfallchirurg 2006; 109: 743-753
• 35 Tsai TT, Yang SC, Niu CC. et al. Early surgery with antibiotics treatment had better clinical outcomes than antibiotics treatment alone in patients with pyogenic spondylodiscitis: a retrospective cohort study. BMC Musculoskeletal Disorders 2017; 18: 175 doi:10.1186/s12891-017-1533-1
• 36 Bernard L, Dinh A, Ghout I. et al. Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial. Lancet 2015; 385(9971): 875-882
• 37 Roblot F, Besnier JM, Juhel L. et al. Optimal duration of antibiotic therapy in vertebral osteomyelitis. Semin Arthritis Rheum 2007; 36: 269-277 doi:10.1016/j.semarthrit.2006.09.004
• 38 Rangaarj G, Cleveland KO, Gelfand MS. Comparative analysis of daptomycin and vancomycinin the treatment of vertebral osteomyelitis. Infect Dis Clin Pract 2014; 22: 219-222
• 39 Berbari EF, Kanj SS, Kowalski TJ. et al. Executive summary: 2015 Infectious Diseases Society of America (IDSA) Clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adultspondylodiszitis. Clin Infect Dis 2015; 61: 859-863
• 40 Zimmerli W. Clinical practice. Vertebral osteomyelitis. N Engl J Med 2010; 362: 1022-1029 doi:10.1056/NEJMcp0910753
• 41 Eysel P, Hopf C, Vogel I. et al. Primary stable anterior instrumentation or dorsoventral spondylodesis in spondylodiscitis? Results of a comparative study. Eur Spine J 1997; 6: 152-157
• 42 Müller EJ, Russe OJ, Muhr G. Osteomyelitis der Wirbelsäule. Orthopäde 2004; 33: 305-315
• 43 Cramer J, Haase N, Behre I. et al. Spondylitis und Spondylodiszitis. Trauma Berufskrankh 2003; 5: 336-341
• 44 Dobran M, Iacoangeli M, Nasi D. et al. Posterior titanium screw fixation without debridement of infected tissue for the treatment of thoracolumbar spontaneous spondylodiscitis. Asian Spine J 2016; 10: 465-471
• 45 Hodgson AR, Stock FE. The classic: anterior spinal fusion: a preliminary communication on the radical treatment of Pottʼs disease and Pottʼs paraplegia. Clin Orthop Relat Res 2006; 444: 10-15
• 46 Kim YM, Choi SM. Posterior only approach for lumbar pyogenic spondylitis with short instrumentation and prolonged suction drainage. Spine 2016; 41: E1022-E1029
• 47 Lu ML, Niu CC, Tsai TT. et al. Transforaminal lumbar interbody debridement and fusion for the treatment of infective spondylodiscitis in the lumbar spine. Eur Spine J 2015; 24: 555-560
• 48 Ghobrial GM, Beygi S, Viereck MJ. et al. Timing in the surgical evacuation of spinal epidural abscesses. Neurosurg Focus 2014; 37: E1
• 49 Lee JS, Suh KT. Posterior lumbar interbody fusion with an autogenous iliac crest bone graft in the treatment of pyogenic spondylodiscitis. J Bone Joint Surg Br 2006; 88: 765-770
• 50 Linhardt O, Matussek J, Refior HJ. et al. Long-term results of ventro-dorsal versus ventral instrumentation fusion in the treatment of spondylitis. Int Orthop 2007; 31: 113-119
• 51 Si M, Yang ZP, Li ZF. et al. Anterior versus posterior fixation for the treatment of lumbar pyogenic vertebral osteomyelitis. Orthopedics 2013; 36: 831-836
• 52 Yilmaz C, Selek HY, Gurkan I. et al. Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg 1999; 81: 1261-1267
• 53 Shetty AP, Aiyer SN, Kanna RM. et al. Pyogenic lumbar spondylodiscitis treated with transforaminal lumbar interbody fusion: safety and outcomes. Int Orthop 2016; 40: 1163-1170
• 54 Dennis Hey HW, Nathaniel Ng LW. et al. Spinal implants can be inserted in patients with deep spine infection: results from a large cohort study. Spine 2017; 42: E490-E495
• 55 Wegner A, Hussmann B, Schmitz D. et al. Minimally invasive dorsal percutaneous spondylodesis in multimorbid patients with discitis. Eur Spine J 2012; 21: 2387
• 56 Lin TY, Tsai TT, Lu ML. et al. Comparison of two-stage open versus percutaneous pedicle screw fixation in treating pyogenic spondylodiscitis. BMC Musculoskelet Disord 2014; 15: 443 doi:10.1186/1471-2474-15-443
• 57 Fantoni M, Trecarichi EM, Rossi B. et al. Epidemiological and clinical features of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci 2012; 16: 2-7
• 58 Bettini N, Girardo M, Dema E. et al. Evaluation of conservative treatment of non specific spondylodiscitis. Eur Spine J 2009; 18: 143-150
• 59 Dupon M, Aegerter P, Mulleman D. Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial. Lancet 2015; 385(9971): 875-882
• 60 Hadjipavlou AG, Mader JT, Necessary JT. et al. Hematogenous pyogenic spinal infections and their surgical management. Spine 2000; 25: 1668-1679