Article Figures & Data
Figures
- Figure 1
Bar graph illustrating the rate of reoperation among 47 patients undergoing surgical intervention for spondylodiscitis with spinal epidural abscess between 2011 and 2018. The reoperation rate was significantly higher in patients who underwent decompression alone as an index operation compared with those who underwent decompression and fusion (51.9% vs 10%, P = 0.004).
- Figure 2.
(A) Sagittal magnetic resonance imaging with contrast of the thoracic spine in a patient who presented with upper thoracic back pain showing discitis-osteomyelitis at T4-5. (B) Sagittal and axial postoperative computed tomography images showing a left-sided T4-5 hemilaminectomy, which was the initial surgical treatment for this patient. (C) Sagittal x-ray images showing the patient’s reoperation, having underwent a T4-5 redo laminectomy and a T2-7 posterior fusion after the patient presented with persistent mechanical back pain, especially with axial loading.
Tables
Total
(n = 47)Decompression Alone
(n = 27)Decompression + Fusion
(n = 20)P Value Mean age, y 59.5 60.3 58.5 0.52 Male, % (n) 68.1% (32) 81.5% (22) 50% (10) 0.03 Presumed source of infection, % (n) Urinary tract 4.3% (2) 7.4% (2) 0% (0) 0.50 Skin and subcutaneous tissues 21.3% (10) 25.9% (7) 15% (3) 0.48 Infected vascular access 2.1% (1) 3.7% (1) 0% (0) 1 Pneumonia 6.4% (3) 0% (0) 15% (3) 0.07 Septic joint 6.4% (3) 3.7% (1) 10% (2) 0.57 Postoperative infection 4.3% (2) 3.7% (1) 5% (1) 1 IVDU 4.3% (2) 0% (0) 10% (2) 0.18 Unknown 51.1% (24) 55.6% (15) 45% (9) 0.56 Underlying illness/conditions, % (n) Diabetes mellitus 42.6% (20) 44.4% (12) 40% (8) 1 Hypertension 68.1% (32) 70.4% (19) 65% (13) 0.76 Hyperlipidemia 8.5% (4) 11.1% (3) 5% (1) 0.63 Immunosuppression 4.3% (2) 7.4% (2) 0% (0) 0.50 ESRD/CKD 19.1% (9) 18.5% (5) 20% (4) 1 Coronary artery disease 21.3% (10) 29.6% (8) 10% (2) 0.15 Atrial fibrillation 14.9% (7) 14.8% (4) 15% (3) 1 Congestive heart failure 12.8% (6) 7.4% (2) 20% (4) 0.38 Liver disease 6.4% (3) 3.7% (1) 10% (2) 0.57 COPD 4.3% (2) 3.7% (1) 5% (1) 1 Peripheral vascular disease 6.4% (3) 7.4% (2) 5% (1) 1 Malignancy 8.5% (4) 3.7% (1) 15% (3) 0.30 IVDU 8.5% (4) 7.4% (2) 10% (2) 1 Hepatitis B/C 6.4% (3) 7.4% (2) 5% (1) 1 Obesity 6.4% (3) 7.4% (2) 5% (1) 1 Rheumatic disease 6.4% (3) 7.4% (2) 5% (1) 1 Clinical data, % (n) Back pain 68.1% (32) 81.5% (22) 50% (10) 0.03 Neck pain 17% (8) 0% (0) 40% (8) 0.0004 Radicular pain 17% (8) 22.2% (6) 10% (2) 0.44 Neurologic deficit 34% (16) 37% (10) 30% (6) 0.76 Involvement levels, % (n) ≥3 Vertebral bodies 42.6% (20) 51.9% (14) 30% (6) 0.15 Epidural involvement 48.9% (23) 44.4% (12) 55% (11) 0.56 Cervical spine only 6.4% (3) 0% (0) 15% (3) 0.07 Thoracic spine only 31.9% (15) 29.6% (8) 35% (7) 0.76 Lumbar spine only 23.4% (11) 25.9% (7) 20% (4) 0.74 Cervicothoracic spine 10.6% (5) 3.7% (1) 20% (4) 0.15 Thoracolumbar spine 12.8% (6) 18.5% (5) 5% (1) 0.22 Lumbosacral spine 14.9% (7) 22.2% (6) 5% (1) 0.22 Bacterial pathogen isolated, % (n) MSSA 34% (16) 33.3% (9) 35% (7) 1 MRSA 19.1% (9) 18.5% (5) 20% (4) 1 Unknown 12.8% (6) 14.8% (4) 10% (2) 1 Group B streptococcus 8.5% (4) 11.1% (3) 5% (1) 0.63 Mycobacterium avium 6.4% (3) 7.4% (2) 5% (1) 1 Alpha streptococcus 4.6% (2) 3.7% (1) 5% (1) 1 Enterococcus faecalis 2.1% (1) 3.7% (1) 0% (0) 1 Escherichia coli 2.1% (1) 3.7% (1) 0% (0) 1 Coagulase-negative staphylococcus 2.1% (1) 3.7% (1) 0% (0) 1 Staphylococcus lugdunensis 2.1% (1) 3.7% (1) 0% (0) 1 Propionibacterium acnes 2.1% (1) 0% (0) 5% (1) 1 Enterobacter 2.1% (1) 0% (0) 5% (1) 1 Nocardia 2.1% (1) 0% (0) 5% (1) 1 Klebsiella pneumoniae 2.1% (1) 0% (0) 5% (1) 1 Mean length of intravenous antibiotic therapy, wk 6.7 6.7 6.7 1 CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; ESRD, end-stage renal disease; IVDU, intravenous drug use; MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-sensitive Staphylococcus aureus.
Total Patients
(n = 47)Decompression Alone Cohort (n = 27) Decompression + Fusion Cohort (n = 20) P Value Mean radiographic follow-up, mo 17.9 19.7 15.3 0.83 Reoperations, % (n) ≥1 Reoperation 34.0% (16) 51.9% (14) 10% (2) 0.004 2 Reoperations 12.8% (6) 18.5% (5) 5% (1) 0.22 Indications for initial reoperation, % (n) Axial pain 27.7% (13) 78.6% (11) 10% (2) 0.025 Progressive deformity 14.9% (7) 50% (7) 0% (0) 0.015 Neurological decline 6.4% (3) 21.4% (3) 0% (0) 0.25 Recurrence of deep infection 8.5% (4) 21.4% (3) 5% (1) 0.63 Hardware failure 4.3% (2) 0% (0) 10% (2) 0.18 Goals of initial reoperation, % (n) Further decompression 6.4% (3) 7.4% (3) 0% (0) 0.25 Fusion 14.3% (7) 29.6% (7) 0% (0) 0.015 Further decompression + fusion 8.5% (4) 14.8% (4) 0% (0) 0.13 Debridement of recurrent infection 0% (0) 0% (0) 5% (1) 0.46 Revision of hardware 4.3% (2) 0% (0) 10% (2) 0.18 Indications for second reoperation, % (n) Axial pain 8.5% (4) 14.8% (4) 0% (0) 0.13 Progressive deformity 4.3% (2) 7.4% (2) 0% (0) 0.5 Recurrence of deep infection 6.4% (3) 7.4% (2) 5% (1) 1 Pseudarthrosis 2.1% (1) 3.7% (1) 0% (0) 1 Hardware failure 2.1% (1) 3.7% (1) 0% (0) 1 Goals of second reoperation, % (n) Further decompression 0% (0) 0% (0) 0% (0) 1 Fusion 6.4% (3) 11.1% (3) 0% (0) 0.25 Further decompression + fusion 0% (0) 0% (0) 0% (0) 1 Debridement of recurrent infection 6.4% (3) 7.4% (2) 5% (1) 1 Revision of hardware 0% (0) 0% (0) 0% (0) 1 Total Patients
(n = 47)Decompression Alone Cohort (n = 27) Decompression + Fusion Cohort (n = 20) P Value Clinical outcomes, % (n) Neurologic exam at latest follow-up Improved 53.2% (25) 59.3% (16) 45% (9) 0.39 Stable 36.2% (17) 29.6% (8) 45% (9) 0.36 Worse 10.6% (5) 11.1% (3) 10% (2) 1 Posthospital disposition Discharged home 36.1% (17) 37% (10) 35% (7) 1 Skilled nursing facility 27.7% (13) 18.5% (5) 40% (8) 0.19 Rehabilitation 17% (8) 22.2% (6) 10% (2) 0.44 Long-term acute care facility 19.1% (9) 22.2% (6) 15% (3) 0.71 Length of stay, d 14.9 13.5 16.7 0.13 30-day Readmission 14.9% (7) 7.4% (2) 25% (5) 0.12 Complications, % (n) Operative complications Total 12.8% (6) 11.1% (3) 15% (3) 1 Durotomy 2.1% (1) 3.7% (1) 0% (0) 1 Wound dehiscence requiring take back 2.1% (1) 3.7% (1) 0% (0) 1 Wound infection requiring take back 2.1% (1) 0% (0) 5% (1) 0.43 Superficial wound dehiscence 2.1% (1) 3.7% (1) 0% (0) 1 Postoperative seroma 2.1% (1) 0% (0) 5% (1) 0.43 Brachial plexopathy 2.1% (1) 0% (0) 5% (1) 0.43 Medical complications Total 12.8% (6) 7.4% (2) 20% (4) 0.38 Deep vein thrombosis 4.3% (2) 7.4% (2) 0% (0) 0.50 Metabolic encephalopathy 2.1% (1) 0% (0) 5% (1) 0.43 Pneumonia 2.1% (1) 0% (0) 5% (1) 0.43 Respiratory failure 2.1% (1) 0% (0) 5% (1) 0.43 Urinary tract infection 2.1% (1) 0% (0) 5% (1) 0.43
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