Abstract
Aim
We report our ten year experience of primary haematogenous non-tuberculous spinal infection.
Method
Retrospective case note review of 42 patients presented to our institution with primary spinal infection during 1995-2005 was carried out. Demographic data, timing and modes of presentation, investigations, and methods of treatment were analysed. The cost benefit of Home Intravenous Antibiotics Service (HIAS) was also investigated.
Results
Mean age was 59.9 years (1-85) with almost equal gender distribution (M 20: F 22). Axial pain was universal. Pyrexia was seen in 62% and major neurological deficit in 10% of cases.
Time from presentation to diagnosis averaged 19 days (range 0-172). Sensitivity for MRI and plain x-ray was 100% and 46% respectively. Blood culture was as sensitive as percutaneous biopsy in patients with pyrexia. Staphylococcus Aureus was the most common organism. Treatment ranged from intravenous antibiotics alone to combined anterior and posterior surgery depending on the presence or absence of significant abscess collection, neurological deficit and structural threat. Mean duration of intravenous antibiotics was 54 days (range 13-240). At mean follow up of 5.4 years (0.6-10.5) there was no mortality directly related to the infection. Recurrence rate was 14%. Significant past medical history (p=0.001), constitutional symptoms (p=0.001) and pyrexia at presentation (p=0.001) and possible male gender (p=0.01) were positively associated with recurrence. Although firm conclusions can not be drawn due to sample size, duration of symptoms (p=0.27) did not appear to affect the risk of recurrence.
When inpatient days were subtracted from days on IV antibiotics for all the patients, HIAS was found to have saved a total of 940 inpatient days.
Conclusion
In spinal infection, disease and patient characteristics dictate the management strategy. Longer antibiotic therapy in patients with positive risk factors for recurrence may be indicated. Finally, HIAS was cost effective in this group of patients.
