Abstract
Introduction
Because it typically afflicts older patients with poorer health and/or risk factors, spondylodiscitis can become life threatening. Lingering symptoms, which can be attributed to residual destruction as well as concurrent degenerative changes in the adjacent segments after inflammation has subsided, are frequently present after both conservative and operative therapies. Here, quality of life outcomes are presented for patients two years after operative and conservative treatment.
Methods
82 patients with spondylodiscitis were included prospectively from 01/2008. 28% of patients were treated conservatively (Group 1) and 72% operatively (Group 2). Clinical findings, SF-36, ODI, COMI, and a visual analog scale (VAS) were evaluated and compared between the groups at admission and follow-up (2 year FU).
Results
Average patient age was 64.9 ± 6.3 years. Average inpatient hospital stay was 26.5 ± 16.9 days. Neurologic deficits were present in 39.0% of patients preoperatively and 18.3% at FU. Abscess formation was diagnosed in 89.0% of cases and intraspinal abscesses in 43.9%. Hospital mortality was 11.0% and total mortality 14.6% at FU. 6.1% of cases were lost to FU. The preoperative ODI scores averaged 75.4 ± 16.6, and did not vary significantly between the groups. At FU, with 33.9 ± 21.2, average score was significantly better (p<0.001). On the SF-36, preoperative average scores were PCS 25.7 ± 7.1 and MCS 37.3 ± 13.4, and at FU PCS 43.5 ± 10.1 (p<0.05) and MCS 47.7 ± 14.8 (p<0.05). COMI scores also showed significant (p<0.001) improvement (preoperatively 9.2 ± 1.0 and at FU 3.5 ± 2.2). On comparison, patients in Group 2 (VAS 8.3) preoperatively had more pain (p<0.05) than those in Group 1 (VAS 6.3), but there was no significant difference at FU (group 2 VAS 2.5 and group 1 VAS 3.0). Over 90% of operated patients reported that treatment helped, while over 30% of conservatively treated patients said that treatment helped a little or not at all.
Discussion
In the pre-antibiotics era, the prognosis for spondylodiscitis was poor. Currently, it can still lead to serious health problems and become life threatening. Quality of life and physical limitations are markedly worse than for the general population. Compared to patients treated conservatively, patients treated with surgery have somewhat improved quality of life and significantly better patient satisfaction.
