Evaluation of spinal deformity and its progression in pyogenic spondylodiscitis: A retrospective MRI study of 59 cases
Introduction: Pyogenic spondylodiscitis management often remains conservative without surgical intervention, yet the risk of spinal deformity under such therapy is unclear. Research question: This study explores spinal deformity progression in conservatively treated patients and identifies predictiv...
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Elsevier
2025-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529425000232 |
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| author | Andreas Kramer Jonathan Neuhoff Santhosh G. Thavarajasingam Rebecca Sutherland Hugh McCaughan Benjamin Davies Ehab Shiban Florian Ringel Andreas K. Demetriades |
| author_facet | Andreas Kramer Jonathan Neuhoff Santhosh G. Thavarajasingam Rebecca Sutherland Hugh McCaughan Benjamin Davies Ehab Shiban Florian Ringel Andreas K. Demetriades |
| author_sort | Andreas Kramer |
| collection | DOAJ |
| description | Introduction: Pyogenic spondylodiscitis management often remains conservative without surgical intervention, yet the risk of spinal deformity under such therapy is unclear. Research question: This study explores spinal deformity progression in conservatively treated patients and identifies predictive factors for deformity advancement. Material and methods: Retrospective cohort design with radiological data analysis from 59 patients with conservatively treated pyogenic spondylodiscitis. Deformities were categorized into four progression types reflecting severity: Type 1 (progressive vertebral body edema/endplate erosion), Type 2 (Type 1 plus disc space collapse), Type 3 (vertebral body destruction/mild translation), and Type 4 (significant segmental kyphosis >20°/severe translation). Results: Among 59 patients, 66% exhibited progressive deformity over a mean follow-up of 10.75 months. The distribution of deformity progression was: Type 1 in two cases (3%), Type 2 in seven cases (12%), Type 3 in 13 cases (22%), and Type 4 in 17 cases (29%). Progression of deformity included a 92% increase in cases with segmental kyphosis >20°; and a 167% increase in cases with segmental translation. Risk factors for significant kyphosis included >50% vertebral body erosive destruction (p < 0.01) and the presence of an epidural abscess (p < 0.05). Lumbar region involvement significantly reduced the likelihood of spinal fusion at follow-up (p < 0.05). A paravertebral abscess was significantly associated with the presence of a fractured vertebrae at follow-up (p < 0.05). Discussion and conclusion: This study underscores the importance of closely monitoring patients with conservatively managed pyogenic spondylodiscitis for progressive spinal deformity, and suggests considering early surgical intervention in cases with a high risk of progression. |
| format | Article |
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| institution | Kabale University |
| issn | 2772-5294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| series | Brain and Spine |
| spelling | doaj-art-3399bdb0ed7a4f87b16be540a6a9ab6f2025-02-09T05:01:43ZengElsevierBrain and Spine2772-52942025-01-015104204Evaluation of spinal deformity and its progression in pyogenic spondylodiscitis: A retrospective MRI study of 59 casesAndreas Kramer0Jonathan Neuhoff1Santhosh G. Thavarajasingam2Rebecca Sutherland3Hugh McCaughan4Benjamin Davies5Ehab Shiban6Florian Ringel7Andreas K. Demetriades8Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany; Department of Neurosurgery, LMU University Hospital, LMU Munich, Germany; Corresponding author. Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.Center for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, GermanyDepartment of Neurosurgery, University Medical Center Mainz, Mainz, Germany; Department of Neurosurgery, LMU University Hospital, LMU Munich, Germany; Imperial Brain & Spine Initiative, Imperial College London, London, United KingdomDepartment of Infectious Diseases, Western General Hospital, Edinburgh, United KingdomDepartment of Infectious Diseases, Western General Hospital, Edinburgh, United KingdomDepartment of Academic Neurosurgery, Addenbroke's Hospital, Cambridge University Hospital NHS Healthcare Trust, Cambridge, United KingdomDepartment of Neurosurgery, University Hospital of Lausitz, Cottbus, GermanyDepartment of Neurosurgery, University Medical Center Mainz, Mainz, Germany; Department of Neurosurgery, LMU University Hospital, LMU Munich, GermanyEdinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Division of Clinical Neurosciences, NHS Lothian, Edinburgh University Hospitals, Edinburgh, United KingdomIntroduction: Pyogenic spondylodiscitis management often remains conservative without surgical intervention, yet the risk of spinal deformity under such therapy is unclear. Research question: This study explores spinal deformity progression in conservatively treated patients and identifies predictive factors for deformity advancement. Material and methods: Retrospective cohort design with radiological data analysis from 59 patients with conservatively treated pyogenic spondylodiscitis. Deformities were categorized into four progression types reflecting severity: Type 1 (progressive vertebral body edema/endplate erosion), Type 2 (Type 1 plus disc space collapse), Type 3 (vertebral body destruction/mild translation), and Type 4 (significant segmental kyphosis >20°/severe translation). Results: Among 59 patients, 66% exhibited progressive deformity over a mean follow-up of 10.75 months. The distribution of deformity progression was: Type 1 in two cases (3%), Type 2 in seven cases (12%), Type 3 in 13 cases (22%), and Type 4 in 17 cases (29%). Progression of deformity included a 92% increase in cases with segmental kyphosis >20°; and a 167% increase in cases with segmental translation. Risk factors for significant kyphosis included >50% vertebral body erosive destruction (p < 0.01) and the presence of an epidural abscess (p < 0.05). Lumbar region involvement significantly reduced the likelihood of spinal fusion at follow-up (p < 0.05). A paravertebral abscess was significantly associated with the presence of a fractured vertebrae at follow-up (p < 0.05). Discussion and conclusion: This study underscores the importance of closely monitoring patients with conservatively managed pyogenic spondylodiscitis for progressive spinal deformity, and suggests considering early surgical intervention in cases with a high risk of progression.http://www.sciencedirect.com/science/article/pii/S2772529425000232Pyogenic spondylodiscitisConservative treatmentSpinal deformity progressionNon-fusion |
| spellingShingle | Andreas Kramer Jonathan Neuhoff Santhosh G. Thavarajasingam Rebecca Sutherland Hugh McCaughan Benjamin Davies Ehab Shiban Florian Ringel Andreas K. Demetriades Evaluation of spinal deformity and its progression in pyogenic spondylodiscitis: A retrospective MRI study of 59 cases Brain and Spine Pyogenic spondylodiscitis Conservative treatment Spinal deformity progression Non-fusion |
| title | Evaluation of spinal deformity and its progression in pyogenic spondylodiscitis: A retrospective MRI study of 59 cases |
| title_full | Evaluation of spinal deformity and its progression in pyogenic spondylodiscitis: A retrospective MRI study of 59 cases |
| title_fullStr | Evaluation of spinal deformity and its progression in pyogenic spondylodiscitis: A retrospective MRI study of 59 cases |
| title_full_unstemmed | Evaluation of spinal deformity and its progression in pyogenic spondylodiscitis: A retrospective MRI study of 59 cases |
| title_short | Evaluation of spinal deformity and its progression in pyogenic spondylodiscitis: A retrospective MRI study of 59 cases |
| title_sort | evaluation of spinal deformity and its progression in pyogenic spondylodiscitis a retrospective mri study of 59 cases |
| topic | Pyogenic spondylodiscitis Conservative treatment Spinal deformity progression Non-fusion |
| url | http://www.sciencedirect.com/science/article/pii/S2772529425000232 |
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