Minimally Invasive Management of Cervical Spondylodiscitis. A Multicenter Experience

Abstract

Background The urgent etiological diagnosis represents the main management objective of cervical spondylodiscitis (CSD) to start as soon as possible antibiotic treatment to prevent neurological deterioration. The present study aimed to evaluate a multicenter experience implementing a minimally invasive surgical approach (MISA) to manage such pathology vs the most complex and aggressive surgical strategies currently used. Patients and methods Retrospective multicenter study on a prospectively built database of a 70 patients’ series in 5 European tertiary neurosurgical centers. Seventy consecutive patients harboring primary CSD undergoing MISA were included. Formal diagnosis was made in all patients on clinical presentation, imaging findings, and laboratory investigation and confirmed by histopathological and bacteriological analysis of perioperative specimens. Results Forty-one patients were men and 29 were women with a mean age of 47.67 years. Severe neck pain was the most common symptom in 45/70 patients. Fifty-one patients presented a single cervical level of spondylodiscitis, 14/70 double level, and 5/70 triple level respectively. The most commonly identified microorganism was Staphylococcus aureus in 49/70 patients. Each patient received a mean of 3 months' antibiotics treatment. With a mean follow-up period of 48 months, all patients showed a complete recovery without neurological deficits. Neither spine instability nor kyphotic deformation was recorded and bony fusion was confirmed radiologically in all patients. No infection recurrence occurred. Conclusions MISA treatment of CSD is a valuable management option to identify the microorganism involved and/or to decompress the spinal cord ensuring as much as possible mechanical stability resulting in excellent patient outcomes.