Surgical treatment of spondylodiscitis in critically ill septic patients.
Critical ill patient
Early surgery
Sepsis
Spinal surgery
Spondylodiscitis
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
17 Aug 2023
17 Aug 2023
Historique:
received:
18
05
2023
accepted:
03
08
2023
medline:
17
8
2023
pubmed:
17
8
2023
entrez:
16
8
2023
Statut:
aheadofprint
Résumé
Surgical procedures in critically ill patients with spondylodiscitis are challenging and there are several controversies. Here, we present our experience with offering surgical intervention early in critically ill septic patients with spondylodiscitis. After we introduced a new treatment paradigm offering early but limited surgery, eight patients with spondylodiscitis complicated by severe sepsis and multiple organ failure underwent urgent surgical treatment over a 10-year period. Outcome was assessed according to the Barthel index at 12-month follow-up and at the last available follow-up (mean 89 months). There were 7 men and 1 woman, with a mean age of 62 years. The preoperative ASA score was 5 in 2 patients, and 4 in 6 patients. Six of them presented with high-grade paresis, and in all of them, spondylodiscitis with intraspinal and/or paravertebral abscesses was evident in MR imaging studies. All patients underwent early surgery (within 24 h after admission). The median time in intensive care was 21 days. Out of the eight patients, seven survived. One year after surgery, five patients had a good outcome (Barthel index: 100 (1); 80 (3); and 70 (1)). At the last follow-up (mean 89 months), 4 patients had a good functional outcome (Barthel index between 60 and 80). Early surgical treatment in critically ill patients with spondylodiscitis and sepsis may result in rapid control of infection and can provide favorable long-term outcome. A general strategy of performing only limited surgery is a valid option in such patients who have a relatively high risk for surgery.
Identifiants
pubmed: 37587320
doi: 10.1007/s00701-023-05748-7
pii: 10.1007/s00701-023-05748-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s).
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