Is surgical treatment better than conservative treatment for spondylodiscitis?
The decision between surgical and conservative treatment for spondylodiscitis hinges on various factors, including patient comorbidities, the severity of the disease, and the presence of complications such as spinal instability or neurological deficits. Conservative treatment, primarily consisting of antibiotics and immobilization, is often the first line of management, especially in cases without severe complications. However, surgical intervention may be necessary in certain scenarios to achieve better outcomes. Studies have shown that the cure rate with medical treatment is high, emphasizing the importance of identifying the causal germ to initiate targeted antibiotherapy to avoid complications and long-term sequelae. Conservative management has been successful in some cases, with early and adequately prolonged antibiotic therapy recommended for spontaneous spondylodiscitis. Furthermore, minimally invasive surgical techniques have emerged as effective alternatives for patients with antibiotic-resistant infections, showing significantly lower post-operative CRP and VAS pain scores compared to open surgery. However, surgery is considered in patients with spinal instability, immobilizing pain, epidural abscess, and newly emerged neurological deficits, as these conditions may not respond adequately to conservative treatment alone. Surgical approaches, including minimally invasive techniques, have been shown to lead to recovery in most cases, especially when conservative measures fail or in the presence of severe disease manifestations. Instrumented osteosynthesis, for instance, has been advocated for preventing spinal deformity and does not hamper healing from infection, allowing early mobilization and rehabilitation. Comparatively, the outcomes between conservative and operative treatments can be comparable after one year, but the choice of treatment must consider the individual patient's condition and disease severity. The novel percutaneous endoscopic lumbar debridement and irrigation drainage (PELDID) technique, combined with the Pola classification system for guiding treatment, represents a promising strategy for treating spontaneous spondylodiscitis, blending the benefits of minimally invasive surgery with the precision of targeted conservative management. In conclusion, while conservative treatment remains a cornerstone in managing spondylodiscitis, surgical intervention, particularly minimally invasive surgery, offers a valuable option for cases where conservative measures are insufficient or when specific complications necessitate a more aggressive approach. The choice between surgical and conservative treatment should be tailored to the patient's specific clinical scenario, considering the potential benefits and risks of each approach.
Answers from top 10 papers
| Papers (10) | Insight |
|---|---|
| Not addressed in the paper. | |
| Surgical treatment, specifically percutaneous suction and irrigation, showed promising results for recalcitrant pyogenic spondylodiscitis in the study, offering a minimally invasive alternative to traditional surgical interventions. | |
| Surgery for spondylodiscitis transmitted from infected aortic aneurysms after EVAR led to infection recovery in most cases, suggesting it may be beneficial compared to conservative treatment. | |
| Surgical treatment may be necessary for severe cases of spondylodiscitis with complications like abscesses or neurological deficits, while conservative treatment suffices for some cases without such complications. | |
| Surgical treatment, specifically the Percutaneous Endoscopic Lumbar Debridement and Irrigation Drainage technique, shows promising results for spontaneous lumbar spondylodiscitis, offering improved outcomes compared to conservative treatment. | |
| Surgical treatment with single-approach vertebral osteosynthesis is preferred over conservative management for spondylodiscitis, preventing deformity, allowing early mobilization, and not hindering infection healing. | |
| Surgical treatment is favored over conservative treatment for spondylodiscitis, as it reduces pain and inflammation significantly, especially in cases of severe infection and structural compromise. | |
3 Citations | Minimally invasive spine surgery is effective for antibiotic-resistant infectious spondylodiscitis, showing improved outcomes compared to open surgery after failed antibiotic therapy, as per the systematic review and meta-analysis. |
| Both conservative and surgical treatments for spondylodiscitis in geriatric patients show comparable outcomes after one year, with surgical consideration for specific conditions like spinal instability and neurological deficits. | |
| Surgical treatment for spondylodiscitis showed no significant difference in cure rates compared to conservative treatment. Identifying the causative germ for targeted antibiotherapy is crucial for successful outcomes. |