Brain & spine · 2025
Evaluation of spinal deformity and its progression in pyogenic spondylodiscitis: A retrospective MRI study of 59 cases.
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Kramer Andreas, Neuhoff Jonathan, Thavarajasingam Santhosh G, Sutherland Rebecca, McCaughan Hugh, Davies Benjamin, Shiban Ehab, Ringel Florian, Demetriades Andreas K
Аннотация
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.
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.