Association between the Spinal Instability Spondylodiscitis Score (SISS) and treatment selection in patients with Spondylodiscitis: A retrospective cohort study.
- 1Department of Neurosurgery, Goethe University Hospital, Frankfurt am Main, Germany.
Abstract
Spondylodiscitis is a severe spinal infection frequently associated with substantial morbidity, neurological deterioration, and spinal instability. Although the Spinal Instability Spondylodiscitis Score (SISS) was developed to standardize instability assessment in patients with spontaneous spondylodiscitis, its clinical utility for treatment allocation between conservative and surgical management remains insufficiently understood. This retrospective single-center cohort study included adult patients with clinically and radiologically confirmed spondylodiscitis treated at a tertiary spine center over a 10-year period. Demographic, clinical, laboratory, radiological, and treatment-related variables were extracted from institutional databases. SISS values were retrospectively calculated according to the original scoring system. Univariable analyses were performed to evaluate associations between baseline variables and treatment allocation. Clinically relevant and statistically associated variables were subsequently entered into multivariable logistic regression models. Receiver operating characteristic (ROC) analysis was additionally performed to evaluate the discriminatory ability of SISS for operative treatment allocation. A total of 216 patients were included in the final analysis, including 145 surgically treated patients (67.1%) and 71 conservatively treated patients (32.9%). Mean SISS values were comparable between treatment groups (8.5 ± 2.1 vs. 8.8 ± 2.2, p = 0.290). In univariable analysis, SISS was not significantly associated with operative treatment allocation (OR 0.93, 95% CI 0.81-1.06, p = 0.281). In multivariable logistic regression analysis, male sex (adjusted OR 2.82, 95% CI 1.36-5.87, p = 0.006), elevated C-reactive protein levels (adjusted OR 1.05, 95% CI 1.01-1.09, p = 0.011), and diabetes mellitus (adjusted OR 5.41, 95% CI 1.90-15.41, p = 0.002) remained independently associated with operative treatment allocation. In contrast, SISS was not independently associated with treatment selection after adjustment for potential confounders (adjusted OR 0.93, 95% CI 0.81-1.06, p = 0.281). ROC analysis demonstrated poor discriminatory performance of SISS for operative treatment allocation, with an AUC of 0.448 (95% CI 0.360-0.520). In this cohort, SISS did not predict real-world treatment allocation; treatment allocation in patients with spondylodiscitis instead appeared to be influenced by a combination of host-related factors and systemic disease severity rather than radiographic instability alone. This finding should not be interpreted as evidence against the prognostic value of SISS for instability-related outcomes, but rather reflects the multifactorial nature of clinical decision-making. Although SISS provides a structured framework for instability assessment, its ability to independently predict treatment selection in routine clinical practice was limited in this cohort. These findings provide important external validation data on the clinical applicability of SISS and support future development of multidimensional decision-support models integrating radiological, clinical, microbiological, and systemic disease-related factors.
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BibTeX
@article{kilinc2026association,
title = {{Association between the Spinal Instability Spondylodiscitis Score (SISS) and treatment selection in patients with Spondylodiscitis: A retrospective cohort study.}},
author = {Fatma Kilinc and Matthias Setzer and Christian Seemann and Marcus Czabanka and Vincent Prinz},
journal = {Brain \& spine},
year = {2026},
month = oct,
doi = {10.1016/j.bas.2026.107496},
url = {https://europepmc.org/article/MED/42999654},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Association between the Spinal Instability Spondylodiscitis Score (SISS) and treatment selection in patients with Spondylodiscitis: A retrospective cohort study.
AU - Fatma Kilinc
AU - Matthias Setzer
AU - Christian Seemann
AU - Marcus Czabanka
AU - Vincent Prinz
PY - 2026
DA - 2026/10/29
JO - Brain & spine
DO - 10.1016/j.bas.2026.107496
UR - https://europepmc.org/article/MED/42999654
AB - Spondylodiscitis is a severe spinal infection frequently associated with substantial morbidity, neurological deterioration, and spinal instability. Although the Spinal Instability Spondylodiscitis Score (SISS) was developed to standardize instability assessment in patients with spontaneous spondylodiscitis, its clinical utility for treatment allocation between conservative and surgical management remains insufficiently understood. This retrospective single-center cohort study included adult patients with clinically and radiologically confirmed spondylodiscitis treated at a tertiary spine center over a 10-year period. Demographic, clinical, laboratory, radiological, and treatment-related variables were extracted from institutional databases. SISS values were retrospectively calculated according to the original scoring system. Univariable analyses were performed to evaluate associations between baseline variables and treatment allocation. Clinically relevant and statistically associated variables were subsequently entered into multivariable logistic regression models. Receiver operating characteristic (ROC) analysis was additionally performed to evaluate the discriminatory ability of SISS for operative treatment allocation. A total of 216 patients were included in the final analysis, including 145 surgically treated patients (67.1%) and 71 conservatively treated patients (32.9%). Mean SISS values were comparable between treatment groups (8.5 ± 2.1 vs. 8.8 ± 2.2, p = 0.290). In univariable analysis, SISS was not significantly associated with operative treatment allocation (OR 0.93, 95% CI 0.81-1.06, p = 0.281). In multivariable logistic regression analysis, male sex (adjusted OR 2.82, 95% CI 1.36-5.87, p = 0.006), elevated C-reactive protein levels (adjusted OR 1.05, 95% CI 1.01-1.09, p = 0.011), and diabetes mellitus (adjusted OR 5.41, 95% CI 1.90-15.41, p = 0.002) remained independently associated with operative treatment allocation. In contrast, SISS was not independently associated with treatment selection after adjustment for potential confounders (adjusted OR 0.93, 95% CI 0.81-1.06, p = 0.281). ROC analysis demonstrated poor discriminatory performance of SISS for operative treatment allocation, with an AUC of 0.448 (95% CI 0.360-0.520). In this cohort, SISS did not predict real-world treatment allocation; treatment allocation in patients with spondylodiscitis instead appeared to be influenced by a combination of host-related factors and systemic disease severity rather than radiographic instability alone. This finding should not be interpreted as evidence against the prognostic value of SISS for instability-related outcomes, but rather reflects the multifactorial nature of clinical decision-making. Although SISS provides a structured framework for instability assessment, its ability to independently predict treatment selection in routine clinical practice was limited in this cohort. These findings provide important external validation data on the clinical applicability of SISS and support future development of multidimensional decision-support models integrating radiological, clinical, microbiological, and systemic disease-related factors.
SN - 2772-5294
ER -