Surgical Treatment of Pyogenic Spondylodiscitis: Is Intradiscal Debridement Necessary?
- 1Klinik für Neurochirurgie, Campus Bielefeld-Bethel, Universitätsklinikum OWL, Bielefeld, Germany
- 2Campus Bielefeld-Bethel, Universitätsinstitut für diagnostische und interventionelle Neuroradiologie OWL, Bielefeld, Germany
Abstract
Study Design: Retrospective Cohort Study.
Objectives: To investigate the role of intradiscal debridement and fusion in the surgical treatment of pyogenic spondylodiscitis.
Methods: Pertinent clinical and imaging data were retrospectively analyzed for 147 consecutive patients who underwent surgery for primary pyogenic spondylodiscitis with (DF) vs. without discectomy/fusion (noDF) between 2016 and 2023.
Results: 84/129 (65.1%) patients with mono-site infections (cervical: 21, thoracic: 38, lumbosacral: 70) underwent DF surgery, whereas 45 (34.9%) had noDF surgery. DF and noDF patients did not differ significantly with respect to age, sex, septic presentation, ASA score, admission KPS and MRC grade, or paravertebral abscess. DF patients had a higher incidence of epidural empyema (p = 0.005), and DF surgery was more often performed in cases with severe vertebral body destruction and for non-thoracic spondylodiscitis (statistical trends only). (Antibiotic) treatment duration, hospital stay, mortality, and complication rates did not differ significantly between the DF and noDF groups. 18 patients had multi-site infections. Treatment duration, complication rates, and outcomes did not vary with the surgical strategy. Complications requiring revision surgery occurred in 19.7% of patients. CTCAE grade ≥3 medical complications were seen in 19.0%. There were 9 (6.1%) in-hospital deaths, and 3-month mortality was 15/140 (10.7%).
Conclusions: Treatment duration, outcomes and complication rates did not vary significantly between DF and noDF patients, while the respective patient cohorts were relatively well balanced with respect to many clinical characteristics. These data suggest that surgery without routine intradiscal debridement may be a reasonable option in carefully selected patients with spondylodiscitis.
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BibTeX
@article{alkassm2026surgical,
title = {{Surgical Treatment of Pyogenic Spondylodiscitis: Is Intradiscal Debridement Necessary?}},
author = {Emad Alkassm and Matthias Matt and Björn Berger and Matthias Simon},
journal = {Global Spine Journal},
year = {2026},
month = oct,
doi = {10.1177/21925682261494609},
url = {https://doi.org/10.1177/21925682261494609},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Surgical Treatment of Pyogenic Spondylodiscitis: Is Intradiscal Debridement Necessary?
AU - Emad Alkassm
AU - Matthias Matt
AU - Björn Berger
AU - Matthias Simon
PY - 2026
DA - 2026/10/30
JO - Global Spine Journal
DO - 10.1177/21925682261494609
UR - https://doi.org/10.1177/21925682261494609
AB - Study Design: Retrospective Cohort Study. Objectives: To investigate the role of intradiscal debridement and fusion in the surgical treatment of pyogenic spondylodiscitis. Methods: Pertinent clinical and imaging data were retrospectively analyzed for 147 consecutive patients who underwent surgery for primary pyogenic spondylodiscitis with (DF) vs. without discectomy/fusion (noDF) between 2016 and 2023. Results: 84/129 (65.1%) patients with mono-site infections (cervical: 21, thoracic: 38, lumbosacral: 70) underwent DF surgery, whereas 45 (34.9%) had noDF surgery. DF and noDF patients did not differ significantly with respect to age, sex, septic presentation, ASA score, admission KPS and MRC grade, or paravertebral abscess. DF patients had a higher incidence of epidural empyema (p = 0.005), and DF surgery was more often performed in cases with severe vertebral body destruction and for non-thoracic spondylodiscitis (statistical trends only). (Antibiotic) treatment duration, hospital stay, mortality, and complication rates did not differ significantly between the DF and noDF groups. 18 patients had multi-site infections. Treatment duration, complication rates, and outcomes did not vary with the surgical strategy. Complications requiring revision surgery occurred in 19.7% of patients. CTCAE grade ≥3 medical complications were seen in 19.0%. There were 9 (6.1%) in-hospital deaths, and 3-month mortality was 15/140 (10.7%). Conclusions: Treatment duration, outcomes and complication rates did not vary significantly between DF and noDF patients, while the respective patient cohorts were relatively well balanced with respect to many clinical characteristics. These data suggest that surgery without routine intradiscal debridement may be a reasonable option in carefully selected patients with spondylodiscitis.
SN - 2192-5682
SN - 2192-5690
ER -