Cervical spondylodiscitis: change in clinical picture and operative management during the last two decades. A series of 50 patients and review of literature.

PURPOSE: The incidence of spondylodiscitis is increasing. This study evaluates the behavior of cervical spondylodiscitis over a period of two decades in a single institution and compares the findings with the literature.
METHODS: Between 1994 and 1999, 20 consecutive patients (group A) suffering from cervical spondylodiscitis underwent surgical treatment in our institution. These were compared to another group consisting of 30 patients (group B) undergoing surgery for the same disease between 2004 and 2009 again in our institution. All patients in both series underwent surgical debridement and reconstruction followed by antibiotic therapy for 8-12 weeks.
RESULTS: The mean age at presentation increased significantly from 59.7 to 64.5 years. Male predominance was noticed in both groups. Accompanying neurological deficit was almost the same (40-45 %), while septicaemia increased from 15 to 40 %. Radiologically, epidural abscess formation increased from 60 to 80 %. The disease was mostly monosegmental in group A (85 %); while in group B, the disease became significantly more aggressive affecting two and three segments in 43.3 % of the cases. There was an increased tendency toward anterior alone surgery in group B (56.7 %) in comparison to group A (35 %). Mean period of follow-up was 2.8 years. Healing of the inflammation was the rule. Mortality rate increased from 5 to 10 %.
CONCLUSIONS: Cervical spondylodiscitis has increased and became more aggressive. While radical surgical debridement, stable reconstruction together with antibiotic therapy remained a reliable approach to achieve complete healing of the inflammation, anterior alone surgery became more applicable.