Etienne Canouï1, Virginie Zarrouk1, Florence Canouï-Poitrine2,3, Ugo Desmoulin2, Véronique Leflon4, Wassim Allaham5, Victoire de Lastours1,6, Pierre Guigui6,7, Bruno Fantin1,6. 1. a Service de Médecine Interne, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris , Clichy , France. 2. b Université Paris-Est Créteil (UPEC), DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit) , Créteil , France. 3. c Service de Santé Publique, Hôpital Henri-Mondor, Assistance Publique Hôpitaux de Paris , Créteil , France. 4. d Service de Microbiologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris , Clichy , France. 5. e Service de Radiologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris , Clichy , France. 6. f Université Paris Diderot, Faculté de Médecine , Paris , France. 7. g Service de Chirurgie Orthopédique, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris , Clichy , France.
Abstract
BACKGROUND: The overall benefit of surgical management in the acute phase of hematogenous pyogenic vertebral osteomyelitis remains difficult to evaluate because of the balance between potential functional benefit versus complications of surgery. METHODS: Between 2000 and 2013, in a tertiary care hospital, we analyzed a cohort of patients with hematogenous pyogenic vertebral osteomyelitis treated surgically and compared them to those treated medically. Neurologic deficit (using the ASIA impairment scale) and pain (using the analgesic level required) 4 months later, recurrences and infection-related deaths 12 months later were evaluated. A propensity score was developed to adjust for nonrandomized allocation to surgery. RESULTS: Ninety patients were included (mean age 64 years, 63% male); 28 (31%) were treated surgically. After adjustment for the propensity score, the improvement in neurological deficit at 4 months did not differ between surgical and medical treatment (p = .82), but the reduction of pain tended to be greater in surgical versus medical treatment (p = .051). Recurrences of infection (5%) and infection-related deaths (12%) occurred at similar rates in both groups at 12 months (p = 1.00 for both). CONCLUSIONS: Patients with hematogenous pyogenic vertebral osteomyelitis requiring surgery improved equally as non-surgical patients in terms of neurological deficit and residual pain. This result was not hampered by increased complications related to surgery. When indicated, surgery is safe and effective in patients suffering from hematogenous pyogenic vertebral osteomyelitis.
BACKGROUND: The overall benefit of surgical management in the acute phase of hematogenous pyogenic vertebral osteomyelitis remains difficult to evaluate because of the balance between potential functional benefit versus complications of surgery. METHODS: Between 2000 and 2013, in a tertiary care hospital, we analyzed a cohort of patients with hematogenous pyogenic vertebral osteomyelitis treated surgically and compared them to those treated medically. Neurologic deficit (using the ASIA impairment scale) and pain (using the analgesic level required) 4 months later, recurrences and infection-related deaths 12 months later were evaluated. A propensity score was developed to adjust for nonrandomized allocation to surgery. RESULTS: Ninety patients were included (mean age 64 years, 63% male); 28 (31%) were treated surgically. After adjustment for the propensity score, the improvement in neurological deficit at 4 months did not differ between surgical and medical treatment (p = .82), but the reduction of pain tended to be greater in surgical versus medical treatment (p = .051). Recurrences of infection (5%) and infection-related deaths (12%) occurred at similar rates in both groups at 12 months (p = 1.00 for both). CONCLUSIONS:Patients with hematogenous pyogenic vertebral osteomyelitis requiring surgery improved equally as non-surgical patients in terms of neurological deficit and residual pain. This result was not hampered by increased complications related to surgery. When indicated, surgery is safe and effective in patients suffering from hematogenous pyogenic vertebral osteomyelitis.
Authors: Thomas K Fehring; Keith A Fehring; Angela Hewlett; Carlos A Higuera; Jesse E Otero; Aaron J Tande Journal: J Bone Joint Surg Am Date: 2020-07-15 Impact factor: 6.558