====== Spondylodiscitis outcome ====== Since the advent of [[antibiotic]]s, mortality has dropped from 25%–56%, to less than 5%. ---- Improvements in surgical and radiological techniques and the discovery of antimicrobial therapy have transformed the outlook for patients with this condition, but morbidity remains significant ((Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother. 2010 Nov;65 Suppl 3:iii11-24. doi: 10.1093/jac/dkq303. PMID: 20876624.)) ---- Spondylodiscitis is a disease causing a profound impact on back pain, function and quality of life. The results suggest that chronic back pain is a debilitating problem, as it has an extensive influence on daily activities and social and psychological well-being, causing significant disability ((Stoop N, Zijlstra H, Ponds NHM, Wolterbeek N, Delawi D, Kempen DHR. Long-term quality of life outcome after spondylodiscitis treatment. Spine J. 2021 Dec;21(12):1985-1992. doi: 10.1016/j.spinee.2021.06.019. Epub 2021 Jun 24. PMID: 34174437.)). ---- [[Surgical site infection]] and medical complications are the main drivers of prolonged hospital stays and [[cost]] of [[care]] ((Abboud T, Melich P, Scheithauer S, Rohde V, Schatlo B. Complications, length of [[hospital stay]] and [[cost]] of [[care]] after surgery for pyogenic [[spondylodiscitis]]. J Neurol Surg A Cent Eur Neurosurg. 2022 Mar 30. doi: 10.1055/a-1811-7633. Epub ahead of print. PMID: 35354215.)). ---- One [[Randomized controlled trial]] suggest that 6 weeks of [[antibiotic]] treatment of pyogenic spondylodiscitis results in a similar outcome when compared to longer treatment duration. However, microorganism-specific studies suggest that at least 8 weeks of antibiotic is required for [[Staphylococcus aureus treatment]] and 8 weeks of [[Daptomycin]] for [[MRSA]] ((Rutges JP, Kempen DH, van Dijk M, Oner FC. Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review. Eur Spine J. 2016 Apr;25(4):983-99. doi: 10.1007/s00586-015-4318-y. Epub 2015 Nov 19. PMID: 26585975.)). ---- If surgery is required, reported literature shows potential for significant pain reduction, improved neurologic function and a high number of patients returning to a normal functional/work status ((Taylor DG, Buchholz AL, Sure DR, Buell TJ, Nguyen JH, Chen CJ, Diamond JM, Washburn PA, Harrop J, Shaffrey CI, Smith JS. Presentation and Outcomes After Medical and Surgical Treatment Versus Medical Treatment Alone of Spontaneous Infectious Spondylodiscitis: A Systematic Literature Review and Meta-Analysis. Global Spine J. 2018 Dec;8(4 Suppl):49S-58S. doi: 10.1177/2192568218799058. Epub 2018 Dec 13. PMID: 30574438; PMCID: PMC6295820.)). ---- The [[spondylodiscitis outcome]] is generally good, and [[antibiotic]]s together with [[spinal bracing]] (immobilization) are adequate treatment in ≈ 75% of cases. Occasionally surgery is required. It is associated with a one-year mortality of 20% and functional impairment among survivors leading to low quality of life ((Akiyama T, Chikuda H, Yasunaga H, et al. Incidence and risk fac- tors for mortality of vertebral osteomyelitis: a retrospective ana- lysis using the Japanese diagnosis procedure combination database. BMJ Open. 2013;3:e002412.)) ((Priest DH, Peacock JE. Jr. Hematogenous vertebral osteomyelitis due to Staphylococcus aureus in the adult: clinical features and therapeutic outcomes. South Med J. 2005;98:854–862.)). Kehrer et al., identified all patients aged 18 years or older treated for infectious spondylodiscitis from January 1994 to May 2009 at hospitals in Funen County, Denmark. Mortality rates among patients were compared with rates among a reference population using Kaplan-Meier plots and mortality rate ratios (MRRs). Short-term mortality was defined as deaths within first year after admission and long-term mortality was deaths thereafter. Factors associated with death were determined. Among 298 identified patients, 61 (20%) died within the first year. Adjusted MRRs were 16.8 (95% confidence interval: 9.9-28.5) for 0 to 90 days; 4.2 (2.5-7.0) for 91 to 365 days; 2.2 (1.6-2.9) for 1 to 4 years; and 1.7 (1.2-2.5) for 5 to 14 years. Mortality rate ratios stratified on microbiological etiology were 8.8 (3.3-22.1) for 0 to 90 days; 1.4 (0.3-5.8) for 91 to 365 days; 3.2 (2.0-5.1) for 1 to 4 years; and 1.1 (0.5-2.4) for 5 to 14 years for unknown etiology and 24.0 (13.0-44.2) for 0 to 90 days; 6.0 (3.1-11.5) for 91 to 365 days; 1.9 (1.1-3.2) for 1 to 4 years; and 2.7 (1.5-4.7) for 5 to 14 years among Staphylococcus aureus infections. The main factors associated with short-term mortality were severe neurologic deficits at the time of admission, epidural abscess, and comorbidities. Long-term mortality seemed independent of microbiological etiology. Mortality remained high the first year after admission and thereafter decreased with time to a level close to the reference population. Short-term mortality was especially related to infection with abscess formation and neurologic deficits and long-term mortality was related to alcohol dependency ((Kehrer M, Pedersen C, Jensen TG, Hallas J, Lassen AT. Increased short- and long-term mortality among patients with infectious spondylodiscitis compared with a reference population. Spine J. 2015 Jun 1;15(6):1233-40. doi: 10.1016/j.spinee.2015.02.021. Epub 2015 Feb 19. PubMed PMID: 25701609. )).