Spontaneous Spinal Infections (SSI) represent a serious pathological entity, very difficult to diagnose and represent a significant clinical problem. If not properly managed, may lead to significant impact in the quality of life. The most relevant problem is not the treatment, conservative or surgical, but early diagnosis, so a careful physical, laboratory and imaging examination is fundamental, with an important help provided by isolation of the pathogen and histology ¹⁾.

Current treatment protocols may require a prompt and multidisciplinary management including infectivologists, neuroradiologists and spine surgeons ²⁾.

Landi et al., tried to study a correlation between type of treatment, timing of treatment and clinical outcome through a multivariate analysis of an observational cohort study with the aim to define what is the optimal clinico-therapeutic management.

They performed a retrospective observational cohort study on all consecutive patients observed in a period of 13 years; From 2001 to 2014 they enrolled 50 consecutive patients with symptomatic spontaneous spinal infections (no previous surgery or recent infection in other site), confirmed with diagnostic imaging. The inclusion parameters were: diagnostic imaging, signs and symptoms positive for SSI, no history of recent infection or surgery. Of each parameter analyzed, they calculated mean and standard deviation and when necessary correlation (ρ), covariance and relation coefficient between type of treatment, timing of treatment and clinical outcome.

The results suggest that an increase of one day from the onset of symptoms and the start of therapy leads to an increase in the ODI scale both at 6 months than at 1 year, with a statistical relevance, so the experience shows a statistically significant correlation and a positive co-variance between timing and outcome at 6 months and 1 year ³⁾.

41 patients aged 65 years and over with spontaneous spinal infections over a 6-year period. The incidence was 9.8/100,000/year. Staphylococcus aureus was the most common isolate. The mean time from symptom onset to diagnosis was 34 days. Most patients presented with back pain and elevated CRP. Differentiation between discitis and other spinal infections does not appear to be important, as clinical characteristics and outcomes are similar ⁴⁾.

Lee et al., retrospectively analyzed the clinical characteristics of 32 patients who underwent surgical treatment from January 2000 to December 2005.

The average follow-up Period was 33.4 months (range, 6 to 87 months). Thirty-two patients presented with the following : 23 cases with pyogenic spondylitis, eight with tuberculous spondylitis and one with fungal spondylitis. The indications for surgery were intractable pain, failure of medical management, neurological impairment with or without an associated abscess, vertebral destruction causing spinal instability and/or segmental kyphosis.

The study included 15 (46.9%) males and 17 (53.1%) females ranging in age from 26 to 75 years (mean, 53.1 years). Diabetes mellitus (DM) and pulmonary Tbc were the most common predisposing factors for pyogenic spondylitis and tuberculous spondylitis. Staphylococcus aureus (13%) was the main organism isolated. The most prevalent location was the lumbar spine (75%). Changes in the pain score, Frankel's classification, and laboratory parameters demonstrated a significant clinical improvement in all patients. However, there were recurrent infections in two patients with tuberculous spondylitis and inappropriate debridement and intolerance of medication and noncompliance. Autologous rib, iliac bone and allograft (fibular) were performed in most patients. However, 10 patients were grafted using a titanium mesh cage after anterior radical debridement. There were no recurrent infections in the 10 cases using the mesh cage with radical debridement.

The findings of this study indicate that surgery based on appropriate surgical indications is effective for the control of spinal infection and prevention of recurrence with anterior radical debridement, proper drug use and abscess drainage ⁵⁾.