Long-term Radiological and Clinical Outcome after Lumbar Spinal Fusion Surgery in Patients with Degenerative Spondylolisthesis: A Prospective 6-Year Follow-up Study

Objective To assess which radiological alignment parameters are associated with a satisfactory long-term clinical outcome after performing lumbar spinal fusion for treating degenerative spondylolisthesis. Methods This single-center prospective study assessed the relation between radiological alignment parameters measured on standing lateral lumbar spine radiographs and the patient-reported outcome using four different questionnaires (COMI, EQ-5D, ODI and VAS) as primary outcome measures (level of evidence: II). The following spinopelvic alignment parameters were used: gliding angle, sacral inclination, anterior displacement, sagittal rotation, lumbar lordosis, sacral slope, pelvic tilt and pelvic incidence. Furthermore, the length of stay and perioperative complications were documented. Only cases from 2013 to 2015 of low-grade degenerative lumbar spondylolisthesis (Meyerding grades I and II) were considered. The patients underwent open posterior lumbar fusion surgery by pedicle screw instrumentation and cage insertion. The operative technique was either a posterior lumbar interbody fusion (PLIF) or a transforaminal lumbar interbody fusion (TLIF) performed by three different senior orthopedic surgeons. Exclusion criteria were spine fractures, minimally invasive techniques, underlying malignant diseases or acute infections, previous or multisegmental spine surgery as well as preoperative neurologic impairment. Of 89 initially contacted patients, 17 patients were included for data analysis (11 males, six females). Results The data of 17 patients after mono- or bisegmental lumbar fusion surgery to treat low-grade lumbar spondylolisthesis and with a follow-up time of least 72 months were analyzed. The mean age was 66.7 +/- 11.3 years. In terms of complications two dural tears and one intraoperative bleeding occurred. The average body mass index (BMI) was 27.6 +/- 4.4 kg/m(2) and the average inpatient length of stay was 12.9 +/- 3.8 days (range: 8-21). The long-term clinical outcome correlated significantly with the change of the pelvic tilt (r(s) = -0.515, P < 0.05) and the sagittal rotation (r(s) = -0.545, P < 0.05). The sacral slope was significantly associated with the sacral inclination (r(s) = 0.637, P < 0.01) and the pelvic incidence (r(s) = 0.500, P < 0.05). In addition, the pelvic incidence showed a significant correlation with the pelvic tilt (r(s) = 0.709, P < 0.01). The change of the different clinical scores over time also correlated significantly between the different questionnaires. Conclusions The surgical modification of the pelvic tilt and the sagittal rotation are the two radiological alignment parameters that can most accurately predict the long-term clinical outcome after lumbar interbody fusion surgery

Treatment Failure in Vertebral Osteomyelitis Is it All About Staphylococcus aureus?

Study Design. Retrospective cohort study. Objective. The aim was to compare the influence of 2 common vertebral osteomyelitis (VO) causing pathogens on treatment failure within the first year of diagnosis. Summary of Background Data. VO is mainly caused by Staphylococcus aureus (SA), while enterococci and streptococci (ENST) are also responsible for a significant proportion of VO, particularly in elderly patients. Data on VO caused by SA show a tendency for worse outcome, whereas data on VO caused by ENST are scarce. For this purpose, our study compares characteristics of patients with VO caused by SA or ENST in order to analyze risk factors for treatment failure. Methods. We conducted a retrospective monocentric study including VO patients from 2008 to 2020. Primary outcome was treatment failure defined as death or relapse within 1 year (T1). We compared patients diagnosed with VO caused by Staphylococcus aureus including MRSA to patients diagnosed with VO caused by Enterococcus and Streptococcus species, which were combined into one group. Polymicrobial infections were excluded. We employed multiple logistic regression analysis to adjust for confounding. To account for moderation, the model was repeated with an included interaction term. Results. Data of 130 VO patients (SA=95; ENST=35) were available at T1. Treatment failure occurred in 37% of SA patients and 23% of ENST patients. On multivariate analysis SA [odds ratio (OR): 3.12; 95% confidence interval (CI): 1.09-10.53; P=0.046], Charlson comorbidity index (OR: 1.31; 95% CI: 1.11-1.58; P=0.002) and infectious endocarditis (IE; OR: 4.29; 95% CI: 1.23-15.96; P=0.024) were identified as independent risk factors for treatment failure. Conclusion. In our cohort every third patient with VO caused by SA or ENST dies within 1 year. Our findings indicate that patients with VO caused by SA, concomitant IE and/or a high Charlson comorbidity index score may be at elevated risk for treatment failure. These findings can be used to individualize patient care and to direct clinical surveillance. This could include echocardiography evaluating for the presence of IE in patients with VO caused by gram-positive pathogens

What Do We Know about Spondylodiscitis in Children? A Retrospective Study

Pediatric spondylodiscitis (PSD) is a rare disease with a major impact on mobility and functional status. Data concerning demographic and microbiological characteristics, clinical course, treatment, and outcome are scarce. Therefore, the aim of this study was to present clinical experiences of a third-level hospital (2009-2019) in PSD and compare these with adult spondylodiscitis (ASD). Of a total of 10 PSD patients, most of the infants presented with unspecific pain such as hip pain or a limping, misleading an adequate diagnosis of spine origin. Eight patients could be treated conservatively whereas surgery was performed in two cases with one case of tuberculous PSD (tPSD). The causative agent was detected in three of the patients. The diagnosis of PSD is often difficult since clinical symptoms are unspecific and causative pathogens often remain undetected. Nevertheless, empirical anti-infective therapy also seems to be effective. Based on recent studies, clinicians should be encouraged to keep the duration of anti-infective therapy in children short. Since comorbidities are not presented in PSD it is unclear which children suffer from PSD; thus, studies are necessary to identify predisposing factors for PSD. In our study, PSD differs from ASD in diagnostic and especially in therapeutic aspects. Therefore, specific guidelines for PSD would be desirable