- OBJECTIVE: Pyogenic spondylodiscitis management often excludes surgical intervention, yet the risk of spinal deformities is unclear. This study explores the radiographic progression of spinal deformities in conservatively treated cases and identifies predictive factors.
MATERIAL/METHODS: This retrospective study analyzed MRI data from patients with conservatively treated pyogenic spondylodiscitis. Deformities were categorized into four progression types reflecting severity: Type 1 (progressive vertebral body edema/endplate erosion), Type 2 (Type 1 plus disc space collapse), Type 3 (vertebral body destruction/mild translation), and Type 4 (significant kyphosis >20°/severe translation). The study aimed to identify radiographic predictors of deformity advancement, such as translation, fractures, and fusion.
RESULTS: Among 59 patients, 66% exhibited progressive deformity over a mean follow-up of 10.75 months. The distribution of progression types was: Type 1 in 2 cases (3%), Type 2 in 7OBJECTIVE: Pyogenic spondylodiscitis management often excludes surgical intervention, yet the risk of spinal deformities is unclear. This study explores the radiographic progression of spinal deformities in conservatively treated cases and identifies predictive factors.
MATERIAL/METHODS: This retrospective study analyzed MRI data from patients with conservatively treated pyogenic spondylodiscitis. Deformities were categorized into four progression types reflecting severity: Type 1 (progressive vertebral body edema/endplate erosion), Type 2 (Type 1 plus disc space collapse), Type 3 (vertebral body destruction/mild translation), and Type 4 (significant kyphosis >20°/severe translation). The study aimed to identify radiographic predictors of deformity advancement, such as translation, fractures, and fusion.
RESULTS: Among 59 patients, 66% exhibited progressive deformity over a mean follow-up of 10.75 months. The distribution of progression types was: Type 1 in 2 cases (3%), Type 2 in 7 cases (12%), Type 3 in 13 cases (22%), and Type 4 in 17 cases (29%). Progression of deformities included a 92% increase of cases with segmental kyphosis >20° and a 167% increase for segmental translation. Risk factors for significant kyphosis included >50% destruction of a vertebral body (p<0.01) and the presence of an epidural abscess at baseline (p<0.05). Furthermore, lumbar region involvement significantly reduced the likelihood of spinal fusion at follow-up (p<0.05). Fractures at follow-up were significantly associated with the presence of a paravertebral abscess at baseline (p<0.05).
CONCLUSION: This study underscores the importance of screening for radiographic risk factors upon treatment initiation. Additionally, it highlights the need for closely monitoring patients with conservatively managed pyogenic spondylodiscitis for progressive spinal deformities and suggests considering early surgical intervention in cases with a high risk of radiological progression.…
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