[Possibilities and limits of conservative therapy of spondylitis and spondylodiscitis].

Abstract

BACKGROUND AND AIM OF THE STUDY:

For many years the treatment of spondylitis and spondylodiscitis has been discussed controversially. The aim of this study is to report on objective and subjective mid-term results of therapy of spondylitis and to present a differentiated concept of treatment.

METHODS:

Between 1988 and 1996, 58 patients were treated with spondylitis or spondylodiscitis. Nine of these patients had to be operated. A biopsy was taken in all of the cases. According to the antibiogram obtained by the biopsy, antibiotics were applied intravenously. The patients were immobilized by a plaster bed for at least 6 weeks and were then treated by a spinal orthosis for another 3 months. Patients were re-examined clinically and radiographically and by a questionnaire (including Roland-Morris score), after 8 years on average.

RESULTS:

Patients were diagnosed correctly 4 months after the begin of the disease. Spondylitis was predominantly localized in the lumbar spine. A positive bacteriological culture was derived from one third of the biopsies; none of them was a specific culture. C-reactive protein was revealed as appropriate for diagnosis and follow-up of spondylitis. In 84% of the patients a total or partial bony fusion was demonstrated radiographically. Questionnaire assessment revealed a significant decrease of the Roland-Morris score (17.8-7.4) and a significant relief of pain (8.9-2.5).

CONCLUSIONS:

We recommend surgical treatment on patients with major vertebral body destruction, epidural abscess and progressive neurological impairment. These indications for operation can be prevented by a rapid diagnosis, so that spondylitis can be successfully treated by consequent immobilization in a plaster bed and appropriate antibiotics.

• Authors: C H Flamme, T Frischalowski, F Gossé
• Journal: Zeitschrift fur Rheumatologie (Z Rheumatol) Vol. 59 Issue 4 Pg. 233-9 (Aug 2000) ISSN: 0340-1855 [Print] Germany
• Vernacular Title: Möglichkeiten und Grenzen der konservativen Therapie bei Spondylitis und Spondylodiszitis.
• PMID: 11013984 (Publication Type: English Abstract, Journal Article)

Chemical References

• Anti-Bacterial Agents

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (adverse effects, therapeutic use)
• Biopsy
• Combined Modality Therapy
• Discitis (drug therapy, pathology)
• Female
• Humans
• Immobilization
• Lumbar Vertebrae (pathology)
• Male
• Middle Aged
• Prognosis
• Spondylitis (drug therapy, pathology)
• Treatment Outcome