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Indications and Limitations of Conservative Treatment for Pyogenic Spondylitis

Fukuda, Koji MD; Miyamoto, Hiroshi MD; Uno, Koki MD; Okada, Yoshiyuki MD

doi: 10.1097/BSD.0b013e31825d6aca
Original Articles

Study Design: Retrospective comparative study.

Objective: To elucidate the indications and limitations of conservative treatment for pyogenic spondylitis (PS).

Summary of Background Data: The optimal strategy for treating PS, conservative or surgical, remains controversial.

Methods: Sixty-eight consecutive patients (44 males, 24 females; 62.6±13.8 y) suffering from PS were enrolled. Forty-three were successfully treated with conservative therapy including immobilization and administration of antibiotics [conservative treatment success (CTS) group]. Twenty-five patients underwent surgical intervention because of ineffective conservative treatment [conservative treatment failure (CTF) group]. Clinical parameters such as duration of symptoms, C-reactive protein (CRP) at admission, durations of hospital stay, and Frankel score, and radiologic parameters such as the presence of epidural abscess, were investigated in both groups.

Results: The duration of symptoms, CRP at admission, and the duration of hospital stay were 1.72±1.02 months, 5.89±6.29 mg/dL, and 85.7±46.0 days, respectively, in the CTS group compared with 7.92±16.9 months, 2.22±3.08 mg/dL, and 95.0±28.0 days in the CTF group. Differences were significant. At follow-up, 100% of the CTS group and 84% of the CTF group were ambulatory. A total of 86.1% of the CTS group lesions occurred at the lumbosacral region, whereas the majority (52%) of those in the CTF group were in the thoracic region. The incidence of epidural abscess was higher in the CTF group (84.0%) than in the CTS group (30.2%), and their greatest likelihoods were at the cervical/thoracic regions and lumbosacral region, respectively.

Conclusions: The early phase of PS, in which the duration of disease between onset and admission was short and CRP at admission was active, was a good indication for conservative treatment regardless of the sites if there was neither paralysis nor worsening of kyphosis, and can even be an option for cases with mild paralysis due to epidural abscess occurring at the lumbosacral region.

Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan

The authors declare no conflict of interest.

Reprints: Hiroshi Miyamoto, MD, Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, 3-1-1 Nishiochiai, Suma-ku, Kobe 654-0155, Japan (e-mail:

Received August 16, 2011

Accepted April 12, 2012

© 2014 by Lippincott Williams & Wilkins, Inc.