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Long-term Functional Outcome in Pyogenic Spinal Infection

O'Daly, Brendan J. MB BCh, BAO, MRCSI; Morris, Seamus F. MCh, FRCS (Tr & Orth); O'Rourke, S Kieran MSc, FRCSI, FRCS(Ed)

doi: 10.1097/BRS.0b013e31816b8872
Clinical Case Series

Study Design. Retrospective.

Objective. To assess long-term adverse functional outcome following pyogenic spinal infection using standardized outcome measures, Oswestry disability index (ODI), and medical outcomes study short form-36 (SF-36).

Summary of Background Data. There is minimal published data regarding the long-term functional outcome in pyogenic spinal infection. Previous studies have used heterogeneous, unreliable, and nonvalidated measure instruments yielding data that is difficult to interpret.

Methods. All cases of pyogenic spinal infection presenting to a single institution managed operatively and nonoperatively from 1994 to 2004 were retrospectively identified. Follow-up was by clinical review and standardized questionnaires. Inclusion in each case was on the basis of consistent clinical, imaging, and microbiology criteria.

Results. Twenty-nine cases of pyogenic spinal infection were identified. Twenty-eight percent were managed operatively and 72% with antibiotic therapy alone. Nineteen patients (66%) had an adverse outcome at a median follow-up of 61 months, despite only 5 patients (17%) having persistent neurologic deficit. A significant difference in SF-36 physical function scores was observed between patients with adverse outcome and patients who recovered (P = 0.003). SF-36 scores of all patients, regardless of management or outcome, failed to reach those of a normative population. A strong correlation was observed between ODI and SF-36 physical function scores (ρ = 0.61, P < 0.05). Seventeen percent (n = 5) of admissions resulted in acute sepsis-related death. Delay in diagnosis of spinal infection (P = 0.025) and neurologic impairment at diagnosis (P < 0.001) were significant predictors of neurologic deficit at follow-up. Previous spinal surgery was associated with adverse outcome in patients requiring readmission within 1 year of hospital discharge following first spinal infection (P = 0.018). No independent predictors of adverse outcome, persistent neurologic impairment, readmission within 1 year, or acute death were identified by logistical regression analysis.

Conclusion. High rates of adverse outcome detected using SF-36 and ODI suggest under-reporting of poor outcome when American Spinal Injury Association score alone is used to qualify outcome.

Poor functional outcome in pyogenic spinal infection at long-term follow-up is reported using Oswestry disability index and short form-36 health survey as standardized outcome measures. Even with apparent full neurologic recovery, SF-36 scores fail to reach those of an age-matched normative population.

From the Department of Orthopaedic Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.

Acknowledgment date: January 24, 2007. Revision date: November 17, 2007. Acceptance date: December 3, 2007.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests Dr. Brendan J. O'Daly, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.