The Role of Instrumentation in the Surgical Treatment of Spondylodiscitis and Spinal Epidural Abscess: A Single-Center Retrospective Cohort Study

Background: Despite the high incidence of spinal infections that require an operation, there is no consensus on the most appropriate initial surgical management for these patients regarding decompression with vs without instrumented fusion. In this study, we investigated the differences in clinical outcomes, complication rates, and reoperation rates between patients with spinal epidural abscess who underwent decompression alone vs decompression with instrumented fusion. Methods: Records of patients undergoing operative intervention for spondylodiscitis with spinal epidural abscess at the authors' institution between 2011 and 2018 were reviewed. Two cohorts were observed: patients who underwent decompression alone and patients who underwent decompression with instrumented fusion as the initial operation. Patient demographics and primary outcomes were analysed and compared. Results: Medical records of 74 patients with spinal infection were reviewed, and 47 patients met the inclusion criteria. There were 27 (57.4%) patients who underwent decompression alone and 20 (42.6%) patients who underwent decompression and fusion. There were no significant differences in the comorbidities, level, and/or extent of infectious involvement between the decompression alone cohort and the decompression with fusion cohort. Although no significant differences were seen between groups with regard to complication rates and neurological outcomes, the reoperation rate was significantly higher in the patients who underwent decompression alone (51.9% vs 10%, P = 0.004). Conclusions: Decompression with instrumented fusion delivers neurological outcomes and complication rates similar to those seen with decompression alone in patients with spondylodiscitis. However, there was a significantly higher reoperation rate in the decompression only cohort compared to the decompression and fusion cohort.