Diagnostic and therapeutic management of lumbar and thoracic spondylodiscitis - an evaluation of 59 cases

Fifty-nine patients with spondylodiscitis (SD) of the thoracic and/or lumba r spine were followed-up clinically and radiologically [X-ray, computed tom ography (CT), magnetic resonance imaging (MRI)] over a mean time of 2.2 yea rs (1-6.5 years). All patients without abscess formation (n = 35) were trea ted conservatively. Out of the group with abscess formation (n = 24) 6 pati ents were also treated conservatively, II were drained under CT control and 7 were operated. At time of diagnosis, "signs of florid inflammation" were seen in 60% of the roentgenograms, in 93% of the CTs and in all of the MRI s. The sensitivity to differentiate between SD with and without abscess for mation was 85% by MRI and 69% by CT. "Signs of regressive inflammation" and "signs of increasing osseous consolidation", essential facts for starting remobilization, could first be seen using CT 6 weeks after onset of therapy . Using MRI these signs were seen with a considerable delay at 12 weeks. Cl inically, only 3 of the 59 analyzed patients developed recurrent SD. In con clusion, MRI is the radiological method of choice for establishing the diag nosis of SD, in particular with regard to differentiating between cases wit h and without abscess formations. In contrast, CT is superior for performin g success control after treatment. Therapeutically, conservative, minimal-i nvasive and operative procedures are not rival but rather complementary.