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Spondylodiscitis is the commonest spine infection, and pyogenic spondylodiscitis is the most common subtype. Whilst antibiotic therapy is the mainstay of treatment, some advocate that early surgery can improve mortality, relapse rates, and length of stay. Given that the condition carries a high mortality rate of up to 20%, the most effective treatment must be identified. We aimed to compare the mortality, relapse rate, and length of hospital stay of conservative versus early surgical treatment of pyogenic spondylodiscitis. All major databases were searched for original studies, which were evaluated using a qualitative synthesis, meta-analyses, influence, and regression analyses. The meta-analysis, with an overall pooled sample size of 10,954 patients from 21 studies, found that the pooled mortality among the early surgery patient subgroup was 8% versus 13% for patients treated conservatively. The mean proportion of relapse/failure among the early surgery subgroup was 15% versus 21% for the conservative treatment subgroup. Further, it concluded that early surgical treatment, when compared to conservative management, is associated with a 40% and 39% risk reduction in relapse/failure rate and mortality rate, respectively, and a 7.75 days per patient reduction in length of hospital stay (p < 0.01). The meta-analysis demonstrated that early surgical intervention consistently significantly outperforms conservative management in relapse/failure and mortality rates, and length of stay, in patients with pyogenic spondylodiscitis.

Pyogenic spondylodiscitis presents significant diagnostic and therapeutic challenges. In Germany, a comprehensive understanding of its epidemiology and inpatient management outcomes is limited, hindering the optimisation of therapeutic strategies. This study aimed to characterise the evolving epidemiological trends of pyogenic spondylodiscitis in Germany, and concurrently evaluate inpatient management strategies and outcomes. We performed a retrospective population-based study of spondylodiscitis cases in Germany from 2005 to 2021, utilising data from the German Federal Statistical Office database. The parameters assessed were incidence trends, demographic characteristics, inpatient management strategies, and inpatient mortality. The study found a significant rise in the population-adjusted incidence of spondylodiscitis in Germany from 2005 to 2021, increasing by 104% from 5.4 to 11.0 cases per 100,000 individuals (p < 0.001). The highest number of diagnoses was recorded in 2019. Age group-adjusted data revealed the largest relative changes in the “90 + ” age group, followed by the “80–89” and “70–79” age groups. These increases were not solely attributable to population changes but were also confirmed after calculating the age-group-adjusted incidence rates. Additionally, our statistical analysis demonstrated that both age and year significantly influenced the incidence of spondylodiscitis. Over the same period, inpatient mortality also surged significantly by 347% (p < 0.001), with the highest increase recorded in the 90 + age group, observing a 2450% rise (p < 0.001). The mean length of inpatient stay decreased by 15% (p < 0.05). Concurrently, there was a significant increase in surgical interventions using spinal stabilisation procedures (p < 0.001), which might suggest a shift in the treatment paradigm for spondylodiscitis. The results underscore a concerning rise in spondylodiscitis incidence and mortality in Germany, particularly affecting the ageing population. A notable shift towards surgical intervention was observed. The data highlights the urgent necessity for high-level evidence studies comparing surgical versus conservative treatment, thereby guiding optimised therapeutic strategies.

With the increasing prevalence of vertebral fractures, accurate diagnosis and prognostication are essential. This study assesses the effectiveness of AI in diagnosing and predicting vertebral fractures through a systematic review and meta-analysis. A comprehensive search across major databases selected studies utilizing AI for vertebral fracture diagnosis or prognosis. Out of 14,161 studies initially identified, 79 were included, with 40 undergoing meta-analysis. Diagnostic models were stratified by pathology: non-pathological vertebral fractures, osteoporotic vertebral fractures, and vertebral compression fractures. The primary outcome measure was AUROC. AI showed high accuracy in diagnosing and predicting vertebral fractures: predictive AUROC = 0.82, osteoporotic vertebral fracture diagnosis AUROC = 0.92, non-pathological vertebral fracture diagnosis AUROC = 0.85, and vertebral compression fracture diagnosis AUROC = 0.87, all significant (p < 0.001). Traditional models had the highest median AUROC (0.90) for fracture prediction, while deep learning models excelled in diagnosing all fracture types. High heterogeneity (I² > 99%, p < 0.001) indicated significant variation in model design and performance. AI technologies show considerable promise in improving the diagnosis and prognostication of vertebral fractures, with high accuracy. However, observed heterogeneity and study biases necessitate further research. Future efforts should focus on standardizing AI models and validating them across diverse datasets to ensure clinical utility.

The right inferior frontal cortex (rIFC) is frequently activated during executive control tasks. Whereas the function of the dorsal portion of rIFC, more precisely the inferior frontal junction (rIFJ), is convergingly assigned to the attention system, the functional key role of the ventral portion, i.e., the inferior frontal gyrus (rIFG), is hitherto controversially debated. Here, we used a two-step methodical approach to clarify the differential function of rIFJ and rIFG. First, we used event-related functional magnetic resonance imaging (fMRI) during a modified stop signal task with an attentional capture condition (acSST) to delineate attentional from inhibitory motor processes (step 1). Then, we applied coordinate-based meta-analytic connectivity modeling (MACM) to assess functional connectivity profiles of rIFJ and rIFG across various paradigm classes (step 2). As hypothesized, rIFJ activity was associated with the detection of salient stimuli, and was functionally connected to areas of the ventral and dorsal attention network. RIFG was activated during successful response inhibition even when controlling for attentional capture and revealed the highest functional connectivity with core motor areas. Thereby, rIFJ and rIFG delineated largely independent brain networks for attention and motor control. MACM results attributed a more specific attentional function to rIFJ, suggesting an integrative role between stimulus-driven ventral and goal-directed dorsal attention processes. In contrast, rIFG was disclosed as a region of the motor control but not attention system, being essential for response inhibition. The current study provides decisive evidence regarding a more precise functional characterization of rIFC subregions in attention and inhibition.

Study Design Retrospective multicenter study. Objective To examine the epidemiology and clinical outcomes of spondylodiscitis in patients with intravenous drug abuse (IVDU) and compare them with non-IVDU patients. Methods Data from 575 patients diagnosed with spondylodiscitis between 1 January 2018 and 31 December 2023 from three high-volume spine centers was analyzed. Of these, 33 (5.74%) were patients with IVDU, and 542 (94.26%) were non-IVDU patients. Clinical characteristics, bacterial spectrum, and treatment outcomes, including revision surgery rates and cure rates, were compared. Results Patients with IVDU were significantly younger (mean age 43.9 ± 9.1 years) compared to non-IVDU patients (mean age 70.5 ± 11.9 years) (P < .0001). The median Charlson Comorbidity Index (CCI) was significantly lower in IVDU patients (1, IQR: 0-3) compared to non-IVDU patients (4, IQR: 3-6) (P < .0001). The bacterial spectrum was similar between both groups, with Staphylococcus aureus as the most frequent pathogen. Revision surgery rates were comparable; however, among patients requiring revision, recurrent or progressive discitis was more frequently the cause in IVDU patients (55.6%) compared to non-IVDU patients (17.9%). At 10-week follow-up, 87.9% of non-IVDU patients were cured, while only 57.9% of IVDU patients achieved a cure (P = .0018). Conclusions IVDU patients with spondylodiscitis are younger and have fewer comorbidities than non-IVDU patients. Contrary to common assumptions, they do not present with more severe infections. However, they experience higher relapse and progression rates, highlighting the need for tailored treatment strategies in this high-risk group.

Ankylosing spinal diseases, such as ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH), are highly important in spinal traumatology and are therefore specifically considered in the AO Spine Classification of spinal injuries. These diseases make the spine extremely susceptible to injury and also complicate the diagnosis and treatment, leading to an increased mortality. Concomitant neurological injuries are frequent. The treatment of such injuries requires great attention and careful preparation. Early and precise diagnostics using computed tomography (CT) and magnetic resonance imaging (MRI) as well as a surgical intervention are crucial for the survival and the quality of life of patients. The treatment is carried out surgically as conservative treatment often leads to high complication rates. In postoperative care special attention must be paid to cardiopulmonary complications.

Bone cement has been used in spinal surgery for as long as 50 years. In contemporary spinal surgery, cement augmentation of fractured osteoporotic vertebrae in the form of vertebroplasty/kyphoplasty as well as cement augmentation of pedicle screws in instrumented procedures of any etiology are established as standard procedures. Both procedures are very effective, although the benefits of vertebroplasty/kyphoplasty procedures have been controversially discussed in the past. Overall, complications rarely occur. The most relevant complication is cement leakage, which is asymptomatic in the majority of cases but in the worst case might lead to neurological deficits, embolic events and even circulatory collapse. Prevention of cement leakage is therefore crucial. Risk factors for cement leakage and preventive measures are presented in a comprehensive review based on the available literature.Bone cement has been used in spinal surgery for as long as 50 years. In contemporary spinal surgery, cement augmentation of fractured osteoporotic vertebrae in the form of vertebroplasty/kyphoplasty as well as cement augmentation of pedicle screws in instrumented procedures of any etiology are established as standard procedures. Both procedures are very effective, although the benefits of vertebroplasty/kyphoplasty procedures have been controversially discussed in the past. Overall, complications rarely occur. The most relevant complication is cement leakage, which is asymptomatic in the majority of cases but in the worst case might lead to neurological deficits, embolic events and even circulatory collapse. Prevention of cement leakage is therefore crucial. Risk factors for cement leakage and preventive measures are presented in a comprehensive review based on the available literature.

Zusammenfassung Ankylosierende Wirbelsäulenerkrankungen wie die ankylosierende Spondylitis (AS) und die diffuse idiopathische skeletale Hyperostose (DISH) sind in der Wirbelsäulentraumatologie von hoher Bedeutung und werden in der AO-Spine-Klassifikation für Wirbelsäulenverletzungen besonders berücksichtigt. Diese Erkrankungen machen die Wirbelsäule äußerst anfällig für Verletzungen und erschweren zudem die Diagnose und Behandlung, was zu einer erhöhten Mortalität führt. Neurologische Begleitverletzungen sind häufig. Die Therapie solcher Verletzungen erfordert eine hohe Aufmerksamkeit und sorgfältige Vorbereitung. Eine frühe und präzise Diagnostik mithilfe von CT und MRT sowie eine operative Intervention sind entscheidend für das Überleben und die Lebensqualität der Patienten. Die Behandlung erfolgt fast immer operativ, da konservative Behandlungen oft mit hohen Komplikationsraten einhergehen. In der postoperativen Betreuung muss v. a. auf kardiopulmonale Komplikationen geachtet werden.

Zusammenfassung Knochenzement wird an der Wirbelsäule schon seit 50 Jahren verwendet. In der modernen Wirbelsäulenchirurgie sind die Zementaugmentation osteoporotisch frakturierter Wirbelkörper in Form der Vertebroplastie/Kyphoplastie sowie die Zementaugmentation von Pedikelschrauben bei instrumentierten Eingriffen jedweder Ätiologie als Standardverfahren etabliert. Beide Verfahren sind sehr effektiv, wobei der Nutzen der Vertebroplastie/Kyphoplastie in der Vergangenheit sehr kontrovers diskutiert wurde. Insgesamt treten selten Komplikationen auf. Die relevanteste Komplikation ist die Zementleckage, die in der Mehrzahl der Fälle asymptomatisch bleibt, im schlimmsten Fall aber auch neurologische Schäden oder embolische Ereignisse bis hin zum Kreislaufversagen nach sich ziehen kann. Der Prophylaxe der Zementextravasation kommt daher überragende Bedeutung zu. Risikofaktoren für die Zementleckage und vorbeugende Maßnahmen werden anhand der vorhandenen Literatur in einem umfassenden Review dargestellt.

ZusammenfassungKnochenzement wird an der Wirbelsäule schon seit 50 Jahren verwendet. In der modernen Wirbelsäulenchirurgie sind die Zementaugmentation osteoporotisch frakturierter Wirbelkörper in Form der Vertebroplastie/Kyphoplastie sowie die Zementaugmentation von Pedikelschrauben bei instrumentierten Eingriffen jedweder Ätiologie als Standardverfahren etabliert. Beide Verfahren sind sehr effektiv, wobei der Nutzen der Vertebroplastie/Kyphoplastie in der Vergangenheit sehr kontrovers diskutiert wurde. Insgesamt treten selten Komplikationen auf. Die relevanteste Komplikation ist die Zementleckage, die in der Mehrzahl der Fälle asymptomatisch bleibt, im schlimmsten Fall aber auch neurologische Schäden oder embolische Ereignisse bis hin zum Kreislaufversagen nach sich ziehen kann. Der Prophylaxe der Zementextravasation kommt daher überragende Bedeutung zu. Risikofaktoren für die Zementleckage und vorbeugende Maßnahmen werden anhand der vorhandenen Literatur in einem umfassenden Review dargestellt.