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Spondylodiscitis is a serious and potentially life-threatening disease. Obesity is a risk factor for many infections, and its prevalence is increasing worldwide. Thus, the aim of this study was to describe characteristics of obese patients with spondylodiscitis and identify risk factors for a severe disease course in obese patients. Between December 2012 and June 2018, clinical records were screened for patients admitted for spondylodiscitis. The final analysis included 191 adult patients (mean age 64.6 ± 14.8 years). Patient data concerning demographics, comorbidities, surgical treatment, laboratory testing, and microbiological workup were analysed using an electronic database. Patients were grouped according to body mass index (BMI) as BMI ≥ 30 kg/m 2 or < 30 kg/m 2 . Seventy-seven patients were classified as normal weight (BMI 18.5–24.9 kg/m 2 ), 65 as preobese (BMI 25–29.9 kg/m 2 ), and 49 as obese (BMI ≥ 30 kg/m 2 ). Obese patients were younger, had a higher revision surgery rate, and showed higher rates of abscesses, neurological failure, and postoperative complications. A different bacterial spectrum dominated by staphylococci species was revealed ( p  = 0.019). Obese patients with diabetes mellitus had a significantly higher risk for spondylodiscitis ( p  = 0.002). The mortality rate was similar in both cohorts, as was the spondylodiscitis localisation. Obesity, especially when combined with diabetes mellitus, is associated with a higher proportion of Staphylococcus aureus infections and is a risk factor for a severe course of spondylodiscitis, including higher revision rates and sepsis, especially in younger patients.

Demographic aging accompanied by increased falls inevitably leads to an increased incidence of atlantoaxial instabilities (AAI). Minimally invasive surgical procedures decrease the perioperative risk and regarding the treatment of AAI, percutaneous transarticular screw fixation of C1/C2 was more frequently considered in the past. This study aims to investigate the outcome of patients treated for AAI by isolated percutaneous transarticular screw fixation of C1/C2 (IPTSFC1/C2) using 3.5 mm fully threaded screws to identify its chances and limitations. In this retrospective study, data from patients who underwent IPTSFC1/C2 were analyzed. 23 patients (17 females and 6 males) with an average age of 73.1 years (y) were included. Mean VAS decreased significantly from preoperative 3.9 ± 1.8 to the last follow-up 2.6 ± 2.5 (p = 0.020) and neurological functions were preserved. In the radiological follow-up, we saw a single malposition of an inserted screw (2.27%) and one single bony fusion (4.54%). However, in 6 of 7 patients (85.71%), there was a loosening of the inserted screws due course. We demonstrated that the use of 3.5 mm fully threaded screws for IPTSFC1/C2 results in low rates of osseous fusions between C1 and C2. Therefore, their use in IPTSFC1/C2 is not suitable, especially for geriatric patients with impaired bone status.

Background and Objectives: In osteoporotic fractures of the spine with resulting kyphosis and threatening compression of neural structures, therapeutic decisions are difficult. The posterior vertebral column resection (pVCR) has been described by different authors as a surgical treatment in a single-stage posterior procedure. The aim of this study is to evaluate midterm outcomes of patients treated by pVCR due to severe osteoporotic fractures. Materials and Methods: Retrospective data analysis of all the patients treated for osteoporotic fractures by pVCR from 2012–2020 at two centers was performed. Demographic data, visual analog scale (VAS), Frankel scale (FS), Karnofsky performance status (KPS), radiological result and spinal fusion rates were evaluated. Results: A total of 17 patients were included. The mean age was 70 ± 10.2 y. The mean VAS decreased significantly from 7.7 ± 2.8 preoperatively to 3.0 ± 1.6 at last follow-up (p < 0.001) and the segmental kyphosis decreased from 29.4 ± 14.1° to 7.9 ± 8.0° (p < 0.001). The neurologic function on the FS did not worsen in any and improved in four of the patients. The median KPS remained stable over the whole observation period (70% vs. 70%). Spinal fusion was observed in nine out of nine patients who received CT follow-up >120 days after index surgery. Conclusions: This study showed that pVCR is a safe surgical technique with few surgical complications and no neurological deterioration considering the cohort. The patients’ segmental kyphosis and VAS improved significantly, while the KPS remained stable.

Patients with new-onset malignant spinal lesions often have an urgent need for local spine intervention and systemic therapy. For optimal management, it is crucial to diagnose the underlying disease as quickly and reliably as possible. The aim of our current study was to determine the feasibility, sensitivity, specificity, and diagnostic certainty of complementary cytological evaluation of spinal lesions suspected of malignancy. In 44 patients, we performed histopathological biopsies and in parallel cytologic preparations from the malignant site. Cytological smears were prepared and stained for May-Grunwald and Giemsa. Bone biopsies were histopathologically analyzed according to the existing standard-of-care practices. In 42 of 44 cases (95%), a cytological sample was successfully obtained. In 40 cases (95.2%, Cohen’s kappa: 0.77), the cytological diagnosis agreed with the histological diagnosis regarding the identification of a malignant lesion. This resulted in a sensitivity of 97% and a specificity of 80% as well as a diagnostic safety of 95%. Cytological analysis in the context of spinal surgery proved sufficient to establish a diagnosis of malignancy or its exclusion, expanding the existing diagnostic spectrum. Furthermore, implementation of this process as a routine clinical diagnostic might shorten the time to diagnosis and improve the treatment of this vulnerable patient group.

PurposeThis study sought to recognize differences in clinical disease manifestations of spondylodiscitis depending on the causative bacterial species.MethodsWe performed an evaluation of all spondylodiscitis cases in our clinic from 2013–2018. 211 patients were included, in whom a causative bacterial pathogen was identified in 80.6% (170/211). We collected the following data; disease complications, comorbidities, laboratory parameters, abscess occurrence, localization of the infection (cervical, thoracic, lumbar, disseminated), length of hospital stay and 30-day mortality rates depending on the causative bacterial species. Differences between bacterial detection in blood culture and intraoperative samples were also recorded.ResultsThe detection rate of bacterial pathogens through intraoperative sampling was 66.3% and could be increased by the results of the blood cultures to a total of 80.6% (n = 170/211). S. aureus was the most frequently detected pathogen in blood culture and intraoperative specimens and and was isolated in a higher percentage cervically than in other locations of the spine. Bacteremic S. aureus infections were associated with an increased mortality (31.4% vs. overall mortality of 13.7%, p = 0.001), more frequently developing complications, such as shock, pneumonia, and myocardial infarction. Comorbidities, abscesses, length of stay, sex, and laboratory parameters all showed no differences depending on the bacterial species.ConclusionBlood culture significantly improved the diagnostic yield, thus underscoring the need for a structured diagnostic approach. MSSA spondylodiscitis was associated with increased mortality and a higher incidence of complications.

Background/Objectives: Vitamin D deficiency contributes to pathological vertebral fragility (path-VF), including fragility fractures and early pedicle screw loosening after posterior instrumented spinal fusion (PISF). Supplementation practices remain inconsistent. This retrospective study evaluated whether patients with path-VF receive appropriate vitamin D3 (Vit.D3) supplementation and assessed the dose–response relationship between daily intake and path-VF risk, particularly in older adults. Methods: A total of 210 patients treated with kyphoplasty or PISF (2022–2023) were classified into a path-VF or control group. Daily oral Vit.D3 intake was categorised as Zero- (0 IU), Low- (<2000 IU), or High-Dose (≥2000 IU). Statistical analyses were performed for each dosage group, including subgroup analyses for patients aged ≥67.5 years. Vertebral BMD was estimated using mean Hounsfield Units (HU) from T11–L5. Results: Patients in the path-VF group received significantly lower Vit.D3 doses than controls (1431.4 ± 1055.7 vs. 2366.7 ± 1186.7 IU/day, p < 0.001). Low-dose supplementation was associated with a markedly increased risk of path-VF compared with high-dose in the overall cohort (OR = 6.5, p = 0.003) and in patients aged ≥67.5 years (OR = 8.6, p = 0.008). Logistic regression identified a threshold of 1900 IU/day (AUC = 0.805). Mean vertebral HU values were significantly lower in the path-VF group than in controls (71.9 ± 29.1 vs. 133.5 ± 52.6, p < 0.001), and no consistent HU gains were observed with increasing Vit.D3 dosage. Conclusions: Low-dose Vit.D3 supplementation was associated with increased path-VF risk, especially in patients aged >67.5 years. Patients without path-VF had received significantly higher doses, suggesting broader benefits of adequate Vit.D3 beyond bone density. A daily intake above 1900 IU may serve as a practical threshold for at-risk elderly patients.

PurposeSurgical intervention with intercorporal stabilisation in spinal infections is increasingly needed. Our aim was to compare titanium and polyetheretherketon (PEEK) cages according to their adhesion characteristics of different bacteria species in vitro. MethodsPlates made from PEEK, polished titanium (Ti), two-surface-titanium (TiMe) (n = 2–3) and original PEEK and porous trabecular structured titanium (TiLi) interbody cages (n = 4) were inoculated in different bacterial solutions, S.aureus (MSSA, MRSA), S.epidermidis and E.coli. Growth characteristics were analysed. Biofilms and bacteria were visualised using confocal- and electron microscopy.ResultsQuantitative adherence of MSSA, MRSA, S.epidermidis and E.coli to Ti, TiMe and PEEK plates were different, with polished titanium being mainly advantageous over PEEK and TiMe with significantly less counts of colony forming units (CFU) for MRSA after 56 h compared to TiMe and at 72 h compared to PEEK (p = 0.04 and p = 0.005). For MSSA, more adherent bacteria were detected on PEEK than on TiMe at 32 h (p = 0.02). For PEEK and TiLi cages, significant differences were found after 8 and 72 h for S.epidermidis (p = 0.02 and p = 0.008) and after 72 h for MSSA (p = 0.002) with higher bacterial counts on PEEK, whereas E.coli showed more CFU on TiLi than PEEK (p = 0.05). Electron microscopy demonstrated enhanced adhesion in transition areas.ConclusionFor S.epidermidis, MSSA and MRSA PEEK cages showed a higher adherence in terms of CFU count, whereas for E.coli PEEK seemed to be advantageous. Electron microscopic visualisation shows that bacteria did not adhere at the titanium mesh structure, but at the border zones of polished material to rougher parts.

Background: Spondylodiscitis is an infectious disease affecting an intervertebral disc and the adjacent vertebral bodies and is often the complication of a distant focus of infection. This study aims to ascertain the regional and hospital-specific disparities in bacterial patterns and resistance profiles in spontaneous and iatrogenic spondylodiscitis and their implications for patient treatment. Methods: We enrolled patients from two German hospitals, specifically comparing a university hospital (UVH) with a peripheral non-university hospital (NUH). We documented patient demographics, laboratory results, and surgical interventions. Microbiological assessments, antibiotic regimens, treatment durations, and resistance profiles were recorded. Results: This study included 135 patients. Upon admission, 92.4% reported pain, with 16.2% also presenting neurological deficits. The primary microbial species identified in both the UVH and NUH cohorts were S. aureus (37.3% vs. 31.3%) and cog. neg. staphylococci (28.8% vs. 34.4%), respectively. Notably, a higher prevalence of resistant bacteria was noted in the UVH group (p < 0.001). Additionally, concomitant malignancies were significantly more prevalent in the UVH cohort. Conclusion: Significant regional variations exist in bacterial prevalence and resistance profiles. Consequently, treatment protocols need to consider these nuances and undergo regular critical evaluation. Moreover, patients with concurrent malignancies face an elevated risk of spondylodiscitis.

Malignant spinal lesions (MSLs) are frequently the first manifestation of malignant disease. Spinal care, diagnostic evaluation, and the initiation of systemic therapy are crucial for outcomes in patients (pts) with advanced cancer. However, histopathology (HP) may be time consuming. The additional evaluation of spinal lesions using cytopathology (CP) has the potential to reduce the time to diagnosis (TTD) and time to therapy (TTT). CP and HP specimens from spinal lesions were evaluated in parallel in 61 pts (CP/HP group). Furthermore, 139 pts in whom only HP was performed were analyzed (HP group). We analyzed the TTD of CP and HP within the CP/HP group. Furthermore, we compared the TTD and TTT between the groups. The mean TTD in CP was 1.7 ± 1.7 days (d) and 8.4 ± 3.6 d in HP (p < 0.001). In 13 pts in the CP/HP group (24.1%), specific therapy was initiated based on the CP findings in combination with imaging and biomarker results before completion of HP. The mean TTT in the CP/HP group was 21.0 ± 15.8 d and was significantly shorter compared to the HP group (28.6 ± 23.3 d) (p = 0.034). Concurrent CP for MSLs significantly reduces the TTD and TTT. As a result, incorporating concurrent CP for analyzing spinal lesions suspected of malignancy might have the potential to enhance pts’ quality of life and prognosis in advanced cancer. Therefore, we recommend implementing CP as a standard procedure for the evaluation of MSLs.

IntroductionVery few publications have previously described spondylodiscitis as a potential complication of endovascular aortic procedures (EVAR/TEVAR). We present to our knowledge the first case series of spondylodiscitis following EVAR/TEVAR based on our data base. Particular focus was laid on the complexity of disease treatment and grave outcome perspectives from a spine surgeon’s point of view in this seriously affected patient group.Materials and methodsA retrospective analysis and chart review was performed for 11 out of 284 consecutive spondylodiscitis patients who underwent EVAR/TEVAR procedure and developed destructive per continuitatem spondylodiscitis.ResultsAll 11 patients had single or more level destructive spondylodiscitis adjacent to the thoracic/lumbar stent graft. In mean, four surgeries were performed per patient to treat this rare complication. Six out of eleven patients (55%) died within 6 months of first identification of per continuitatem spondylodiscitis. In four patients due to persisting infection of the graft and recurrence of the abscess formation, a persisting fistula from anterior approach to the skin was applied.ConclusionsDestructive per continuitatem spondylodiscitis is a rare and severe complication post-EVAR/TEVAR. Clinical and imaging features of anterior paravertebral disease and anterior vertebral body involvement suggest direct continuous spread of the graft infection to the adjacent vertebral column. The mortality rate of these severe infections is extremely high and treatment with a permanent fistula may be one salvage procedure.