Deformity Progression in Non-Tuberculous Spinal Infection
Pengsuwan G, MD1, Chotivichit A, MD1, Korwutthikulrangsri E, MD1
Affiliation : 1 Siriraj Spinal Unit, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Spinal infection accounts for 2 to 7% of all musculoskeletal infections. Surgical treatment is normally indicated in
concurrent neurological deficit that requires decompression, and in failure of medical treatment. Spinal deformity and instability are
also potential indications for surgical treatment. Few studies have investigated the factors associated with deformity progression.
Objective : To investigate the incidence of and factors associated with the development of spinal deformity in non-tuberculous
spinal infection.
Materials and Methods : A retrospective review of patients diagnosed with spinal infection by clinical and imaging study at Siriraj
Hospital (Bangkok, Thailand) from January 2009 to December 2015 was conducted. The exclusion criteria were suspected or
confirmed diagnosis of tuberculous infection, age under 18 years, no radiographic study available, and/or loss to follow-up before
6 months. Radiographic parameters at initial presentation and at follow-up were recorded. Cobb angles that changed more than 10
degrees, or vertebral height loss of more than 15% compared to the initial measurement were defined as deformity.
Results : There were 62 non-tuberculous spinal infections included in the present study composed of 30 females and 32 males with
a mean age of 61.3 years (range 28 to 89). The most common site of infection was the lumbar spine (65.1%), followed by the thoracic
spine (26.7%)then cervical spine (7.9%). Location of infection was a significant factor associated with deformity (p = 0.006)
Causative pathogen was identified in 35 patients (56.5%). The most frequently observed organism was S. aureus (16.1%), followed
by E. coli and S. agalactiae (both 9.7%). Spinal deformities were detected in 39 patients (62.9%). Surgical treatment was performed
in 35 patients (56.5%).
Conclusion : In the present study, 62.9% of patients developed deformity, and most commonly in the lumbar spine. Location of the
infection and number of the infected vertebrae are the significant factors associated with deformity progression.
Keywords : Spinal deformity, Spinal infection, Spondylodiscitis, Osteomyelitis, Bacteria, Non-tuberculous
