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Therapie der Spondylodiszitis

Wann und wie konservativ – wann und wie operativ?

Treatment of spondylodiscitis

When and how conservatively—when and how operatively?

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Hintergrund

Die Spondylodiszitis ist eine seltene, aber komplexe Erkrankung mit steigender Inzidenz. Diagnostische Algorithmen und Behandlungsoptionen werden kontrovers diskutiert. Nationale Leitlinien sind zwar für Mai 2020 geplant, fehlen aber nach wie vor, so dass diagnostische Algorithmen und Behandlungsoptionen weiterhin kontrovers diskutiert werden.

Zielsetzung

Es erfolgen die Präsentation eines Diagnostikalgorithmus und Behandlungsvorschläge mit Fokus auf die antibiotische Therapie.

Methoden

Eine umfassende Literatursuche wurde durchgeführt, um klinische Studien, nationale Leitlinien, Reviewartikel und Expertenmeinungen zu identifizieren, analysieren und diskutieren.

Resultate

Aufgrund der unspezifischen Klinik erfolgt die Diagnosestellung häufig verzögert. Meist kann die korrekte Diagnose nur mithilfe einer Kombination aus klinischen, laborchemischen und radiologischen Befunden gestellt werden. Die antibiotische Therapie ist eine Säule der Spondylodiszitistherapie. Empfohlen wird eine umgehende empirische antibiotische Therapie bis zur Identifikation des Pathogens. Eine konservative Therapie kann in Erwägung gezogen werden, wenn keine neurologischen Defizite, größeren Abszesse, knöchernen Destruktionen, Instabilitäten oder ein septisches Krankheitsbild vorliegen. Eine engmaschige Reevaluation und klinische Kontrollen sind in der poststationären Nachbehandlung essenziell. Die zeitgerechte operative Therapie kann zu einer schnellen Besserung der neurologischen Symptomatik, einer Sicherung der Diagnose durch Probenentnahme, Stabilisierung und Vermeidung von Deformitäten führen.

Schlussfolgerung

Die Diagnosestellung und Behandlung der Spondylodiszitis stellt eine Herausforderung dar und ist nach wie vor assoziiert mit einer hohen Morbidität und Mortalität. Schlüsselfaktoren einer erfolgreichen Behandlung sind die schnelle und korrekte Diagnosestellung und die adäquate antibiotische Therapie.

Abstract

Background

Spondylodiscitis is a rare but complex disease with an increasing incidence. Diagnostic algorithms and treatment options for spondylodiscitis are controversially discussed. National guidelines for Germany do not currently exist but are planned for May 2020.

Objective

A diagnostic algorithm and treatment recommendations are presented with a focus on antibiotic treatment.

Methods

A comprehensive literature search was performed using the PubMed database to identify, analyze and discuss clinical studies, national guidelines, systematic and narrative reviews as well as expert opinions.

Results

The diagnostics of spondylodiscitis are often delayed due to the nonspecific clinical manifestation. The correct diagnosis can mostly be made using a combination of clinical, laboratory and radiographic findings. An immediate empirical antimicrobial treatment is recommended until the pathogen has been identified. Conservative treatment can be considered in patients without neurological deficits, larger abscesses, bony destruction, instability or sepsis. A continuous re-evaluation and clinical control are essential in the posthospital follow-up treatment. The timely operative treatment can lead to a rapid improvement of neurological symptoms, diagnosis confirmation through intraoperative samples, stabilization and prevention of deformities.

Conclusion

The diagnostics and treatment of spondylodiscitis are a challenge and it is still associated with a high morbidity and mortality. Rapid and correct diagnosis as well as an adequate antimicrobial therapy are key factors for a successful treatment of spondylodiscitis.

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Authors and Affiliations

  1. Chirurgische Universitäts- und Poliklinik, BG Universitätsklinikum Bergmannsheil Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland

    E. Yilmaz, C. Kruppa, T. A. Schildhauer & M. F. Hoffmann

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  1. E. Yilmaz
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  2. C. Kruppa
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Correspondence to E. Yilmaz.

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E. Yilmaz, C. Kruppa, T.A. Schildhauer und M.F. Hoffmann geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

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Yilmaz, E., Kruppa, C., Schildhauer, T.A. et al. Therapie der Spondylodiszitis. Trauma Berufskrankh 21, 236–246 (2019). https://doi.org/10.1007/s10039-019-00445-0

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