Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations
Year: 2024
Type: article
Abstract: Introduction: The management of de novo non-specific spinal infections (spondylodiscitis - SD) remains inconsistent due to varying clinical practices and a lack of high-level evidence, particularly regarding the indications for surgery. Research question: This study aims to develop consensus recommendations for the diagnosis and management of SD, addressing diagnostic modalities, surgical indications, and treatment strategies. Material and methods: A Delphi process was conducted with 26 experts from the European Association of Neurosurgical Societies (EANS). Sixtytwo statements were developed on diagnostic workup, management decisions, surgical techniques, non-surgical treatment, and follow-up and submitted to the panel of experts. Results: Consensus was reached on 38 of 62 statements. MRI was confirmed as the gold standard for diagnosis. Regarding surgical indications, the panel agreed that any new neurological deficit, even subtle, warrants surgical consideration. Motor deficits with a motor score (MRC) below 4 and bladder or bowel dysfunction were unanimously considered clear indications for surgery. For spinal deformity and instability, thresholds such as kyphosis >20°, scoliosis >10°, and vertebral body collapse >50% were established to guide surgical decision-making. Minimally invasive surgery (MIS) was endorsed whenever feasible, and a 12 week antibiotic treatment regimen was favored in cases of complicated infections. Discussion and conclusion: This EANS consensus provides updated recommendations for SD management, incorporating recent evidence on improved outcomes with surgical therapy. While these guidelines offer a more structured approach to clinical decision-making, further research is required to optimize surgical timing and validate the long-term impact of these treatment strategies.
Source: Brain and Spine
Authors: Andreas Kramer, Santhosh G. Thavarajasingam, Jonathan Neuhoff, Benjamin Davies, Giuseppe Barbagallo, Bertrand Debono, Bart Depreitere, Sven O. Eicker, Nikolay Gabrovsky, Marisa L. Gandia-Gonzalez, Marcel Ivanov, Radek Kaiser, Stanislav Kaprovoy, Nikolay Konovalov, Jesus Lafuente, Andrzej Maciejczak, Bernhard Meyer, Paulo Pereira, Yana Petrova, Wilco C. Peul, Carla Reizinho, Yu-Mi Ryang, Nico Sampron, Ralph Schär, Enrico Tessitore, Claudius Thomé, Jake Timothy, Carmen Vleggeert-Lankamp, Andreas K. Demetriades, Ehab Shiban, Florian Ringel
Institutions: University Medical Center of the Johannes Gutenberg University Mainz, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, University of Cambridge, Addenbrooke's Hospital, University of Catania, Universitair Ziekenhuis Leuven, Hospital Universitario La Paz, Royal Hallamshire Hospital, Oxford University Hospitals NHS Trust, Burdenko Neurosurgery Institute, Hospital Del Mar, University of Rzeszów, TUM Klinikum, Technical University of Munich, Universidade do Porto, Hospital de São João, Medical University of Sofia, Leiden University, Leiden University Medical Center, Medisch Centrum Haaglanden, Stichting Haaglanden Medisch Centrum, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Helios Hospital Berlin-Buch, Donostiako Unibertsitate Ospitalea, University of Bern, University Hospital of Bern, University Hospital of Geneva, Innsbruck Medical University, Universität Innsbruck, Leeds Teaching Hospitals NHS Trust, NHS Lothian, Edinburgh Royal Infirmary, Medizinische Universität Lausitz - Carl Thiem
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,950
OpenAlex ID: W4405926668