There is no difference in perioperative results between posterior instrumentation with and without interbody cage and debridement in primary spondylodiscitis in adults: a multicenter surveillance study from the German Spine Registry (DWG Register)

Primary spondylodiscitis is a medically challenging disease that can lead to recurrent back pain, progressive kyphotic deformity, and neurologic deficits. The incidence rate of primary non-tuberculosis spondylodiscitis has been estimated from 2.2 to 2.4 cases per 100,000 person-years, and it has been reported to be increasing because of the aging population. The objectives were to determine the safety and efficacy of posterior instrumentation (PI) with and without interbody cage, bony attachment and debridement in the treatment of primary spondylodiscitis by comparing perioperative data, functional outcomes, and overall infection-free survival.Analysis of data from the DWG Registry on patients who have undergone posterior instrumentation with and without interbody cage, bony attachment and debridement in primary spondylodiscitis from the thoracolumbar junction to S1 (Th10-S1) at 10 institutions from January 2012 to December 2016.In total, 420 posterior instrumentations with and without interbody cage, bony attachment and debridement in primary spondylodiscitis in the thoracolumbar junction to S1 were identified in the registry; N.=138 were exclusively percutaneous posterior instrumented (PPI), while N.=102 underwent open posterior instrumentation (OPI) without interbody cage, bony attachment and debridement and N.=180 OPI with interbody cage, bony attachment and debridement. Clinical evaluation after surgery did not show a significant difference between groups including improvement of the mobilization and infection-free survival. However, with PPI the duration of operation and blood loss was significantly less than OPI with and without interbody cage, bony attachment and debridement.The results suggest interbody cage, bony attachment and debridement as not indispensable for treatment in primary spondylodiscitis. Therefore, we encourage the use of posterior stabilization alone in the treatment of spondylodiscitis as less invasive procedure reducing costs in instrumentation.