Assessment of Therapeutic Decision-Making in Spontaneous Spondylodiscitis: A Retrospective Study Across 2 Neurosurgical Centers.

Abstract

Spondylodiscitis requires timely diagnosis and intervention to prevent infection progression and long-term complications. While clinical experience often guides treatment decisions, the lack of strong evidence-based protocols has created a significant gap in care. To address this, Pluemer et al. developed the "Spinal Infection Treatment Evaluation" (SITE) score, which incorporates variables such as neurological symptoms, infection location, radiological findings, pain severity, and comorbidities, to support neurosurgeons in making more evidence-based therapeutic decisions. A retrospective study was conducted on 42 patients with de novo spinal infections who underwent surgery between March 2018 and March 2023 at 2 neurosurgical centers. All patients were aged more than 18 years and had not responded to medical therapy. Key data, including patient demographics, infection sites, laboratory results (C-reactive protein, white blood cell), neurological status, and magnetic resonance imaging findings were examined. Functional outcomes were measured using the visual analog scale and Core Outcome Measures Index. The SITE score was applied retrospectively to assess its relevance to treatment decisions. Staphylococcus aureus was the most frequent pathogen (47.6%), and 76% of patients presented with neck or back pain. The SITE score accurately predicted surgical intervention in 98% of cases. Pain levels significantly decreased, with the preoperative visual analog scale score of 6.59 reducing to 2.17 6 months post-treatment. Functional improvements were also evident, with Core Outcome Measures Index scores dropping from 5.4 preoperatively to 1.9 at 6 months. The SITE score proves to be a promising tool for evaluating the severity of de novo spinal infections and guiding treatment strategies. By integrating multiple clinical factors, it offers an objective framework that can enhance patient outcomes. However, further validation across different clinical settings is needed to solidify its utility in evidence-based care.