Severity and Outcomes of Neurologic Deficits Associated with Pyogenic Spondylodiscitis: A Systematic Review

Abstract

Introduction: Patients with advanced pyogenic spondylodiscitis can present with neurologic deficits, however, the prevalence, severity, and outcome of the neurologic deficits are not well known. A systematic review was performed to improve knowledge of this commonly encountered clinical scenario. Methods: A comprehensive search of databases including PubMed, Science Direct and Google Scholar from 20002020 was performed. From 1478 articles, 75 were screened and 40 included. As the most commonly used classification for neurologic status was Frankel grading, we categorized the various neurologic findings corresponding to Frankel’s descriptions. Results of treatment were expressed as complete recovery, partial recovery, unchanged, or deterioration. Results: Among 3197 patients with pyogenic spondylodiscitis, 1314 cases showed a variety of neurologic manifestation: 415 (32%) presented with subjective symptoms including radicular pain, sciatica or numbness, 899 (28%) were diagnosed with a significant neurologic deficit on initial presentation. Patients with Frankel A/B deficits (N = 286, 22%) had the lowest proportion with complete recovery (16%) and the highest proportion to remain unchanged after treatment (34%). Patients with Frankel C deficits (N = 333, 25%) were more likely to have complete recovery (29%), although the majority had only partial recovery (53%), or remained unchanged (16%). Patients with Frankel D deficits (N = 280, 21%) were the most likely to experience complete recovery (53%) with a similar number of patients exhibited partial (25%) or no recovery (20%). A small percentage (2%) of patients in each Frankel group deteriorated after treatment. The comparison of neurologic outcome in the non-surgically treated (n = 97) versus surgically treated (n = 449) patients revealed that surgical intervention was associated with improved neurologic recovery (R = 0.205, p < 0.000). Conclusion: The considerable number of neurologic deficits in addition to their poor recovery even after surgical intervention demonstrates that early diagnosis of pyogenic spondylodiscitis is crucial. Prompt surgical intervention is likely associated with improved neurologic recovery when compared to non-surgical treatment.