Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations
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 recomme...
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2025-01-01
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| author | 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 |
| author_facet | 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 |
| author_sort | Andreas Kramer |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-4066fb3f07004079a042ac40d0a2142f |
| institution | Kabale University |
| issn | 2772-5294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| series | Brain and Spine |
| spelling | doaj-art-4066fb3f07004079a042ac40d0a2142f2025-01-09T06:15:02ZengElsevierBrain and Spine2772-52942025-01-015104178Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendationsAndreas Kramer0Santhosh G. Thavarajasingam1Jonathan Neuhoff2Benjamin Davies3Giuseppe Barbagallo4Bertrand Debono5Bart Depreitere6Sven O. Eicker7Nikolay Gabrovsky8Marisa L. Gandia-Gonzalez9Marcel Ivanov10Radek Kaiser11Stanislav Kaprovoy12Nikolay Konovalov13Jesus Lafuente14Andrzej Maciejczak15Bernhard Meyer16Paulo Pereira17Yana Petrova18Wilco C. Peul19Carla Reizinho20Yu-Mi Ryang21Nico Sampron22Ralph Schär23Enrico Tessitore24Claudius Thomé25Jake Timothy26Carmen Vleggeert-Lankamp27Andreas K. Demetriades28Ehab Shiban29Florian Ringel30Department of Neurosurgery, University Medical Center Mainz, Mainz, GermanyDepartment of Neurosurgery, University Medical Center Mainz, Mainz, GermanyCenter for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, GermanyDepartment of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospital NHS Healthcare Trust, Cambridge, UKDepartment of Neurosurgery, University of Catania, Catania, ItalyCentre Francilien Du Dos, Clinique des Franciscaines, Versailles, FranceDepartment of Neurosurgery, University Hospitals Leuven, Leuven, BelgiumDepartment of Spine and Scoliosis Surgery, Lubinus Clinicum, Kiel, GermanyClinic of Neurosurgery, University Hospital Pirogov, Sofia, BulgariaDepartment of Neurosurgery, University Hospital La Paz, Madrid, SpainRoyal Hallamshire Hospital, Sheffield, UKDepartment of Spinal Surgery, Oxford University Hospitals, NHS Foundation Trust, Oxford, UKDepartment of Spinal and Peripheral Nerve Surgery, N.N. Burdenko National Medical Center of Neurosurgery, Mosocow, RussiaDepartment of Spinal and Peripheral Nerve Surgery, N.N. Burdenko National Medical Center of Neurosurgery, Mosocow, RussiaDepartment of Neurosurgery, Hospital Universitario Del Mar, Barcelona, SpainDepartment of Neurosurgery, St Lukas Hospital, Tarnów, Poland; Medical Faculty, University of Rzeszów, PolandDepartment of Neurosurgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, GermanyDepartment of Neurosurgery, ULS São João, Porto, Portugal; Faculty of Medicine, University of Porto, PortugalDepartment of Neurosurgery, University Hospital Sofiamed, Sofia, BulgariaDepartment of Neurosurgery, University Neurosurgical Centre Holland, Leiden University Medical Centre, Leiden, The Netherlands and Department of Neurosurgery, Haaglanden Medical Centre, The Hague, the NetherlandsDepartamento de Neurocirurgia, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, PortugalDepartment of Neurosurgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; Department of Neurosurgery & Center for Spine Therapy, Helios Klinikum Berlin-Buch, Berlin, GermanyServicio de Neurocirugía, Hospital Universitario Donostia, San Sebastian, SpainDepartment of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of Neurosurgery, Geneva University Hospitals, Geneva, SwitzerlandDepartment of Neurosurgery, Medical University Innsbruck, Innsbruck, AustriaDepartment of Neurosurgery, Leeds Teaching Hospital NHS Trust, Leeds, UKDepartment of Neurosurgery, Leiden University Medical Centre, Leiden, the NetherlandsDepartment of Neurosurgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UKDepartment of Neurosurgery, Lausitz University Hospital, Cottbus, GermanyDepartment of Neurosurgery, University Medical Center Mainz, Mainz, Germany; Corresponding author. Department of Neurosurgery University Medical Center Mainz Langenbeckstr. 1 55131, Mainz, Germany.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.http://www.sciencedirect.com/science/article/pii/S2772529424014346De novo spinal infectionSpondylodiscitisPyogenicNon-specificDiscitisSpinal osteomyelitis |
| spellingShingle | 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 Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations Brain and Spine De novo spinal infection Spondylodiscitis Pyogenic Non-specific Discitis Spinal osteomyelitis |
| title | Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations |
| title_full | Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations |
| title_fullStr | Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations |
| title_full_unstemmed | Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations |
| title_short | Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations |
| title_sort | diagnosis and management of de novo non specific spinal infections european association of neurosurgical societies eans spine section delphi consensus recommendations |
| topic | De novo spinal infection Spondylodiscitis Pyogenic Non-specific Discitis Spinal osteomyelitis |
| url | http://www.sciencedirect.com/science/article/pii/S2772529424014346 |
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