About this Research Topic

Background

Despite the improvement of diagnostic methods and in prevention and treatment strategies, spinal infections are still a devastating disease with immense impact on patients' lives. Pyogenic Spondylodiscitis is associated with a high mortality rate and treatment strategies are often inconsistent. Considering the growing incidence of spinal infections and number of spinal procedures in an aging population, prevention of spondylodiscitis and the management of implant-associated vertebral osteomyelitis is becoming increasingly important. In particular, this geriatric population is prone to fatal disease courses, and optimal therapy must be chosen meticulously, taking into account various patient- and pathogen-related factors.

Accurate diagnostic tools are critical for the detection of spinal infections and the indication for surgery, but the sensitivity and specificity rates of different modalities vary considerably.

Identification of the causative pathogen enables targeted antibiotic therapy, which is a central pillar of both conservative and surgical therapy. However, the proportion of pathogen-negative spondylodiscitis and implant-associated vertebral osteomyelitis cases is high. Here, diagnostics face a challenge. Histopathology can provide important additional information. Further, the role of sonication of removed implants for microbiological diagnosis should be further evaluated.

In implant-associated vertebral osteomyelitis, differentiation from aseptic screw loosening and pseudarthrosis is often difficult. The importance of 18F-FDG PET/CT has been suggested but remains to be demonstrated.

In both spondylodiscitis and implant-associated vertebral osteomyelitis, the indication for surgery plays a critical role. The selection of patients who will best benefit from surgery is the focus of research efforts. On the other hand, identification of patients at risk of fulminant disease progression is critical for early and targeted treatment.

Finally, patient-centered criteria must be defined that support the decision-making for the surgical strategy, that ranges from abscess decompression, minimal invasive procedures to 360° stabilization with vertebral body replacement.

This special issue should, therefore, serve as a platform to deliver novel insights in prevention, diagnosis, decision making and treatment strategies of spinal infections. This special issue focuses on the following topics:

1. Diagnostic modalities that guide the indication of the therapeutic regimen.

2. The role of patient-, pathogen- and therapy-related factors on the clinical outcome.

3. Established and novel surgical techniques or potential alternatives.

We encourage authors to submit their original research articles and reviews for basic, clinical, and translational scientific papers to approach new frontiers in this important clinical and scientific field.

Keywords: Spinal Infection, Spondylodiscitis, Vertebral Osteomyelitis, Implant-associated Infection, Prevention, Antibiotic Stewardship, Surgery, Vertebral Body Replacement, Diagnostic Algorithm, Sonication, 18F-FDG PET/CT

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