Aktuelle Behandlungsstrategien der Spondylodiszitis in deutschen Akutkliniken

Zusammenfassung

Hintergrund: Die Spondylodiszitis ist eine seltene Erkrankung, die mit einer hohen Mortalität einhergeht. Behandlungsleitlinien existieren nicht, die Studienlage ist inhomogen. Mit Algorithmen wurde in den letzten Jahren versucht, die Therapie zu strukturieren. Vor allem das frühzeitige Erkennen der Erkrankung ist für das spätere Outcome wichtig. Die Therapie erfolgt sowohl in orthopädisch/unfallchirurgischen als auch in neurochirurgischen Kliniken. Material und Methoden: Eine Umfrage zu diesem Thema wurde von uns online an orthopädische, unfallchirurgische und neurochirurgische Kliniken in Deutschland geschickt. Ziel war es, die aktuellen Versorgungsstrategien in Deutschland zu erfassen. Zusätzlich sollten Unterschiede zwischen den Fachbereichen eruiert werden. Ergebnisse: Insgesamt beantworteten 164 Kliniken die Umfrage. Die Rücklaufquote betrug 16 % bei den orthopädisch/unfallchirurgischen und 32 % bei den neurochirurgischen Kliniken. Unterschiede zwischen den beiden Fachbereichen finden sich insbesondere bei der Verwendung systemischer und lokaler Antibiotika, in der Wahl der operativen Zugänge zur BWS und LWS sowie in der postoperativen Bildgebung. Patienten mit neurologischen Ausfällen werden fachübergreifend gehäuft in Kliniken mit hohen Fallzahlen behandelt. Operativ wählen 2/3 der antwortenden Kliniken eine einzeitige operative Behandlung. Minimalinvasive Verfahren und die Verwendung von Cages sind weit verbreitet. Insgesamt liegt nach Einschätzung der Teilnehmer nach operativer Versorgung tendenziell ein besseres Outcome und eine höhere Patientenzufriedenheit vor. Schlussfolgerungen: Die hier abgebildete Inhomogenität der Versorgungsstrategien stellt die Notwendigkeit von Therapieleitlinien als Orientierungshilfe eindeutig dar. Dieses wird aufgrund der geringen Inzidenz und der aktuellen Studienlage eine Herausforderung für die Zukunft sein.

Abstract

Background: Spondylodiscitis is a rare disease which is associated with high mortality. No guidelines for treatment exist and the available studies are not homogeneous. Attempts have been made in recent years to structure therapy using algorithms. Early recognition of the disease is above all important for its later outcome. Therapy takes place in not only orthopaedic/trauma surgery clinics but also in neurosurgical clinics. Material and Method: We sent an online survey on this subject to orthopaedic clinics, trauma surgery and neurosurgery clinics in Germany. The aim was to ascertain current care strategies in Germany. A further objective was to elicit differences between the specialist fields. Results: A total of 164 clinics responded to the survey. The response rate was 16 % of the orthopaedic/trauma surgery clinics and 32 % of the neurosurgical clinics. Differences between the two specialist fields can be found particularly in the use of systemic and local antibiotics, in the choice of surgical access to the thoracic spine and the lumbar spine and in post-operative imaging. In both specialist fields, patients with neurological dysfunctions are treated primarily in clinics with high case numbers. In terms of surgery, 2/3 of the responding clinics choose a one-stage operative treatment. Minimally invasive procedures and the use of cages are widespread. The participants estimate that, on the whole, a better outcome and higher patient satisfaction tend to exist after operative treatment. Conclusions: The lack of homogeneity regarding treatment strategies which is indicated here clearly shows the need for therapy guidelines as an aid to orientation. This will be a challenge for the future due to the low incidence and the situation regarding currently available studies.

Schlüsselwörter

Spondylodiszitis - Therapie - Onlineumfrage - Akutkliniken

Key words

spondylodiscitis - treatment - online survey - surgical clinics

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