Conservative versus surgical treatment in HPSSI. A Meta-analysis
Description
The articles included in this review met the following criteria: 1. Study Design: Retrospective double arm cohort studies comparing Surgical to Conservative Treatment of spinal infections; No RCTs were found in our search. 2. Comparative Analysis: Studies comparing Surgical Treatment (ST) to Conservative Treatment (CT); 3. Patient Population: Studies involving patients with hematogenous, septic spondylodiscitis or spondylitis, not ankylosing spondylitis, not tuberculosis; 4. Studies with primary endpoint the incidence of hematogenous spinal infection.
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Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic search was conducted across PubMed, Cochrane, ScienceDirect and Scopus to identify studies published between 2005 and 2025. The process was designed to identify all eligible studies using the following queries: 1. (“spondylodiscitis” OR “spondylitis”) NOT “ankylosing spondylitis” NOT “tuberculosis”. 2. (“spinal infection” OR “infection of the spine”) AND (“conservative treatment” OR “surgical treatment”) The articles included in this review met the following criteria: 1. Study Design: Retrospective double arm cohort studies comparing Surgical to Conservative Treatment of spinal infections; No RCTs were found in our search. 2. Comparative Analysis: Studies comparing Surgical Treatment (ST) to Conservative Treatment (CT); 3. Patient Population: Studies involving patients with hematogenous, septic spondylodiscitis or spondylitis, not ankylosing spondylitis, not tuberculosis; 4. Studies with primary endpoint the incidence of hematogenous spinal infection. The criteria for including studies in this review were based on the PICO [55] (Population, Intervention, Comparison, and Out-come) framework. 1. Population (P): Adults with primary hematogenous septic spinal infection, encompassing the subgroups of native spondylitis, septic spondylodisci-tis, discitis, spondylitis, and vertebral osteomyelitis, refers to adult patients (≥18 years) diagnosed with an acute or subacute infection of the spinal column resulting from hematogenous spread of pathogens, primarily bacterial in origin, affecting the cervical, thoracic, thoracolumbar, lumbar, or lumbosacral spine. 2. Interventional treatment (I): Traditional open anterior, posterior or combined surgery, minimal invasively, endoscopic techniques involving or not spi-nal instrumentation. 3. Comparison-Controls (C): Patients who received Conservative Treatment (CT) (antibiotics, brace, aspiration). 4. Outcome (O): Incidence rates differences between conservative and surgical treatment regarding mortality, recurrence and length of hospital stay. The inclusion criteria for the Meta-Analysis were as follows: ● Condition: Adults with hematogenous, septic spondylodiscitis or spondylitis, not ankylosing spondylitis, not tuberculosis, not fungus, not caused by pre-vious surgery or trauma. ● Clinical Presentation: Fever, pain, cachexia. ● Diagnostic Confirmation: MRI showing destruction of the vertebral endplates and discs, roentgenograms, biopsy, elevated CRP. ● Study Size: Studies with at least 10 cases each; ● Outcome Reporting: Series specifically reporting on adults with hematogenous, septic spondylodiscitis or spondylitis, not ankylosing spondylitis, not tu-berculosis, not fungus, not caused by previous surgery or trauma, treated surgically, conservatively or both. ● Language: Articles published in English and German.