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Background <p>The optimal management of spontaneous spondylodiscitis (SD) remains controversial, with limited randomized evidence comparing conservative antibiotic therapy versus surgical intervention. This study aimed to compare efficacy, complications, and functional outcomes of conservative versus surgical management in spontaneous SD.</p> Methods <p>This prospective randomized clinical trial enrolled 30 patients with spontaneous spondylodiscitis randomized equally to conservative management (<i>n</i> = 15) or surgical intervention plus antibiotics (<i>n</i> = 15). Primary outcomes were length of hospital stay (LOS), antibiotic duration, complications, laboratory/radiological resolution, and functional recovery (Visual Analogue Scale (VAS), MacNab criteria) assessed at 3, 6, and 12 months.</p> Results <p>Surgical patients had significantly shorter LOS (8 ± 2.75 vs. 38.7 ± 8.75 days, <i>P</i> &lt; 0.001) and antibiotic duration (1.6 ± 1.25 vs. 3.86 ± 2.75 months, <i>P</i> = 0.009). Complication rates were similar (66.7% vs. 60.0%, <i>P</i> = 1.000). Laboratory normalization occurred in 60% conservative vs. 46.7% surgical cases (<i>P</i> = 0.432); solid fusion rates were 53.3% vs. 46.7% (<i>P</i> = 0.701). Both groups showed significant VAS improvement (mean 3.0 vs. 2.8, <i>P</i> = 0.7), with excellent-to-good MacNab outcomes in 73.3% vs. 60% (<i>P</i> = 0.34).</p> Conclusions <p>Surgical management significantly reduces LOS and antibiotic duration while achieving comparable long-term functional outcomes to conservative treatment, suggesting early surgery as a more efficient approach for spontaneous SD.</p>

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Conservative versus surgical management of spontaneous spondylodiscitis: a prospective randomized controlled trial (RCT)

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月27日

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  • Abdelghany Mohammed Nasser Elshamy,
  • Ashraf Shaker Zidan,
  • Mohamed Ali Kassem,
  • Wael K. Zakaria,
  • Ibrahim Elsayed Ahmed AbdelAal

摘要

Background

The optimal management of spontaneous spondylodiscitis (SD) remains controversial, with limited randomized evidence comparing conservative antibiotic therapy versus surgical intervention. This study aimed to compare efficacy, complications, and functional outcomes of conservative versus surgical management in spontaneous SD.

Methods

This prospective randomized clinical trial enrolled 30 patients with spontaneous spondylodiscitis randomized equally to conservative management (n = 15) or surgical intervention plus antibiotics (n = 15). Primary outcomes were length of hospital stay (LOS), antibiotic duration, complications, laboratory/radiological resolution, and functional recovery (Visual Analogue Scale (VAS), MacNab criteria) assessed at 3, 6, and 12 months.

Results

Surgical patients had significantly shorter LOS (8 ± 2.75 vs. 38.7 ± 8.75 days, P < 0.001) and antibiotic duration (1.6 ± 1.25 vs. 3.86 ± 2.75 months, P = 0.009). Complication rates were similar (66.7% vs. 60.0%, P = 1.000). Laboratory normalization occurred in 60% conservative vs. 46.7% surgical cases (P = 0.432); solid fusion rates were 53.3% vs. 46.7% (P = 0.701). Both groups showed significant VAS improvement (mean 3.0 vs. 2.8, P = 0.7), with excellent-to-good MacNab outcomes in 73.3% vs. 60% (P = 0.34).

Conclusions

Surgical management significantly reduces LOS and antibiotic duration while achieving comparable long-term functional outcomes to conservative treatment, suggesting early surgery as a more efficient approach for spontaneous SD.