Risk Factors for Surgical Treatment in the Management of Pyogenic Spondylitis

Purpose The frequency of pyogenic spondylitis has increased owing to an aging population and a growing number of immunocompromised patients. This study investigated risk factors for surgery in patients with pyogenic spondylitis treated at our hospital. Methods Seventy-one patients (52 males, 19 females) with pyogenic spondylitis treated from 2014 to 2023 were included. Conservative treatment was the primary approach, with surgery indicated for cases resistant to conservative management or with worsening neurological symptoms. Initial surgery involved minimally invasive stabilization, with debridement and anterior fixation performed when necessary. Age, sex, body mass index (BMI), fever rate, hospitalization duration, time to diagnosis, bacterial presence, blood tests, epidural abscess, immunocompromised status, and comorbidities were compared between the conservative and surgical treatment groups. Multivariate analysis identified risk factors for surgery. Results No significant differences were found in age, sex, BMI, fever rate, hospitalization duration, culture-positive rate, or blood tests. However, the prevalence of epidural abscess (36.6% vs. 60%) and diabetes mellitus (22% vs. 53.3%) was significantly higher in the surgical group (P < 0.05). Epidural abscess (odds ratio: 3.79, P = 0.0198) and diabetes mellitus (odds ratio: 3.83, P = 0.0261) were independent risk factors in the logistic regression analysis. Conclusion This study found no significant differences in inflammatory markers at admission or during hospitalization. Patients with epidural abscesses and diabetes mellitus were more likely to require surgery. Advances in minimally invasive surgery may have changed the risk factors for surgery compared with previous years.