Cervical pyogenic spinal infections: are they more severe diseases than infections in other vertebral locations?

PURPOSE: Cervical spine pyogenic infections are unusual compared to other vertebral segments, but they can be associated to worse clinical outcomes. We compared all patients with cervical spine pyogenic infections to those with thoracolumbar involvement in terms of epidemiology, prognostic factors and clinical outcomes. METHODS: We retrospectively reviewed all patients discharged from our institution with diagnosis of pyogenic spinal infections (PSI) during a 14-year period. Patients' demographics, etiologic agent, co-morbidities, site of infection, white blood cell count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) at time of presentation, neurological impairment and mortality were registered to compare clinical outcomes of patients with PSI affecting the cervical spine and other segments. RESULTS: We studied 102 patients with PSI. Nineteen (18.6 %) had cervical involvement; 73.7 % of them were males, with a mean age of 65.22 years. 89.7 % of them presented spondylodiscitis; 12 patients (63.2 %) exhibited a one segment involvement (C5-C6 being the most common), and 11 patients presented an epidural abscess. Thirteen patients (68.4 %) exhibited neurological deficit. Seventeen patients (89.5 %) presented elevated ESR and CRP, while 12 patients (63.2 %) exhibited leukocytosis. The causative organism was identified in 17 patients (89.5 %). Despite similar baseline characteristics, compared to PSI in other locations, patients with cervical PSI presented significantly more neurological involvement (68.4 vs. 41 %; p = 0.03), they more often required surgical treatment (84.2 vs. 46.3 %; p < 0.01), and they had and increased mortality (21.1 % compared to 3.6 %; p = 0.02). CONCLUSION: An early diagnosis and prompt treatment should be the goal treating cervical PSI, considering the potential devastating complications and increased mortality.