Spondylodiscitis presents a significant diagnostic and treatment challenge to healthcare providers, with various risk factors and treatment outcomes having been identified. Malnutrition, a multifactorial condition defined by imbalance or deficiency of nutrients, is a known risk factor for various adverse events such as postoperative infection and readmissions in spine surgery. However, its impact in SD has not yet been explored. The study aims to assess the prevalence of malnutrition and hypoalbuminemia in SD patients and their impact on the 90-day-all-cause readmission and in-hospital mortality rates. Using the 2020 Nationwide Readmission Database, adult patients were selected by primary ICD-10 diagnosis for SD (M46.2x, M46.3x and M46.4x). Demographic information and clinical data were extracted. Readmissions were identified by VisitLink. Patients were categorized into 2 groups: those with malnutrition and/or hypoalbuminemia and those without. Descriptive and comparative analysis, with multivariate regression models to assess for independent risk factors of mortality and readmission were performed. Using the 2020 Nationwide Readmission Database, adult patients were selected by primary ICD-10 diagnosis for SD (M46.2x, M46.3x and M46.4x). Demographic information and clinical data were extracted. Readmissions were identified by VisitLink. Patients were categorized into 2 groups: those with malnutrition and/or hypoalbuminemia and those without. Descriptive and comparative analysis, with multivariate regression models to assess for independent risk factors of mortality and readmission were performed. Malnutrition and hypoalbuminemia are relatively common in SD patients and are significant risk factors for both in-hospital mortality and readmission. Early identification, including screening for hypoalbuminemia and management of malnutrition, may be beneficial in SD treatment.

Occipitocervical arthrodesis has a variety of indications to treat craniocervical and atlantoaxial pathologies for which a selective cervical fusion would not provide sufficient stability. Over time, the indications for occipitocervical fusions (OCFs) have evolved, as new technologies and surgical techniques were developed. In this bibliometric analysis, we aim to explore the progression of OCF literature over time, analyzing the trends in publications and citations, publishing countries and authors, keywords, and topics. The Web of Science database was used for data retrieval on July 3, 2024, with the search "occipitocervical fusion" OR "occipito-cervical fusion" OR "occipitocervical arthrodesis" OR "occipital cervical fusion" OR "occipital cervical arthrodesis" OR ("OCF" AND "spine surgery"). Excel was used to create the citation analysis and publication trend figures, along with the publishing countries and author analysis. The bibliometric software VosViewer was used to generate the keyword co-occurrence network visualizations. Overall, 762 articles were extracted. The number of pertinent publications and citations increased until 2020 before beginning to decrease. We found that Ehlers Danlos syndrome has become a more prevalent topic, as the association between Ehlers Danlos syndrome and craniocervical instability has received further scrutiny. "Dysphagia" continues to be a commonly cited topic, while, conversely, rheumatoid arthritis has decreased in publication frequency, possibly related to advances in medical management and surgical techniques. Overall, the United States, China, and Japan are the top publishing countries. This analysis of OCF literature provides a helpful overview of emerging trends and clinician concerns, especially as seen through the perspective of time.

Distal junctional kyphosis (DJK) and distal junctional failure (DJF) are known complications of adult multilevel spinal fusion surgery. Previous literature has extensively investigated proximal junctional kyphosis and proximal junctional failure, but DJK and DJF are relatively understudied. This study investigates the association between bone mineral density (BMD) and DJK/DJF via a systematic review and meta-analysis. A literature search was conducted across PubMed, Cochrane, Web of Science, Embase, and Scopus to find studies reporting DJK, DJF, and BMD. A 12-month minimum follow-up and radiographic biomarker for BMD (Hounsfield units [HU] or a T-score) individually reported for each patient type were required for inclusion. Studies that did not report individualized biomarkers but provided averaged estimates of the effect of BMD on DJK/DJF development were used for systematic review. Our search yielded 12 unique studies with 1094 patients, of which 5 studies with a total of 519 patients were suitable for comparison by meta-analysis. Patients who developed DJK/DJF had significantly lower HUs (113.17 ± 33.86) than patients who did not develop DJK/DJF (142.51 ± 41.39). No significant difference was found with regard to dual-energy X-ray absorptiometry measurements, age, or body mass index between patients who did and did not develop DJK/DJF. Patients who developed DJK/DJF had significantly lower computed tomography-measured HU as compared to those without DJK/DJF. Our findings highlight the potential importance of BMD evaluation with computed tomography prior to multilevel spine fusion surgery, though further research would be helpful to evaluate the significance of dual-energy X-ray absorptiometry-based BMD measurements on DJK/DJF development.

Spondylodiscitis (SD) poses an increasing challenge to healthcare providers by its insidious onset and diverse clinical manifestations, concurrent with an aging population, immunocompromising conditions and various influencing comorbidities. Overall mortality remains relatively high, up to 7.3%, despite advancements in diagnostics and treatment. Past studies have struggled to differentiate leading causes for mortality. With this study we want to utilize the large data group available through the National Inpatient Sample (NIS) to assess the in-hospital mortality in patients with SD in different age-groups and to identify risk factors. Utilizing the 2020 NIS, Healthcare Utilization Project (HCUP) adults (>18 years) were screened using the primary diagnosis of SD by ICD-10 Code (M46.2x, M46.3x and M46.4x). Demographic information, admission details, clinical data, comorbidities, and surgical treatment were extracted using the Clinical Classifications Software Refined (CSSR) categories. Comorbidities include pre-existing conditions and those acquired during hospitalization. Age was categorized into 3 groups (<65 years; 65-79: ≥ 80). The primary outcome was in-hospital mortality, with multivariable logistic regression analysis used to identify independent risk factors. In total 3,975 patients met our inclusion criteria resulting with an in-hospital mortality rate of 0.9 %. The mortality group was significantly older (70.86 years to 58.74 years compared to the survival group) with elective admission being more common (p=<0.001) with a similar sex distribution. Patients ages 65-79 were more common in the mortality group. Overall fourteen comorbidities differed significantly between the two groups. Chronic diseases were more common in the mortality group, whereas alcohol and substance abuse were more prevalent in the survival group. Age, especially patients < 65 years, elective admission status, paralysis and pneumonia were identified as independent risk factors for mortality. Management of SD remains complex. Our study revealed a lower rate of in-hospital mortality and length of stay than previous studies. Elective admission status was the strongest predictor of mortality, highlighting the benefits of early diagnosis and treatment. Patients > 65 years, especially octogenarians, were identified to be particular at risk. Risk factors contributing to mortality in SD may differ from etiological risk factors, highlighting areas for potential further research.

Objective The rising incidence of spondylodiscitis (SD) poses a challenge to healthcare systems worldwide. Treatment approaches are inconsistent, devoid of standardized algorithms and lack evidence-based guidelines. To date there is a knowledge gap relative to treatment, readmission rates and efficacy for different SD management strategies. This study aims to assess the 90-day all-cause readmission rates for SD relative to treatment pathways. Methods Using the 2020 Nationwide Readmissions Database we screened adult patients (> 18 years) for primary diagnosis of SD by ICD-10 Codes. Demographic/clinical data, and treatments was extracted. The cohort was divided into two groups by treatment at initial admission. Descriptive and comparative analysis, with a multivariate regression to identify independent risk factors for readmission, were performed. Results Out of 6,139 patients, 1,258 patients (20.5%) receiving surgical treatment. The overall, readmission rate was 35%. Surgically treated patients had a significantly lower readmission rate and a shorter time to readmission (29.3%; 41.65 days (± 22.84)). Those receiving surgical care during both stays (0.8%) had the longest time to readmission at 50.85 days (± 24.27). A change in treatment upon readmission was observed in 8.4%. Surgical management at index admission was identified as a protective factor against readmission. Conclusion SD management remains challenging. We showed that primary surgical treatment of SD resulted in a significantly lower readmission rate with a longer time interval until readmission compared to non-surgically treatment. Surgery at initial admission was identified as a protective factors against readmission. A more definitive initial approach towards SD might lower unexpected readmissions.

Background: Spondylodiscitis is a growing infectious condition with significant morbidity. The impact of multifocal involvement remains understudied. This study compared 90-day all-cause readmission rates between patients with solitary versus multifocal spondylodiscitis and identified the associated risk factors. Methods: A retrospective analysis of the 2020 Nationwide Readmissions Database was conducted. Adult patients with primary spondylodiscitis were identified using ICD-10 codes and categorized into solitary or multifocal involvement groups. Demographic, clinical, and surgical data were extracted. Descriptive statistics and multivariate logistic regression were performed. Results: Of 6132 patients, 585 (9.6%) had multifocal disease. Multifocal patients were slightly younger (58.9 vs. 60.3 years; p = 0.049); had longer hospital stays (14.7 vs. 11.4 days; p < 0.001), time to readmission (p < 0.001); and surgery was more common (p = 0.003). Ninety-day readmission rates were similar (35.6% vs. 34.9%; p = 0.766). Type 2 diabetes was the only comorbidity significantly associated with multifocal disease (p = 0.020) and independently predicted readmission (aOR 1.236). Surgery and longer length of stay were protective (aOR 0.743; 0.0990). Conclusions: Multifocal spondylodiscitis is relatively common but not an independent risk factor for readmission. Readmission rates of both cohorts were similar. Surgery and prolonged hospitalization may reduce readmission risk.