Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations

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• dc.contributor.author Krämer, Andreas
• dc.contributor.author Lafuente Baraza, Jesus
• dc.contributor.author Ringel, Florian
• dc.date.accessioned 2025-10-22T15:19:39Z
• dc.date.available 2025-10-22T15:19:39Z
• dc.date.issued 2024
• dc.date.updated 2025-10-22T15:19:38Z
• dc.description.abstract Introduction: The management of de novo non-specific spinal infections (spondylodiscitis - SD) remains inconsistent due to varying clinical practices and a lack of high-level evidence, particularly regarding the indications for surgery. Research question: This study aims to develop consensus recommendations for the diagnosis and management of SD, addressing diagnostic modalities, surgical indications, and treatment strategies. Material and methods: A Delphi process was conducted with 26 experts from the European Association of Neurosurgical Societies (EANS). Sixtytwo statements were developed on diagnostic workup, management decisions, surgical techniques, non-surgical treatment, and follow-up and submitted to the panel of experts. Results: Consensus was reached on 38 of 62 statements. MRI was confirmed as the gold standard for diagnosis. Regarding surgical indications, the panel agreed that any new neurological deficit, even subtle, warrants surgical consideration. Motor deficits with a motor score (MRC) below 4 and bladder or bowel dysfunction were unanimously considered clear indications for surgery. For spinal deformity and instability, thresholds such as kyphosis >20°, scoliosis >10°, and vertebral body collapse >50% were established to guide surgical decision-making. Minimally invasive surgery (MIS) was endorsed whenever feasible, and a 12 week antibiotic treatment regimen was favored in cases of complicated infections. Discussion and conclusion: This EANS consensus provides updated recommendations for SD management, incorporating recent evidence on improved outcomes with surgical therapy. While these guidelines offer a more structured approach to clinical decision-making, further research is required to optimize surgical timing and validate the long-term impact of these treatment strategies.
• dc.format.mimetype application/pdf
• dc.identifier.citation Kramer A, Thavarajasingam SG, Neuhoff J, Davies B, Barbagallo G, Debono B, Depreitere B, Eicker SO, Gabrovsky N, Gandia-Gonzalez ML, Ivanov M, Kaiser R, Kaprovoy S, Konovalov N, Lafuente J, Maciejczak A, Meyer B, Pereira P, Petrova Y, Peul WC, Reizinho C, Ryang YM, Sampron N, Schär R, Tessitore E, Thomé C, Timothy J, Vleggeert-Lankamp C, Demetriades AK, Shiban E, Ringel F. Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations. Brain Spine. 2024 Dec 31;5:104178. DOI: 10.1016/j.bas.2024.104178
• dc.identifier.doi http://dx.doi.org/10.1016/j.bas.2024.104178
• dc.identifier.issn 2772-5294
• dc.identifier.uri http://hdl.handle.net/10230/71630
• dc.language.iso eng
• dc.publisher Elsevier
• dc.relation.ispartof Brain and Spine. 2024;5:104178
• dc.rights © 2024 Published by Elsevier B.V. on behalf of EUROSPINE, the Spine Society of Europe, EANS, the European Association of Neurosurgical Societies. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0/
• dc.subject.keyword Consensus
• dc.subject.keyword De novo spinal infection
• dc.subject.keyword Discitis
• dc.subject.keyword Non-specific
• dc.subject.keyword Pyogenic
• dc.subject.keyword Spinal osteomyelitis
• dc.subject.keyword Spondylodiscitis
• dc.title Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion