What are the score and classification systems used in surgical planning for spondylodiscitis (infection of the intervertebral disc and adjacent vertebrae)?

From the Guidelines

The most commonly used score and classification systems for surgical planning of spondylodiscitis include the Pola Classification, SINS (Spinal Instability Neoplastic Score), and Garg Classification, which guide decisions regarding conservative versus surgical management, timing of intervention, and specific surgical approaches. These systems are essential in determining the optimal treatment approach based on disease severity, patient factors, and anatomical considerations.

Key Classification Systems

• The Pola Classification categorizes patients based on neurological status, sepsis severity, bone destruction, and abscess formation.
• The SINS (Spinal Instability Neoplastic Score) assesses spinal stability, with high scores (>7) typically requiring stabilization procedures.
• The Garg Classification focuses on the extent of vertebral body destruction, helping determine whether anterior column reconstruction is necessary. According to the 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines 1, surgical intervention is recommended in patients with progressive neurologic deficits, progressive deformity, and spinal instability with or without pain despite adequate antimicrobial therapy. The use of MRI in evaluating patients with suspected spine infection, as discussed in the ACR Appropriateness Criteria 1, provides valuable information on the extent of the infectious process, which can inform surgical planning.

Surgical Planning Considerations

• Patients with extensive epidural abscesses on the Pola Classification often need urgent decompression.
• The Garg Classification helps determine whether anterior column reconstruction is necessary.
• The SINS score guides decisions regarding stabilization procedures. By using these standardized assessment tools, healthcare providers can make more objective decisions, communicate more effectively, and potentially improve patient outcomes through appropriate surgical planning tailored to the specific disease characteristics and patient needs.