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Numerous factors influence the outcome of SI and both conservative and operative care can be applied. As SI is associated with mortality rates between 2 and 20% even in developed countries, the purpose of the present study was to investigate the occurrence and causes of death in patients suffering from SI.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A retrospective analysis was performed on 197 patients, categorized into two groups according to their outcome: D (death) and S (survival). The diagnosis was based on clinical and imaging (MRI) findings. Data collected included demographics, clinical characteristics, comorbidities, infection parameters, treatment details, outcomes, and causes of death.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The number of deaths was significantly higher in the conservative group (<jats:italic>n<\/jats:italic>\u2009=\u20099\/51, 18%) compared with the operative counterpart (<jats:italic>n<\/jats:italic>\u2009=\u20098\/146, 6%; <jats:italic>p<\/jats:italic>\u2009=\u20090.017). Death caused by septic multiorgan failure was the major cause of fatalities (<jats:italic>n<\/jats:italic>\u2009=\u200910\/17, 59%) followed by death due to cardiopulmonary reasons (<jats:italic>n<\/jats:italic>\u2009=\u20094\/17, 24%). The most frequent indication for conservative treatment in patients of group D included \u201chighest perioperative risk\u201d (<jats:italic>n<\/jats:italic>\u2009=\u20095\/17, 29%).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>We could demonstrate a significantly higher mortality rate in patients solely receiving conservative treatment. Mortality is associated with number and type of comorbidities, but also tends to be correlated with primarily acquired infection. As causes of death are predominantly associated with a septic patient state or progression of disease, our data may call for an earlier and more aggressive treatment. Nevertheless, prospective clinical trials will be mandatory to better understand the pathogenesis and course of spinal infection, and to develop high quality, evidence-based treatment recommendations.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00701-020-04507-2","type":"journal-article","created":{"date-parts":[[2020,7,29]],"date-time":"2020-07-29T20:03:35Z","timestamp":1596053015000},"page":"2887-2894","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Early surgery may lower mortality in patients suffering from severe spinal infection"],"prefix":"10.1007","volume":"162","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5644-2399","authenticated-orcid":false,"given":"Sara","family":"Lener","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Wipplinger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Stocsits","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Hartmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anja","family":"Hofer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudius","family":"Thom\u00e9","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,7,29]]},"reference":[{"issue":"3","key":"4507_CR1","doi-asserted-by":"publisher","first-page":"201","DOI":"10.3109\/23744235.2015.1103897","volume":"48","author":"T Aagaard","year":"2016","unstructured":"Aagaard T, Roed C, Dahl B, Obel N (2016) Long-term prognosis and causes of death after spondylodiscitis: a Danish nationwide cohort study. 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All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers\u2019 bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"For this type of study, ethical approval is not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}