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van Gerven C, Eid K, Krüger T, Fell M, Kendoff D, Friedrich M, Kraft CN. Serum C-reactive protein and WBC count in conservatively and operatively managed bacterial spondylodiscitis. J Orthop Surg (Hong Kong) 2021; 29:2309499020968296. [PMID: 33377405 DOI: 10.1177/2309499020968296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE C-reactive protein (CRP) and white blood cell (WBC) count are routine blood chemistry parameters in monitoring infection. Little is known about the natural history of their serum levels in conservative and operative spondylodiscitis treatment. METHODS Pre- and postoperative serum levels of CRP and WBC count in 145 patients with spondylodiscitis were retrospectively assessed. One hundred and four patients were treated by debridement, spondylodesis, and an antibiotic regime, 41 only with a brace and antibiotics. The results of the surgical group were compared to 156 patients fused for degenerative disc disease (DDD). RESULTS Surgery had a significant effect on peak postoperative CRP levels. In surgically managed patients, CRP peaked at 2-3 days after surgery (spondylodiscitis: pre-OP: 90 mg/dl vs. post-OP days 2-3: 146 mg/dl; DDD: 9 mg/dl vs. 141 mg/dl; p < 0.001), followed by a sharp decline. Although values were higher for spondylodiscitis patients, dynamics of CRP values were similar in both groups. Nonoperative treatment showed a slower decline. Surgically managed spondylodiscitis showed a higher success rate in identifying bacteria. Specific antibiotic treatment led to a more predictable decline of CRP values. WBC did not show an interpretable profile. CONCLUSION CRP is a predictable serum parameter in patients with spondylodiscitis. WBC count is unspecific. Initial CRP increase after surgery is of little value in monitoring infection. A preoperative CRP value, and control once during the first 3 days after surgery is sufficient. Closer monitoring should then be continued. Should a decline not be observed, therapy needs to be scrutinized, antibiotic treatment reassessed, and concomitant infection contemplated.
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Affiliation(s)
- Christina van Gerven
- Department of Orthopaedics, Trauma Surgery and Hand Unit, 27664Helios Klinikum Krefeld, Krefeld, Germany
| | - Kevin Eid
- Department of Orthopaedics, Trauma Surgery and Hand Unit, 27664Helios Klinikum Krefeld, Krefeld, Germany
| | - Tobias Krüger
- Department of Radiology, 31098Zuger Kantonsspital AG, Baar, Switzerland
| | - Michael Fell
- Department of Orthopaedics, Trauma Surgery and Hand Unit, 27664Helios Klinikum Krefeld, Krefeld, Germany
| | - Daniel Kendoff
- Department of Orthopaedics and Trauma Surgery, 325716Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Michael Friedrich
- Department of Gynaecology and Obstetrics, 27664Helios Klinikum Krefeld, Krefeld, Germany
| | - Clayton N Kraft
- Department of Orthopaedics, Trauma Surgery and Hand Unit, 27664Helios Klinikum Krefeld, Krefeld, Germany
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Pfahler S, Pflugmacher R, Karakostas P, Dabir D, Schäfer VS. [Coexistent septic arthritis and spondylodiscitis as important differential diagnosis in immunosuppressed patients]. Z Rheumatol 2020; 80:184-188. [PMID: 33336292 PMCID: PMC7929961 DOI: 10.1007/s00393-020-00943-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Abstract
Die septische Arthritis und Spondylodiszitis stellen bei immunsupprimierten Patienten eine wichtige Differenzialdiagnose des Gelenk- oder Wirbelsäulenschmerzes dar. Hierbei kommt es zu einem Erregerbefall eines Gelenks bzw. einer Bandscheibe und angrenzender Wirbelkörper. Es zeigen sich meist unspezifische Symptome wie lokaler Gelenk- oder Rückenschmerz, Fieber und verringerter Allgemeinzustand. Diagnostisch kann bei klinischem Verdacht die bakterielle Besiedelung durch eine Gelenkpunktion und Blutkulturen nachgewiesen werden. Zur Diagnosefindung einer Spondylodiszitis sollte eine bildmorphologische Darstellung mittels Magnetresonanztomographie erfolgen. Neben einer adäquaten Schmerztherapie und empirischer antibiotischer Therapie sollte bei einer septischen Arthritis die chirurgische Entfernung des infektiösen Materials aus dem Gelenk angestrebt werden. Eine chirurgische Versorgung der Spondylodiszitis sollte bei auftretenden Komplikationen erfolgen. Die folgende Kasuistik stellt den gleichzeitigen Befund einer septischen Polyarthritis und Spondylodiszitis bei einem immunsupprimierten Patienten mit HIV-Infektion vor und zeigt eindrücklich das Auftreten von Komplikationen bei Verzögerung einer adäquaten Therapie.
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Affiliation(s)
- S Pfahler
- Medizinische Klinik III, Onkologie, Hämatologie, Rheumatologie und klinische Immunologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - R Pflugmacher
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - P Karakostas
- Medizinische Klinik III, Onkologie, Hämatologie, Rheumatologie und klinische Immunologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - D Dabir
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - V S Schäfer
- Medizinische Klinik III, Onkologie, Hämatologie, Rheumatologie und klinische Immunologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland.
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Pingel A. [Spondylodiscitis]. Z Orthop Unfall 2020; 159:687-703. [PMID: 32851619 DOI: 10.1055/a-1129-9246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Spondylodiscitis is an infection of the spine that first affects the vertebral endplates ("spondylitis") and then spreads to the adjacent intervertebral disc ("spondylodiscitis"). As it is a potentially life-threatening systemic disease rapid, often surgical treatment is required. Due to the multimorbidity of the patients and the complexity of the therapy, a multidisciplinary approach is essential. The vast majority of the cases heals under conservative therapy. An absolute indication for surgical therapy is given for acute septic courses or if there are new relevant neurological deficits. In addition, urgent surgical treatment is required for epidural abscesses that can be diagnosed by means of magnetic resonance imaging. In developed countries, over 90% of all spondylodiscitis cases come to a complete recovery.
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Farah K, Peyriere H, Graillon T, Prost S, Dufour H, Blondel B, Fuentes S. Minimally invasive posterior fixation and anterior debridement-fusion for thoracolumbar spondylodiscitis: A 40-case series and review of the literature. Neurochirurgie 2019; 66:24-28. [PMID: 31836488 DOI: 10.1016/j.neuchi.2019.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/20/2019] [Accepted: 10/26/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Pyogenic spondylodiscitis is a rare disease, but incidence is increasing. Reported failure rates following conservative management range from 12% to 18%. The purpose of this study was to determine the safety and efficacy of posterior percutaneous pedicle screw fixation combined with anterior debridement and fusion (ADF) for infective spondylodiscitis in the thoracic and/or lumbar spine. METHODS The retrospective study cohort comprised all patients without neurological deficit who underwent minimally invasive posterior and anterior surgery between April 2008 and April 2016 for thoracic and/or lumbar spondylodiscitis. RESULTS Forty patients were eligible (16 female: 40%). The lumbar region was affected in 31 cases (77.5%). Source of infection was identified in only 22 cases (55%) and bacteriological identification was obtained in 32 cases (80%). Mean hospital stay was 14.8 days (range, 6-39 days). Complete recovery was achieved in 39 patients (97.5%) at 3 months' follow-up. Mean preoperative local kyphosis angle was 16.1o, versus 14o at 1-year (P>0.05). 36 patients (90%) had at least 1 year's follow-up, and fusion was obtained for all these cases. CONCLUSION Two-stage minimally invasive surgery is effective and safe for the treatment of single or two-level thoracolumbar spondylodiscitis. It could be an alternative to conventional open surgery or conservative treatment.
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Affiliation(s)
- K Farah
- Department of neurosurgery, La Timone university hospital, AP-HM, 13005 Marseille, France; Spine Unit, La Timone university hospital, AP-HM, Marseille, France.
| | - H Peyriere
- Department of neurosurgery, La Timone university hospital, AP-HM, 13005 Marseille, France; Spine Unit, La Timone university hospital, AP-HM, Marseille, France
| | - T Graillon
- Department of neurosurgery, La Timone university hospital, AP-HM, 13005 Marseille, France; Spine Unit, La Timone university hospital, AP-HM, Marseille, France
| | - S Prost
- Department of orthopedic surgery, La Timone university hospital, AP-HM, Marseille, France; Spine Unit, La Timone university hospital, AP-HM, Marseille, France
| | - H Dufour
- Department of neurosurgery, La Timone university hospital, AP-HM, 13005 Marseille, France; Spine Unit, La Timone university hospital, AP-HM, Marseille, France
| | - B Blondel
- Department of orthopedic surgery, La Timone university hospital, AP-HM, Marseille, France; Spine Unit, La Timone university hospital, AP-HM, Marseille, France
| | - S Fuentes
- Department of neurosurgery, La Timone university hospital, AP-HM, 13005 Marseille, France; Spine Unit, La Timone university hospital, AP-HM, Marseille, France
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Abstract
BASICS Postoperative surgical site infections of the spine have been described in up to 20% of patients and can result in serious consequences for the patient and substantial treatment costs. Typical bacteria often arise from skin or fecal flora. Various risk factors for infection have been described, including obesity, diabetes, high ASA scores, as well as intraoperative factors such as heavy blood loss, dural tears, or several revision procedures. Consequently, the prophylaxis with pre- and postoperative risk minimization is of particular importance. TREATMENT When an infection has developed, it is important to carry out early operative revision involving tissue debridement, lavage and acquiring microbiological samples for culture. If the infection presents early, the instrumentation can often be retained. Adjuvant measures such as negative pressure wound treatment may improve the outcome. In late-onset infections, due to the biofilm production on the instrument surface or in cases of implant loosening, one should attempt to remove the instrumentation, and in cases of instability replace it. This article deals with the current literature on the subject and provides an overview of the data with regard to peri- and postoperative infections.
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Homagk L, Jarmuzek T, Homagk N, Hofmann GO. RETRACTED ARTICLE: Advantages of clinical pathways in severity-based treatment of spondylodiscitis. Neurosurg Rev 2019; 43:337. [PMID: 31446510 DOI: 10.1007/s10143-019-01166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/20/2019] [Accepted: 08/20/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Lars Homagk
- Praxisklinik Dr. Homagk, Naumburg, Germany.
- , Weißenfels, Germany.
| | - T Jarmuzek
- Centre for Spinal Cord Injuries, BG -Kliniken Bergmannstrost, Halle/Saale, Germany
| | - N Homagk
- Praxisklinik Dr. Homagk, Naumburg, Germany
| | - G O Hofmann
- Department of Trauma, Hand and Reconstructive Surgery, Friedrich Schiller University, Jena, Germany
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Homagk L, Marmelstein D, Homagk N, Hofmann GO. SponDT (Spondylodiscitis Diagnosis and Treatment): spondylodiscitis scoring system. J Orthop Surg Res 2019; 14:100. [PMID: 30971277 PMCID: PMC6458762 DOI: 10.1186/s13018-019-1134-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spondylodiscitis is a chameleon among infectious diseases due to the lack of specific symptoms with which it is associated. It is nevertheless a serious infection, with 7% mortality of hospitalized patients, in large part because of delayed diagnosis. The aim of this study was to develop a diagnosis and course-of-disease index to optimize its treatment. MATERIAL AND METHODS Through analysis of 296 patients between January 1998 and December 2013, we developed a scoring system for spondylodiscitis, which we term SponDT (Spondylodiscitis Diagnosis and Treatment) based on three traits: (1) the inflammatory marker C-reactive protein (CRP) (mg/dl), (2) pain according to a numeric rating scale (NRS) and (3) magnetic resonance imaging (MRI), to monitor its progression following treatment. RESULTS The number of patients receiving treatment increased over the past 15 years of our study. We also found an increasing age of patients at the point of diagnosis across the study, with an average age of 67.7 years. In 34% of patients, spondylodiscitis developed spontaneously. Almost 70% of them did not receive treatment until the first diagnosis using SponDT. Following treatment against spondylodiscitis, pain intensity decreased from 6.0 to 3.1 NRS. The inflammatory markers also decreased (CRP from 119.2 to 46.7 mg/dl). Similarly, MRI revealed a regression in inflammation following treatment. By employing SponDT, patients were diagnosed and entered into treatment with a score of 5.6 (severe spondylodiscitis) and discharged with a score of 2.4 (light/healed spondylodiscitis). CONCLUSION SponDT can be used to support the diagnosis of spondylodiscitis, particularly in patients suffering from back pain and elevated levels of inflammation, and can be used during the course of treatment to optimize control of therapy. LEVEL OF EVIDENCE IIa-evidence from at least one well-designed controlled trial which is not randomized.
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Affiliation(s)
- Lars Homagk
- Praxisklinik Dr. Homagk - MVZ GmbH, 06667, Weißenfels, Germany. .,Praxisklinik Dr. Homagk, Markt 3, 06618, Naumburg, Germany.
| | - Daniel Marmelstein
- Centre for Spinal Cord Injuries and Department of Orthopedics, BG Kliniken Bergmannstrost, 06112, Halle (Saale), Germany
| | - Nadine Homagk
- Centre for Spinal Cord Injuries and Department of Orthopedics, BG Kliniken Bergmannstrost, 06112, Halle (Saale), Germany
| | - Gunther O Hofmann
- Clinic of Trauma Hand- und Reconstructive Surgery, Friedrich-Schiller-University Jena, Jena, Germany
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Gregori F, Grasso G, Iaiani G, Marotta N, Torregrossa F, Landi A. Treatment algorithm for spontaneous spinal infections: A review of the literature. J Craniovertebr Junction Spine 2019; 10:3-9. [PMID: 31000972 PMCID: PMC6469318 DOI: 10.4103/jcvjs.jcvjs_115_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Primary spinal infections are rare pathologies with an estimated incidence of 5% of all osteomyelitis. The diagnosis can be challenging and this might result in a late identification. The etiological diagnosis is the primary concern to determine the most appropriate treatment. The aim of this review article was to identify the importance of a methodological attitude toward accurate and prompt diagnosis using an algorithm to aid on spinal infection management. Methods: A search was done on spinal infection in some databases including PubMed, ISI Web of Knowledge, Google Scholar, Ebsco, Embasco, and Scopus. Results: Literature reveals that on the basis of a clinical suspicion, the diagnosis can be formulated with a rational use of physical, radiological, and microbiological examinations. Microbiological culture samples can be obtained by a percutaneous computed tomography-guided procedure or by an open surgical biopsy. When possible, the samples should be harvested before antibiotic treatment is started. Indications for surgical treatment include neurological deficits or sepsis, spine instability and/or deformity, presence of epidural abscess and failure of conservative treatment. Conclusion: A multidisciplinary approach involving both a spinal surgeon and an infectious disease specialist is necessary to better define the treatment strategy. Based on literature findings, a treatment algorithm for the diagnosis and management of primary spinal infections is proposed.
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Affiliation(s)
- Fabrizio Gregori
- Department of Human Neurosciences, Division of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Giovanni Grasso
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo, Italy
| | - Giancarlo Iaiani
- Department of Tropical and Infectious Diseases, Aou Policlinico Umberto I, Rome, Italy
| | - Nicola Marotta
- Department of Human Neurosciences, Division of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Fabio Torregrossa
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo, Italy
| | - Alessandro Landi
- Department of Human Neurosciences, Division of Neurosurgery, Sapienza University of Rome, Rome, Italy
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Abstract
Spondylodiscitis is a severe infectious disease of the intervertebral discs and of the adjacent parts of the vertebral bodies, culminating in destruction of the mobile segment. It is accompanied by a mortality rate of approximately 15%. Severe courses of the disease can also lead to abscess formation and dispersal of sepsis. Malpositioning of the axis organ and deficits in neurological function up to paraplegia are also possible complications. Timely diagnostics and targeted therapy contribute to minimizing the risk of significant health disorders. This review article gives a summary of important algorithms in the diagnostics and treatment and discusses them against the background of currently available literature. According to the current state of knowledge the surgical treatment of spondylodiscitis provides many advantages and is therefore the method choice, even if a conservative approach can be successful in selected cases. The endpoints of treatment are cleansing of the infection with normalization of laboratory parameters of inflammation and the osseous fusion of the mobile segment.
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Homagk L, Homagk N, Klauss JR, Roehl K, Hofmann GO, Marmelstein D. Spondylodiscitis severity code: scoring system for the classification and treatment of non-specific spondylodiscitis. Eur Spine J 2015; 25:1012-20. [PMID: 25895880 DOI: 10.1007/s00586-015-3936-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 04/06/2015] [Accepted: 04/06/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Established treatment options of spondylodiscitis, a rare but serious infection of the spine, are immobilization and systemic antibiosis. However, the available data for specific treatment recommendations are very heterogeneous. Our intention was to develop a classification of the severity of spondylodiscitis with appropriate treatment recommendations. MATERIALS AND METHODS From 10/1/1998 until 12/31/2004, 37 cases of spondylodiscitis were examined regarding medical history, gender status, location and extent of spondylodiscitis, type and number of operations. Subsequently, a classification of six grades according to severity has been developed with specific treatment recommendations. The further evaluation of our classification and corresponding treatment modalities from 1/1/2005 to 12/31/2009 including further 132 cases, resulted in a classification of only three grades of severity (the SSC--spondylodiscitis severity code), with a follow-up until 12/31/2011. Between 01/01/2012 and 12/31/2013, a prospective study of 42 cases was carried out. Overall, 296 cases were included in the study. 26 conservatively treated cases were excluded. RESULTS AND CONCLUSION The main localization of spondylodiscitis was the lumbar spine (55%) followed by the thoracic spine (34%). The classification of patients into 3 grades of severity depends on clinical and laboratory parameters, the morphological vertebral destruction seen in radiological examinations and the current neurological status. Therapies are adapted according to severity and they include a specific surgical management, systemic antibiotic therapy according to culture and sensitivity tests, physiotherapy and initiation of post-hospital follow-up. 40.6% of patients are associated with neurological deficits, classified as severity grade 3 and treated surgically with spinal stabilization and decompression. 46.9% of patients corresponded to severity grade 2, with concomitant vertebral destruction were dorsoventrally stabilized. The 31 patients of severity Grade 1 were treated surgically with dorsal stabilization. From 1998 to 2013, the time from the onset of symptoms to the first surgical treatment was about 69.4 days and has not changed significantly. However, the time from admission to surgical treatment had been reduced to less than 2 days. Also the time of hospitalization was reduced and we see positive effects regarding the sensation of pain. 270 patients underwent surgery. We treated 89% dorsally and 21% dorsoventrally. With the spondylodiscitis severity code, a classification of the severity of spondylodiscitis could be established and used for a severity-based treatment. In addition, specific parameters for the treatment of individual grades of severity can be determined in a clinical pathway.
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Affiliation(s)
- L Homagk
- Centre for Spinal Cord Injuries, BG-Kliniken Bergmannstrost, Halle (Saale), Germany. .,Asklepios Clinic Weißenfels, Naumburger Straße 76, 06667, Weißenfels, Germany.
| | - N Homagk
- Centre for Spinal Cord Injuries, BG-Kliniken Bergmannstrost, Halle (Saale), Germany
| | - J R Klauss
- Centre for Spinal Cord Injuries, BG-Kliniken Bergmannstrost, Halle (Saale), Germany
| | - K Roehl
- Centre for Spinal Cord Injuries, BG-Kliniken Bergmannstrost, Halle (Saale), Germany
| | - G O Hofmann
- Centre for Spinal Cord Injuries, BG-Kliniken Bergmannstrost, Halle (Saale), Germany.,Department of Trauma, Hand and Reconstructive Surgery, Friedrich Schiller University Jena, Jena, Germany
| | - D Marmelstein
- Centre for Spinal Cord Injuries, BG-Kliniken Bergmannstrost, Halle (Saale), Germany
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Madert J, Liem M, Frosch KH, Niemeyer T. [Dorsolateral access and interbody spinal fusion in spondylodiscitis of the thoracolumbar spine (TLIF technique)]. Oper Orthop Traumatol 2013; 25:262-72. [PMID: 23756595 DOI: 10.1007/s00064-012-0214-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
UNLABELLED SURGICAL GOAL: Resolve infection and achieve primary stability of instrumentation and permanent fusion of the affected spinal segment by means of debridement of the focus of infection. Defect-filling using autologous/allograft bone or a spacer, as well as immobilization by means of dorsal instrumentation. INDICATION Acute and chronic thoracolumbar spondylodiscitis. CONTRAINDICATIONS Purely epidural abscesses requiring only decompression (fenestration). Defects whose size make a ventral approach necessary. SURGICAL TECHNIQUE Classic dorsal approach to the thoracolumbar spine. Pedicle placed using screws depending on the size of the spinal defect for mono-, bi-, or multisegmental spinal fusion. Exposure performed at the level of the infected spinal disc or vertebral body on the more strongly affected side. Focus of infection removed. Depending on the degree of infection, defect filling is carried out using autologous bone or cancellous allograft, followed by rod assembly. POSTOPERATIVE MANAGEMENT Back brace-free follow-up treatment, physiotherapy and back training. Antibiotic administration until inflammation values fall within the normal range, or for at least 14 days. RESULTS Successful fusion of affected segments, including resolution of infection, is reported in over 90% of cases described in the literature. The revision rate among our mostly multimorbid patient group with an average age of 66 years was 16%. Of 39 of the 114 (34%) patients with preoperative neurological deficits, 26 (66%) demonstrated postoperative regression. Nine patients (23%) showed no improvement, whilst exacerbation of existing neurological deficits was seen in four patients (11%). Staphylococcus was the major pathogen in 34% of cases.
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Affiliation(s)
- J Madert
- Chirurgisch-Traumatologisches Zentrum, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099 Hamburg, Germany
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Abstract
The localization of HIV-1 proviruses in compositional DNA fractions from 27 AIDS patients during the chronic phase of the disease with depletion of CD4+ and different levels of viremia showed the following. (1) At low viremia, proviruses are predominantly localized in the GC-richest isochores, which are characterized by an open chromatin structure; this result mimics findings on HIV-1 integration in early infected cells in culture. (2) At higher viremia, an increased distribution of proviruses in GC-poor isochores (which match the GC poorness of HIV-1) was found; this suggests a selection of cells in which the 'isopycnic' localization leads to a higher expression of proviruses and, in turn, to higher viremia. (3) At the highest viremia, integrations in GC-rich isochores are often predominant again, but generally not at the same level as in (1); this may be the consequence of new integrations from the extremely abundant RNA copies.
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Affiliation(s)
- L Tsyba
- Laboratoire de Génétique Moléculaire, Institut Jacques Monod, Paris, France
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