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Schindler M, Walter N, Reinhard J, Pagano S, Szymski D, Alt V, Rupp M, Lang S. Midterm survival and risk factor analysis in patients with pyogenic vertebral osteomyelitis: a retrospective study of 155 cases. Front Surg 2024; 11:1357318. [PMID: 38835852 PMCID: PMC11148346 DOI: 10.3389/fsurg.2024.1357318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 05/10/2024] [Indexed: 06/06/2024] Open
Abstract
Background Pyogenic vertebral osteomyelitis (VO) represents a clinical challenge and is linked to substantial morbidity and mortality. This study aimed to examine mortality as well as potential risk factors contributing to in-hospital mortality among patients with VO. Methods This retrospective analysis involved patients receiving treatment for VO at University Regensburg in Germany from January 1, 2000, to December 3, 2020. It included in-hospital mortality rate, comorbidities and pathogens. Patients were identified using ICD-10 diagnosis codes: M46.2, M46.3, M46.4, and M46.5. Kaplan-Meier probability plots and odds ratios (OR) for mortality were calculated. Results Out of the total cohort of 155 patients with VO, 53 patients (34.1%) died during a mean follow-up time of 87.8 ± 70.8 months. The overall mortality was 17.2% at one year, 19.9% at two years and 28.3% at five years. Patients with congestive heart failure (p = 0.005), renal disease (p < 0.001), symptoms of paraplegia (p = 0.029), and sepsis (p = 0.006) demonstrated significantly higher overall mortality rates. In 56.1% of cases, pathogens were identified, with Staphylococcus aureus (S. aureus) and other unidentified pathogens being the most common. Renal disease (OR 1.85) and congestive heart failure (OR 1.52) were identified as significant risk factors. Conclusion Early assessment of the specific risk factors for each patient may prove beneficial in the management and treatment of VO to reduce the risk of mortality. These findings demonstrate the importance of close monitoring of VO patients with underlying chronic organ disease and early identification and treatment of sepsis. Prioritizing identification of the exact pathogens and antibiotic sensitivity testing can improve outcomes for patients in this high-risk group.
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Affiliation(s)
- Melanie Schindler
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Jan Reinhard
- Department of Orthopaedic Surgery, University Hospital of Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
| | - Stefano Pagano
- Department of Orthopaedic Surgery, University Hospital of Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
| | - Dominik Szymski
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Siegmund Lang
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
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Chiu YC, Yang SC, Kao YH, Tu YK. Interim Use of Antibiotic-Loaded Cement Spacer for Patients with Infected Cervical Fusion. World Neurosurg 2024; 184:e511-e517. [PMID: 38316175 DOI: 10.1016/j.wneu.2024.01.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE The management of postoperative deep infection after anterior cervical discectomy and fusion (ACDF) remains challenging for spine surgeons. Our institution uses handmade antibiotic-loaded cement spacers to treat these complex cases. This study aimed to determine the efficacy and feasibility of this treatment. METHODS This study included 4 patients with deep cervical spine infections after ACDF who underwent our treatment between March 2012 and January 2022. Patients' laboratory data, visual analog scale scores, comorbidities, complications, and neurological status were recorded. Their clinical conditions were also evaluated based on the Neck Disability Index, Japanese Orthopaedic Association score, and Odom criteria. RESULTS Infection eradication was achieved in all patients after treatment. The average preoperative visual analog scale score was 7.5 (range: 7-8); this decreased to 1.25 (range: 1-2) at 1 year postoperatively. None of the patients experienced severe complications, such as neurological deterioration or bone graft dislodgement. The Neck Disability Index improved from a preoperative value of 54% (range: 48-60%) to 6% (range: 4-8%) at 1 year postoperatively. The Japanese Orthopaedic Association score improved from a preoperative score of 10.25 (range: 10-11)-14.75 (range: 14-16) at 1 year postoperatively. All patients achieved excellent outcomes based on Odom criteria at 1 year postoperatively. CONCLUSIONS Good clinical outcomes were achieved in this study. Although 2-stage surgery is required, this technique could be an alternative for patients with postoperative deep infection after ACDF.
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Affiliation(s)
- Yen-Chun Chiu
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Chinese Medicine for Post Baccalaureate, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Shih-Chieh Yang
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
| | - Yu-Hsien Kao
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yuan-Kun Tu
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
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Iqbal J, Khan MM, Thabet A, Mohammed K, Scalia G, Chaurasia B. Successful management of cervical tuberculosis and severe kyphosis using polyetheretherketone expandable cage and titanium plate: A case report. Clin Case Rep 2024; 12:e8793. [PMID: 38634094 PMCID: PMC11021619 DOI: 10.1002/ccr3.8793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/02/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Key Clinical Message Successful management of cervical tuberculosis and severe kyphosis was achieved using a PEEK expandable cage and titanium plate, demonstrating favorable outcomes in restoring cervical alignment and stability. This approach represents a promising alternative for addressing complex cervical pathologies, highlighting the potential of PEEK-based interventions in surgical management. Abstract Cervical tuberculosis can lead to severe vertebral destruction and kyphosis, posing challenges in surgical management. Recent advancements, including the use of polyetheretherketone (PEEK) expandable cages and titanium plates, show promise in addressing multilevel cervical pathologies. This report details the successful treatment of a 27-year-old male with cervical tuberculosis and severe kyphosis. Surgical intervention involved prevertebral abscess evacuation, C5-C7 corpectomy, and insertion of a PEEK expandable cage with an anterior titanium plate. Postoperative care included a Philadelphia collar, and follow-up demonstrated restored cervical alignment and stability. The use of PEEK-based surgical interventions, as demonstrated in this case, represents a significant evolution in managing complex cervical conditions. The successful outcome highlights the potential benefits of PEEK expandable cages in addressing cervical tuberculosis and kyphosis. Further research is needed to validate these findings and establish PEEK-based interventions as a viable alternative in such cases.
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Affiliation(s)
- Javeed Iqbal
- Department of NeurosurgeryHamad General Hospital – Surgical Specialty CenterDohaQatar
| | - Muhammad Mohsin Khan
- Department of NeurosurgeryHamad General Hospital – Surgical Specialty CenterDohaQatar
| | - Abdulnasser Thabet
- Department of NeurosurgeryHamad General Hospital – Surgical Specialty CenterDohaQatar
| | - Kazim Mohammed
- Department of NeurosurgeryHamad General Hospital – Surgical Specialty CenterDohaQatar
| | - Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck SurgeryGaribaldi HospitalCataniaItaly
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Treffy RW, Laing B, Eraky AM, Shabani S. Cervical spine spondylodiscitis: Review of literature on current treatment strategies. Heliyon 2023; 9:e17875. [PMID: 37483708 PMCID: PMC10359881 DOI: 10.1016/j.heliyon.2023.e17875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/15/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023] Open
Abstract
Infections of the spine are an ever-increasing health concern requiring an often complex and prolonged treatment that can lead to significant morbidity. Of particular interest is the cervical spine where there is an increase rate of post-infectious deformity, secondary neurological deficits and substantially higher rates of associated morbidity and mortality than the thoracic or lumbar spine. In this review, we explore the diagnosis and treatment of spondylodiscitis with particular focus on the cervical spine.
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Affiliation(s)
- Randall W. Treffy
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Brandon Laing
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Akram M. Eraky
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Saman Shabani
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
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5
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Zou LC, Qian J, Bian ZY, Wang XP, Xie T. Pyogenic spondylitis caused by Escherichia coli: A case report and literature review. World J Clin Cases 2023; 11:3583-3591. [PMID: 37383891 PMCID: PMC10294177 DOI: 10.12998/wjcc.v11.i15.3583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/04/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Pyogenic spondylitis is often manifested as atypical low back pain and fever, which makes it easy to be confused with other diseases. Here we report a case of pyogenic spondylitis and describe the diagnosis and treatment based on the related literature.
CASE SUMMARY The reported case suffered from pyogenic spondylitis caused by Escherichia coli and complicated with bacteremia and psoas abscess. Acute pyelonephritis was initially diagnosed due to atypical symptoms. Symptoms were improved from antibiotic treatment while developing progressive lower limb dysfunction. One month post the admission, the patient underwent anterior lumbar debridement + autogenous iliac bone graft fusion + posterior percutaneous screw-rod internal fixation, and received 6 wk of antibiotic treatment after the operation. Reexamination 4 mo post the operation showed that the patient had no evident pain in the waist, and walked well with no evident dysfunction of lower limbs.
CONCLUSION Here we describe the application value of several imaging examinations, such as X-ray, computed tomography and magnetic resonance imaging, and certain tests like erythrocyte sedimentation rate and C-reactive protein in the clinical treatment of pyogenic spondylitis. This disease requires early diagnosis and treatment. Sensitive antibiotics should be used in early stages and surgical intervention should be taken if necessary, which may help for a speedy recovery and prevent the occurrence of severe complications.
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Affiliation(s)
- Lai-Cheng Zou
- Department of Orthopedic Surgery, The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Jin Qian
- Department of Orthopedic Surgery, The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Zhen-Yu Bian
- Department of Orthopedic Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Xue-Peng Wang
- Department of Orthopedic Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Tao Xie
- Department of Orthopedic Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
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Han B, Wang J, Hai Y, Sun D, Liang W, Yin P, Ding H. The Incidence, Changes and Treatments of Cervical Deformity After Infection and Inflammation. Neurospine 2023; 20:205-220. [PMID: 37016867 PMCID: PMC10080454 DOI: 10.14245/ns.2244744.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/15/2022] [Indexed: 04/03/2023] Open
Abstract
A healthy cervical spine with normal movement is the basis of many daily activities and is essential for maintaining a good quality of life. However, the alignment, fusion, and structure of the cervical spine can change for various reasons, leading to cervical deformity, mainly kyphosis. Approximately 5%‒20% of spinal infections in the cervical spine cause cervical deformity. The deformity can recover early; however, the disease's long-term existence or the continuous action of abnormal stress may lead to intervertebral fusion and abnormal osteophytes. Many gaps and controversies exist regarding infectious cervical deformities, including a lack of clear definitions and an acceptable classification system thereby requiring further research. Moreover, there is no consensus on the indications for postinfectious cervical deformity associated with <i>Mycobacterium tuberculosis</i>, <i>Staphylococcus aureus</i>, and Brucellosis. Therefore, we reviewed and discussed the incidence, clinical manifestations, changes, and treatment of infectious and inflammatory secondary cervical deformities from common to rare to provide a theoretical basis for clinical decision-making.
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Affiliation(s)
- Bo Han
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jianqiang Wang
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yong Hai
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Corresponding Author Yong Hai Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chao-Yang District, Beijing 100020, China
| | - Duan Sun
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Weishi Liang
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Peng Yin
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hongtao Ding
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Hamed M, Brandecker S, Lampmann T, Asoglu H, Salemdawod A, Güresir E, Vatter H, Banat M. Early fusion outcome after surgical treatment of single-level and multi-level pyogenic spondylodiscitis: experience at a level 1 center for spinal surgery-a single center cohort study. J Orthop Surg Res 2023; 18:107. [PMID: 36793045 PMCID: PMC9930249 DOI: 10.1186/s13018-023-03584-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
STUDY DESIGN Retrospective single center cohort study. PURPOSE Spinal instrumentation in combination with antibiotic therapy is a treatment option for acute or chronic pyogenic spondylodiscitis (PSD). This study compares the early fusion outcome for multi-level and single-level PSD after urgent surgical treatment with interbody fusion in combination with fixation. METHODS This is a retrospective cohort study. Over a 10 year period at a single institution, all surgically treated patients received surgical debridement, fusion und fixation of the spine to treat PSD. Multi-level cases were either adjacent to each other on the spine or distant. Fusion rates were assessed at 3 and 12 months after surgery. We analyzed demographic data, ASA status, duration of surgery, location and length of spine affected, Charlson comorbidity index (CCI), and early complications. RESULTS A total of 172 patients were included. Of these, 114 patients suffered from single-level and 58 from multi-level PSD. The most frequent location was the lumbar spine (54.0%) followed by the thoracic spine (18.0%). The PSD was adjacent in 19.0% and distant in 81.0% of multi-level cases. Fusion rates at the 3 month follow-up did not differ among the multi-level group (p = 0.27 for both adjacent and distant sites). In the single-level group, sufficient fusion was achieved in 70.2% of cases. Pathogen identification was possible 58.5% of the time. CONCLUSIONS Surgical treatment of multi-level PSD is a safe option. Our study demonstrates that there was no significant difference in early fusion outcomes between single-level and multi-level PSD, whether adjacent or distant.
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Affiliation(s)
- Motaz Hamed
- grid.15090.3d0000 0000 8786 803XDepartment of Neurosurgery, University Hospital of Bonn, Venusberg-Campus 1, Building 81, 53127 Bonn, Germany
| | - Simon Brandecker
- grid.15090.3d0000 0000 8786 803XDepartment of Neurosurgery, University Hospital of Bonn, Venusberg-Campus 1, Building 81, 53127 Bonn, Germany
| | - Tim Lampmann
- grid.15090.3d0000 0000 8786 803XDepartment of Neurosurgery, University Hospital of Bonn, Venusberg-Campus 1, Building 81, 53127 Bonn, Germany
| | - Harun Asoglu
- grid.15090.3d0000 0000 8786 803XDepartment of Neurosurgery, University Hospital of Bonn, Venusberg-Campus 1, Building 81, 53127 Bonn, Germany
| | - Abdallah Salemdawod
- grid.15090.3d0000 0000 8786 803XDepartment of Neurosurgery, University Hospital of Bonn, Venusberg-Campus 1, Building 81, 53127 Bonn, Germany ,grid.411024.20000 0001 2175 4264Center for Advanced Imaging Research, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Marlene and Stewart Greenebaum, Comprehensive Cancer, Center University of Maryland, Baltimore, USA
| | - Erdem Güresir
- grid.15090.3d0000 0000 8786 803XDepartment of Neurosurgery, University Hospital of Bonn, Venusberg-Campus 1, Building 81, 53127 Bonn, Germany
| | - Hartmut Vatter
- grid.15090.3d0000 0000 8786 803XDepartment of Neurosurgery, University Hospital of Bonn, Venusberg-Campus 1, Building 81, 53127 Bonn, Germany
| | - Mohammed Banat
- Department of Neurosurgery, University Hospital of Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany.
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Mariniello G, Corvino S, Corazzelli G, Maiuri F. Cervical epidural abscess complicated by a pharyngoesophageal perforation after anterior cervical spine surgery for subaxial spondylodiscitis. Surg Neurol Int 2023; 14:102. [PMID: 37025524 PMCID: PMC10070333 DOI: 10.25259/sni_114_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/09/2023] [Indexed: 04/08/2023] Open
Abstract
Background The anterior approach to the cervical spine is safe and effective, but not without risks. The pharyngoesophageal perforation (PEP) is a rare but potentially life-threatening complication of this surgical route. A prompt diagnosis and adequate treatment are crucial for the prognosis; nevertheless, there is no unique consent about the best management. Case Description A 47-year-old woman was referred to our neurosurgical unit for clinical and neuroradiological signs of multilevel cervical spine spondylodiscitis, which was conservatively treated with long-term antibiotic therapy and cervical immobilization after computed tomography-guided biopsy. Nine months later, when the infection was resolved, the patient underwent C3-C6 spinal fusion with anterior plate and screws through anterior approach to the cervical spine for degenerative vertebral changes causing severe myelopathy, and C5- C6 retrolisthesis with instability. Five days after surgical procedure, the patient developed a pharyngoesophageal-cutaneous fistula, detected through wound drainage, and confirmed by swallowing contrast study, without systemic signs of infection. The PEP was conservatively treated, with antibiotic therapy and parenteral nutrition, and it was monitored through seriate swallowing contrast and magnetic resonance studies up to the complete resolution. Conclusion The PEP is a potentially fatal complication of the anterior cervical spine surgery. We suggest an accurate intraoperative control of the pharyngoesophageal's tract integrity at the end of the surgical procedure and a longtime follow-up, because the risk of occurrence is up to several years after surgery.
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Affiliation(s)
- Giuseppe Mariniello
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
| | - Sergio Corvino
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
| | - Giuseppe Corazzelli
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
- Corresponding author: Giuseppe Corazzelli, Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy.
| | - Francesco Maiuri
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
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Sommer B, Babbe-Pekol T, Feulner J, Richter RH, Buchfelder M, Shiban E, Sesselmann S, Forst R, Wiendieck K. Long-Term Clinical and Radiologic Outcome Following Surgical Treatment of Lumbar Spondylodiscitis: A Retrospective Bicenter Study. J Neurol Surg A Cent Eur Neurosurg 2023; 84:44-51. [PMID: 35760291 DOI: 10.1055/s-0042-1748767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND STUDY AIMS Spinal instrumentation for spondylodiskitis (SD) remains highly controversial. To date, surgical data are limited to relatively small case series with short-term follow-up data. In this study, we wanted to elucidate the biomechanical, surgical, and neurologic long-term outcomes in these patients. MATERIAL AND METHODS A retrospective analysis from two German primary care hospitals over a 9-year period (2005-2014) was performed. The inclusion criteria were (1) pyogenic lumbar SD, (2) minimum follow-up of 1 year, and (3) surgical instrumentation. The clinical and radiologic outcome was assessed before surgery, at discharge, and at a minimum of 12 months of follow-up. Follow-up included physical examination, laboratory results, CT and MRI scans, as well as assessment of quality of life (QoL) using short-form health survey (SF-36) inventory, Oswestry Disability Questionnaire, and visual analog scale (VAS) spine score. RESULTS Complete data were available in 70 patients (49 males and 21 females, with an age range of 67±12.3 years) with a median follow-up of 6.6 ± 4.2 years. Follow-up data were available in 70 patients after 1 year, in 58 patients after 2 years, and in 44 patients after 6 years. Thirty-five patients underwent posterior stabilization and decompression alone and 35 patients were operated on in a two-stage 360-degree interbody fusion with decompression. Pre- and postoperative angles of the affected motion segment were 17.6 ± 10.2 and 16.1 ± 10.7 degrees in patients with posterior instrumentation only and 21.0 ± 10.2 and 18.3 ± 10.5 degrees in patients with combined anterior/posterior fusion. Vertebral body subsidence was seen in 12 and 6 cases following posterior instrumentation and 360-degree instrumentation, respectively. Nonfusion was encountered in 22 and 11 cases following posterior instrumentation and 360-degree instrumentation, respectively. The length of hospital stay was 35.0 ± 24.5 days. Surgery-associated complication rate was 18% (12/70). New neurologic symptoms occurred in 7% (5/70). Revision surgery was performed in 3% (2/70) due to screw misplacement/hardware failure and in 3% (2/70) due to intraspinal hematoma. Although patients reported a highly impaired pain deception and vitality, physical mobility was unaffected and pain disability during daily activities was moderate. CONCLUSION Surgical treatment of SD with a staged surgical approach (if needed) is safe and provides very good long-term clinical and radiologic outcome.
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Affiliation(s)
- Björn Sommer
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany.,Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany
| | - Timo Babbe-Pekol
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
| | - Julian Feulner
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
| | - Richard Heinrich Richter
- Department of Orthopedic Surgery, Malteser Waldkrankenhaus St. Marien, University Hospital Erlangen, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
| | - Ehab Shiban
- Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany
| | - Stefan Sesselmann
- Department of Orthopedic Surgery, Malteser Waldkrankenhaus St. Marien, University Hospital Erlangen, Erlangen, Germany.,Institute for Medical Engineering, OTH Technical University of Applied Sciences Amberg-Weiden, Amberg, Germany
| | - Raimund Forst
- Department of Orthopedic Surgery, Malteser Waldkrankenhaus St. Marien, University Hospital Erlangen, Erlangen, Germany
| | - Kurt Wiendieck
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany.,Department of Spine Surgery, Kliniken Dr. Erler GmbH, Nürnberg, Germany
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10
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Sung MJ, Kim SK, Seo HY. Chronological Analysis of Primary Cervical Spine Infection: A Single-Center Analysis of 59 Patients over Three Decades (1992–2018). J Clin Med 2022; 11:jcm11082210. [PMID: 35456302 PMCID: PMC9027371 DOI: 10.3390/jcm11082210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022] Open
Abstract
Primary cervical spine infections progress quickly and cause neurological impairment at an early stage. Despite their clinical significance, few studies have investigated primary cervical spine infections, owing to the rarity of the condition. This study analyzed the characteristics of 59 patients treated for primary cervical spine infections between 1992 and 2018 at our hospital. Clinical and radiological analyses were conducted. Moreover, a comparative analysis was performed, incorporating each patient’s underlying disease, mortality and complications, and treatment results. Comparison between groups based on the chronological period (1992–2000, 2001–2009, and 2010–2018) revealed that the mean age of onset has increased significantly in recent years. The rate of neurological impairment, duration of antibiotic use, and frequency of underlying disease increased significantly with time. No significant differences among groups were observed in the hematological and microbiological analyses. The incidence rate of epidural abscess and multisegmental infection increased significantly in recent years. There was no statistically significant difference in the complication and mortality rates, according to the time period. We think that prompt diagnosis and appropriate treatment are necessary, considering the current trends in primary cervical spine infection.
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Affiliation(s)
- Myung-Jin Sung
- Department of Orthopaedic Surgery, Chonnam National University Hospital, Gwangju 61469, Korea; (M.-J.S.); (H.-Y.S.)
| | - Sung-Kyu Kim
- Department of Orthopaedic Surgery, Chonnam National University Hospital, Gwangju 61469, Korea; (M.-J.S.); (H.-Y.S.)
- Department of Orthopaedic Surgery, Chonnam National University Medical School, Gwangju 61469, Korea
- Correspondence: ; Tel.: +82-62-220-6336; Fax: +82-62-225-7794
| | - Hyoung-Yeon Seo
- Department of Orthopaedic Surgery, Chonnam National University Hospital, Gwangju 61469, Korea; (M.-J.S.); (H.-Y.S.)
- Department of Orthopaedic Surgery, Chonnam National University Medical School, Gwangju 61469, Korea
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11
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Long segment spinal reconstruction of C3-T1 utilizing single strut fibula free flap following debridement and corpectomy for chronic osteomyelitis. Am J Otolaryngol 2022; 43:103310. [PMID: 34894445 DOI: 10.1016/j.amjoto.2021.103310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/28/2021] [Indexed: 11/24/2022]
Abstract
Cervical vertebral osteomyelitis (CVO) is a complex destructive pathology that presents as a significant challenge to reconstructive surgeons. Advanced cases of CVO involving neurologic deficits, spinal column instability, or refractory infection require surgical intervention with bony debridement and decompression followed by spinal reconstruction, realignment, and stabilization. Reconstruction of the spine is typically performed through an anterior approach with or without posterior instrumentation. Restoration of the anterior spinal column can be performed with titanium or PEEK cages, allograft bone or vascularized autograft bone. Anterior spine reconstruction using vascularized osseous free flaps has been well documented in the medical literature; however, to our knowledge, we report the largest osteomyelitic anterior cervical spine defect that has been reconstructed using a single strut osseous free flap. This was a complex case of cervical osteomyelitis in a patient with prior C4-C7 anterior cervical corpectomy and fusion who presented with instrumentation failure and septicemia. Anterior column reconstruction required a vascularized fibular strut spanning six vertebral levels from C3-T1, as well as a trapezius myocutaneous pedicled flap for posterior soft tissue coverage.
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Nabizadeh N, Crawford CH, Glassman SD, Dimar Ii JR, Carreon LY. Severity and Outcome of Neurologic Deficits in Patients with Pyogenic Spondylodiscitis: A Systematic Review. Orthop Clin North Am 2022; 53:105-112. [PMID: 34799016 DOI: 10.1016/j.ocl.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Patients with advanced pyogenic spondylodiscitis can present with neurologic deficits. However, the prevalence, severity, and outcome of the neurologic deficits are not well known. A systematic review was performed to improve the knowledge of this commonly encountered clinical scenario. The considerable number of severe neurologic deficits in addition to their poor recovery, even after surgical intervention, demonstrates that the early diagnosis of pyogenic spondylodiscitis is crucial. Prompt surgical intervention is likely associated with a greater chance of improvement of neurologic status than nonsurgical treatment.
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Affiliation(s)
- Naveed Nabizadeh
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA
| | - Charles H Crawford
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 South Jackson Street, 1st Floor ACB, Louisville, KY 40202, USA
| | - Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 South Jackson Street, 1st Floor ACB, Louisville, KY 40202, USA
| | - John R Dimar Ii
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 South Jackson Street, 1st Floor ACB, Louisville, KY 40202, USA
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA.
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Mutoh M, Fukuoka T, Suzuki O, Hattori S. Three-Staged Surgical Strategy as a Combined Approach for Multilevel Cervical Pyogenic Spondylodiscitis. Cureus 2021; 13:e17747. [PMID: 34659960 PMCID: PMC8493043 DOI: 10.7759/cureus.17747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2021] [Indexed: 11/08/2022] Open
Abstract
Cervical pyogenic spondylodiscitis is rare but can lead to severe clinical problems that often require aggressive surgical treatment for neurological deterioration and life-threatening conditions. Although combined surgical procedures are often utilized to treat multilevel cervical regions, there is a clinical debate regarding the appropriate order and timing of surgeries using the anterior and posterior approaches. Here, we report a case of severe multilevel cervical pyogenic spondylodiscitis treated using a three-staged surgical strategy consisting of cervical laminectomy, posterior fixation, and anterior corpectomy and fusion with an autologous long bone graft; the outcome was quite favorable. Our report demonstrates the safety and usefulness of three-staged surgery in the multilevel cervical region, especially under urgent situations.
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Affiliation(s)
- Manabu Mutoh
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, JPN
| | - Toshiki Fukuoka
- Department of Neurosurgery, Nagoya Ekisaikai Hospital, Nagoya, JPN
| | - Osamu Suzuki
- Department of Neurosurgery, Nagoya Ekisaikai Hospital, Nagoya, JPN
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An Independent Validation of the Brighton Spondylodiscitis Score and a Proposal to Modify the Score. J Am Acad Orthop Surg 2020; 28:701-706. [PMID: 32039921 DOI: 10.5435/jaaos-d-19-00505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The Brighton Spondylodiscitis Score (BSS) aims to identify patients with pyogenic spinal infections (PSIs) requiring surgery; an independent assessment of the BSS is required. METHODS We evaluated 60 patients with PSIs. Using the BSS, we determined whether patients with low, moderate, and high risk (LMHR) had different rates of surgery. We proposed a modified score (MS) using a logistic regression (LOGR). Applying the MS, we determined whether patients with LMHR exhibited different rates of surgery. Another LOGR determined the association of the BSS and the MS with surgery. A C-statistic using the BSS and the MS was generated. RESULTS We studied 60 patients (mean age = 63 years); 37 (62%) were men; 30 (50%) required surgery. Using the BSS, patients with LMHR had similar rates of surgery (P = 0.53). LOGR showed that cervical PSIs had a larger chance of surgery (odds ratio [OR] = 7.3 [1.1 to 51.3]) than other locations. Using the MS, patients with moderate- and high-risk were operated more frequently than low-risk patients (P = 0.04). The BSS did not predict surgery (OR = 1.07; P = 0.31), but the MS did (OR = 1.16; P = 0.02). The C-statistic using the BSS (0.59) improved using the MS (0.69), P = 0.03. DISCUSSION The discriminatory capacity to predict surgery of the BSS augmented using the MS. LEVEL OF EVIDENCE II (Diagnostic study: Transverse study).
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Impact of the localization on disease course and clinical management in spondylodiscitis. Int J Infect Dis 2020; 99:122-130. [PMID: 32721536 DOI: 10.1016/j.ijid.2020.07.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/09/2020] [Accepted: 07/19/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Spondylodiscitis is a severe infection of the spine that can take a diverse number of disease courses depending on its localization, resulting in specific therapeutic strategies. This study aims to identify localization specific characteristics and clinical parameters for spondylodiscitis. METHODS A retrospective review was performed of 211 patients from 2013-2018 with proven spondylodiscitis. In total, 33 were cervical, 48 thoracic and 112 lumbar. In 18 patients disseminated infestations of several localizations were found. The patient records were evaluated for clinical and outcome parameters and demographic characteristics. RESULTS Patient age, Body Mass Index, inpatient and intensive care stay, and inpatient complications did not differ significantly between different infection localizations. C-reactive protein (CrP) levels showed a significantly reduced value in the thoracic area compared to other localizations. For comorbidities, there was a significantly higher prevalence of endocarditis in disseminated and lumbar infestations compared to thoracic and cervical cases. Epidural abscesses showed a highly increased incidence in cervical cases. With a 30-day mortality rate of 12.1% for cervical, 12.5% thoracic, 13.4% lumbar, and 22.2% in disseminated disease, no significant difference was observed. CONCLUSIONS The present study determined that, although the 30-day mortality rate does not differ according to the localization of the infection, specific clinical parameters, such as CrP values or comorbidities, showed localization-dependent differences.
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Sideris G, Nikolopoulos T, Papadimitriou N. Spontaneous, Non-Traumatic Retropharyngeal Abscess Complicated by Spinal Osteomyelitis and Epidural Abscess in Immunocompetent Adult: Management and Proposal Pathophysiological Mechanism. Cureus 2020; 12:e9028. [PMID: 32775107 PMCID: PMC7406186 DOI: 10.7759/cureus.9028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Retropharyngeal abscess (RPA) in adults is a potentially life-threatening condition that relates in most of the cases with local trauma. Non-traumatic RPA complicated by spinal osteomyelitis and epidural abscess is a rare entity in immunocompetent adults and represents an emergency medical condition when the patient develops neurologic symptoms. This article presents a case of non-traumatic RPA complicated by spinal osteomyelitis and epidural abscess in a 77-year-old male with the free past medical history. We highlight the importance of early and meticulous daily drainage as well as sequential MRI scanning for early diagnosis, treatment and follow-up for signs of vertebral involvement. The patient had a full recovery and was subsequently discharged with per os four-month antibiotic treatment. The definitive mechanism is unclear for non-traumatic cases with “hematogenous path” being the closest description. Spontaneous RPA can develop from bacteria infection spread of adjacent structures, local inflammatory process and microthrombosis formation can impair the blood supply of vertebral and intervertebral disks.
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Anterior Cervical Debridement and Fusion for Cervical Pyogenic Spondylodiscitis: Use of Anterior Cervical Plating or Not? Spine (Phila Pa 1976) 2020; 45:431-437. [PMID: 31651678 DOI: 10.1097/brs.0000000000003298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective multicenter case series. OBJECTIVE We sought to evaluate the safety and efficacy of anterior cervical plating in anterior cervical debridement and fusion (ACDF) for patients with cervical pyogenic spondylodiscitis (CPS). SUMMARY OF BACKGROUND DATA Due to concerns about bacterial seeding on the foreign material after instrumentations in pyogenic infections, the safety and efficacy of anterior cervical plating for CPS are still undetermined and controversial. Little information is available about the safety and efficacy of anterior cervical plating to manage CPS. METHODS Twenty-three patients who underwent ACDF with (n = 12) or without (n = 11) plating for CPS were included. The mean age was 62.6 years. Medical records were reviewed and radiological parameters including segmental height, segmental angle, C2-C7 angle, and fusion status were analyzed. The mean follow-up period after surgery was 21.3 months. RESULTS After ACDF with plating, segmental height, segmental angle, and C2-C7 angle were significantly improved compared with preoperative conditions and remained well-maintained at the last follow-up. After ACDF without plating, three radiological parameters were also initially improved compared with preoperative condition, but significantly deteriorated to preoperative levels at the time of the last follow-up. The fusion rate was higher in the ACDF with plating group compared with the ACDF without plating group (90.9% vs. 63.6%; P < 0.01). One patient who received ACDF with plating and four patients who received ACDF without plating underwent revision surgery due to nonunion or bone graft dislodgement. No recurrence of pyogenic spondylodiscitis occurred in either group. CONCLUSION ACDF with plating showed better surgical outcomes compared with ACDF without plating for CPS. We recommend the use of anterior cervical plating, which can provide biomechanical stability, for better healing of CPS. To our knowledge, this is the largest surgical case series of CPS. LEVEL OF EVIDENCE 4.
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Tonetti DA, Eichar B, Ares WJ, Kanter AS, Hamilton DK. Should the Presence of Spondylodiscitis Alter the Surgical Treatment of Patients with Symptomatic Ventral Cervical Epidural Abscesses? An Institutional Analysiss. World Neurosurg 2020; 138:e282-e288. [PMID: 32112938 DOI: 10.1016/j.wneu.2020.02.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Spinal epidural abscess is a rare pathology with an incidence that has tripled in the past 2 decades. Ventral cervical epidural abscesses (vCEA) of the cervical spine pose particular treatment challenges because of the anatomical location. The aim of this report is to identify trends in the surgical management of these patients and to determine whether concomitant spondylodiscitis warrants fusion at the index surgery. METHODS Patients presenting to a quaternary care institution from January 2009 to December 2018 with isolated vCEA were identified. Patients were excluded if they had dorsal or circumferential epidural abscesses. Clinical and radiographic data were collected. Patients with vCEA were stratified by the presence or absence of spondylodiscitis upon presentation. Clinical outcomes analyzed included neurological sequelae and the need for revision surgery. RESULTS During the 10-year study period, 36 patients presented with symptomatic isolated vCEA and constituted the study cohort; 16 (44%) had concurrent spondylodiscitis. All 36 patients underwent surgical decompression; the initial surgical approach was anterior-only for 7 patients (19%), posterior-only for 27 patients (75%), and and a combined approach for 2 patients (6%). Four patients from the total cohort (11%) ultimately required a revision operation; all 4 were from the subset with concurrent spondylodiscitis (25% vs. 0%, P = 0.03). CONCLUSIONS vCEA can be evacuated safely and effectively by a variety of strategies in patients with neurologic deficits. Concomitant spondylodiscitis with cervical epidural abscess may warrant instrumented fusion as part of the initial surgical strategy.
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Affiliation(s)
- Daniel A Tonetti
- The Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
| | - Bradley Eichar
- The Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - William J Ares
- The Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Adam S Kanter
- The Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David Kojo Hamilton
- The Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Nicolás MCJ, Guillermo GGO, Benito RCL, Gerardo CGC, Esteban RV, Atenas KGL, Ricardo MP. SERRATIA MARCESCENS AS A CAUSE OF CERVICAL MYELOPATHY. COLUNA/COLUMNA 2019. [DOI: 10.1590/s1808-185120191804192964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: The main causative agent of spinal infections is Mycobacterium Tuberculosis, followed by saprophytes of the skin. The most affected segment is the lumbar, followed by the thoracic. Objective: Case report. Results: A previously healthy 40-year-old man with posterior cervical pain and myelopathy was referred to our spine service for vertebral destruction syndrome in C3-C4 and altered carbohydrate metabolism. Microdiscectomy and abscess drainage were performed and a biopsy was taken for definitive diagnosis. Multiresistant Serratia Marcescens was isolated in the culture. Both the myelopathy and carbohydrate intolerance were resolved as the infection was resolved. Conclusion: The significance of this case lies in the infective presentation of the S. Marcescens in an immunocompetent person, since it is mainly an opportunistic microorganism, and in the atypical location. The most commonly isolated pathogen is Mycobacterium Tuberculosis, followed by Staphylococcus aureus. Identification of the causative agent is essential to the initiation of antibiotic therapy. Therefore, microbiological isolation plays a fundamental role in the treatment, recovery and quality of life of the patient. Level of evidence V; Case report.
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Miyazaki M, Abe T, Ishihara T, Kanezaki S, Notani N, Kataoka M, Tsumura H. Cervical alignment after single-level anterior cervical corpectomy and fusion using autologous bone graft without spinal instrumentation for cervical pyogenic spondylitis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:479-484. [PMID: 31707454 DOI: 10.1007/s00590-019-02594-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Subsidence in anterior cervical corpectomy and fusion (ACCF) for cervical degenerative disease (CDD) are constantly observed during the postoperative course. Although kyphotic change of cervical alignment occurred frequently in cervical pyogenic spondylitis (CPS) postoperatively, studies on the postoperative change in segmental angle for CPS are limited. This study aimed to analyze cervical alignment after single-level ACCF using autologous bone graft without spinal instrumentation for CPS compared with that for CDD. METHODS Six patients underwent single-level ACCF using autologous bone graft without spinal instrumentation for CPS. The control group included 18 age-matched patients who underwent single-level ACCF using autologous bone graft for CDD without spinal instrumentation for the same duration. Cervical and lateral plain radiographs and computed tomography scans were taken. The Frankel classification was used to assess the neurological status preoperatively, postoperatively, and at 2-year follow-up for CPS. RESULTS At 2-year follow-up, the average segmental angle at the fusion level was - 12.2° ± 6.9° for CPS and - 5.2° ± 7.6° for CDD (p = 0.04). Changes in segmental angle at the fusion level were - 7.2 ± 9.0° for CPS and - 1.1° ± 7.1° for CDD (p = 0.02). At 2-year follow-up, the average anterior segmental fusion height was 23.4 ± 1.7 mm for CPS and 29.1 ± 5.1 mm for CDD (p < 0.001). At 2-year follow-up, bone fusion in the CPS group was classified as grade 5 (complete fusion) in 4 patients (66.7%) and grade 4 (probable fusion) in 2 (33.3%). In the CDD group, it was grade 5 in 13 patients (72.2%) and grade 4 in 5 patients (27.8%). Overall, both groups achieved 100% bone fusion rate. The Frankel classification in all CPS cases improved or leveled off. CONCLUSION Progression of segmental kyphosis angle and subsidence of graft bone were observed postoperatively on all CPS cases. However, the neurological recovery and bone union were satisfactory.
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Affiliation(s)
- Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan.
| | - Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Toshinobu Ishihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Naoki Notani
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Masashi Kataoka
- Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
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Aljawadi A, Jahangir N, Jeelani A, Ferguson Z, Niazi N, Arnall F, Pillai A. Management of Pyogenic Spinal Infection, review of literature. J Orthop 2019; 16:508-512. [PMID: 31680742 DOI: 10.1016/j.jor.2019.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/11/2019] [Indexed: 12/15/2022] Open
Abstract
Objective To evaluate the available evidence for the management of Pyogenic Spinal Infection (PSI). Methods and results A comprehensive search for the relevant literature published between 1990 and 2018 to evaluate the management of PSI was conducted.Nonoperative management of carefully selected patients for an adequate duration of antibiotics can result in satisfactory outcomes with low recurrence rate. When there is an indication for surgery, posterior approach, with or without debridement of infected tissue reported to be associated with good outcomes. Conclusion Studies with larger sample sizes and longer duration of follow up are recommended to formulate more comprehensive evidence.
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Affiliation(s)
- Ahmed Aljawadi
- Trauma and Orthopaedics, Manchester Foundation Trust, Southmoor Rd, Wythenshawe, Manchester, M23 9LT, UK
| | - Noman Jahangir
- Trauma and Orthopaedics, Manchester Foundation Trust, Southmoor Rd, Wythenshawe, Manchester, M23 9LT, UK
| | - Ana Jeelani
- Trauma and Orthopaedics, Manchester Foundation Trust, Southmoor Rd, Wythenshawe, Manchester, M23 9LT, UK
| | - Zak Ferguson
- Trauma and Orthopaedics, Manchester Foundation Trust, Southmoor Rd, Wythenshawe, Manchester, M23 9LT, UK
| | - Noman Niazi
- Trauma and Orthopaedics, Manchester Foundation Trust, Southmoor Rd, Wythenshawe, Manchester, M23 9LT, UK
| | - Frances Arnall
- Fellow Higher Education Academy, MSc Trauma & Orthopaedics Academic Module lead, School of Health Sciences, Allerton Building C711, University of Salford, Fredrick Road Campus, M6 6PU, UK
| | - Anand Pillai
- Trauma and Orthopaedics, Manchester Foundation Trust, Southmoor Rd, Wythenshawe, Manchester, M23 9LT, UK
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Aljawadi A, Sethi G, Imo E, Arnall F, Choudhry MN, George KJ, Tambe A, Verma R, Yasin MN, Mohammed S, Siddique I. Medium-term outcome of posterior surgery in the treatment of non-tuberculous bacterial spinal infection. J Orthop 2019; 16:569-575. [PMID: 31680747 DOI: 10.1016/j.jor.2019.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 06/16/2019] [Indexed: 12/17/2022] Open
Abstract
Objective to evaluate the outcome of posterior spinal stabilization surgery for the management of bacterial spinal infection. Methods 21 patients with bacterial infection were managed surgically with posterior stabilization. Outcome measures included neurological status. Follow-up data collected using Spine Tango COMI questionnaires and Euro Qol EQ-5D. Results The mean improvement in neurological deficits was 0.91 Frankel grade. Residual symptoms of pain had no or minor effect on the work or usual activities in 52% of subjects, with 88% reported having either no or mid problems with mobility. Conclusion Posterior surgery can improve neurological outcome in approximately half of the patients.
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Affiliation(s)
- Ahmed Aljawadi
- Trauma and Orthopaedics, University of Salford, Salford, Manchester, M5 4WT, UK
| | - Gagan Sethi
- Trauma and Orthopaedics - Spinal, University of Salford, Manchester, UK
| | - Eze Imo
- Trauma and Orthopaedics, Arrowe Park Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Merseyside, CH49 5PE, UK
| | - Frances Arnall
- School of Health Sciences, Allerton Building C711, University of Salford, Fredrick Road Campus, M6 6PU, UK
| | | | | | - Anant Tambe
- Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - Rajat Verma
- Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - Mohammed Naveed Yasin
- Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - Saeed Mohammed
- Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
| | - Irfan Siddique
- Department of Spinal Surgery, Salford Royal NHS Trust, Stott Lane, Salford, M6 8HD, UK
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Rosinsky P, Mandler S, Netzer N, Ady M, Elmaliache D, Sagiv S, Ben-Galim P. Antibiotic-Resistant Spondylodiscitis With Canal Invasion and Aggressive Evolution to Epidural Abscess: A Case Series of Spontaneous Occurrence in 16 Patients. Int J Spine Surg 2019; 12:743-750. [PMID: 30619679 DOI: 10.14444/5093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background The study aimed to assess the effectiveness of antibiotic treatment for spondylodiscitis, its failure rates, and the need for surgical intervention. Methods This is a retrospective study of patients who presented with spontaneous deep spinal infections and spondylodiscitis between 2011 and 2013. Clinical, bacteriologic, and radiographic data during hospitalization were analyzed. Results A total of 16 patients presented with deep spinal infections during the study period; 15 of them presented with spontaneous pyogenic spondylodiscitis, and 1 presented with epidural abscess. Median age was 68 years (range, 50-80 years), and 6 (38%) were healthy young laborers. None of the patients were immunocompromised. On admission all patients presented with pain, there was fever in 3 patients (19%), and there was elevated blood C-reactive protein, white blood cell count and erythrocyte sedimentation rate, with a mean of 147 ± 83.1 mg/L, 11.65 ± 5.6 × 103/μL, 93.6 ± 35.1 mm/h, respectively. A total of 15 patients (94%) developed infections that were refractory to appropriate culture-specific intravenous antibiotic treatment (mean, 10.2 days); 8 patients (50%) deteriorated neurologically and required wide surgical decompression. Complications included widespread epidural free gas in 2 patients (12%), multiple bilateral psoas abscesses in 2 patients (12%), kyphotic segmental instability in 4 patients (25%), and inferior vena cava septic thrombi in 1 patient (6%). A total of 3 patients (19%) died within 6 months; 7 of 13 surviving patients still had residual neurologic deficits at the 6-month follow-up. Conclusions Spondylodiscitis may be resistant to antibiotic treatment and may evolve into epidural abscess via extension of the infection and pus into the spinal canal, necessitating repetitive surgical treatment due to neurologic and clinical deterioration, and expansion of the persistent infection with a mass effect. Increased vigilance for this condition and its misleading initial presentations is warranted.
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Affiliation(s)
| | - Shay Mandler
- Department of Orthopaedic Surgery, Rehovot, Israel
| | - Niv Netzer
- Department of Orthopaedic Surgery, Rehovot, Israel
| | - Meital Ady
- Imaging, Kaplan Medical Center, Rehovot, Israel
| | | | - Shaul Sagiv
- Department of Orthopaedic Surgery, Rehovot, Israel
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Burkhardt BW, Müller SJ, Wagner AC, Oertel JM. Anterior cervical spine surgery for the treatment of subaxial cervical spondylodiscitis: a report of 30 consecutive patients. Neurosurg Focus 2019; 46:E6. [DOI: 10.3171/2018.10.focus18464] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/22/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEInfection of the cervical spine is a rare disease but is associated with significant risk of neurological deterioration, morbidity, and a poor response to nonsurgical management. The ideal treatment for cervical spondylodiscitis (CSD) remains unclear.METHODSHospital records of patients who underwent acute surgical management for CSD were reviewed. Information about preoperative neurological status, surgical treatment, peri- and postoperative processes, antibiotic treatment, repeated procedure, and neurological status at follow-up examination were analyzed.RESULTSA total of 30 consecutive patients (17 male and 13 female) were included in this retrospective study. The mean age at procedures was 68.1 years (range 50–82 years), with mean of 6 coexisting comorbidities. Preoperatively neck pain was noted in 21 patients (70.0%), arm pain in 12 (40.0%), a paresis in 12 (40.0%), sensory deficit in 8 (26.7%), tetraparesis in 6 (20%), a septicemia in 4 (13.3%). Preoperative MRI scan revealed a CSD in one-level fusion in 21 patients (70.0%), in two-level fusions in 7 patients (23.3%), and in three-level fusions in 2 patients (6.7%). In 16 patients an antibiotic treatment was initiated prior to surgical treatment. Anterior cervical discectomy and fusion with cervical plating (ACDF+CP) was performed in 17 patients and anterior cervical corpectomy and fusion (ACCF) in 12 patients. Additional posterior decompression was performed in one case of ACDF+CP and additional posterior fixation in ten cases of ACCF procedures. Three patients died due to multiple organ failure (10%). Revision surgery was performed in 6 patients (20.7%) within the first 2 weeks postoperatively. All patients received antibiotic treatment for 6 weeks. At the first follow-up (mean 3 month) no recurrent infection was detected on blood workup and MRI scans. At final follow-up (mean 18 month), all patients reported improvement of neck pain, all but one patients were free of radicular pain and had no sensory deficits, and all patients showed improvement of motor strength. One patient with preoperative tetraparesis was able to ambulate.CONCLUSIONSCSD is a disease that is associated with severe neurological deterioration. Anterior cervical surgery with radical debridement and appropriate antibiotic treatment achieves complete healing. Anterior cervical plating with the use of polyetheretherketone cages has no negative effect of the healing process. Posterior fixation is recommended following ACCF procedures.
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Taylor DG, Buchholz AL, Sure DR, Buell TJ, Nguyen JH, Chen CJ, Diamond JM, Washburn PA, Harrop J, Shaffrey CI, Smith JS. Presentation and Outcomes After Medical and Surgical Treatment Versus Medical Treatment Alone of Spontaneous Infectious Spondylodiscitis: A Systematic Literature Review and Meta-Analysis. Global Spine J 2018; 8:49S-58S. [PMID: 30574438 PMCID: PMC6295820 DOI: 10.1177/2192568218799058] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
STUDY DESIGN Systematic literature review. OBJECTIVES The aims of this study were to (1) describe the clinical features, disabilities, and incidence of neurologic deficits of pyogenic spondylodiscitis prior to treatment and (2) compare the functional outcomes between patients who underwent medical treatment alone or in combination with surgery for pyogenic spondylodiscitis. METHODS A systematic literature review was performed using PubMed according to PRISMA guidelines. No year restriction was put in place. Statistical analysis of pooled data, when documented in the original report (ie, number of patients with desired variable and number of patients evaluated), was conducted to determine the most common presenting symptoms, incidence of pre- and postoperative neurologic deficits, associated comorbidities, infectious pathogens, approach for surgery when performed, and duration of hospitalization. Outcomes data, including return to work status, resolution of back pain, and functional recovery were also pooled among all studies and surgery-specific studies alone. Meta-analysis of studies with subgroup analysis of pain-free outcome in surgical and medical patients was performed. RESULTS Fifty of 1286 studies were included, comprising 4173 patients undergoing either medical treatment alone or in combination with surgery. Back pain was the most common presenting symptom, reported in 91% of patients. Neurologic deficit was noted in 31% of patients. Staphylococcus aureus was the most commonly reported pathogen, seen in 35% of reported cases. Decompression and fusion was the most commonly reported surgical procedure, performed in 80% of the surgically treated patients. Combined anterior-posterior procedures and staged surgeries were performed in 33% and 26% of surgeries, respectively. The meta-analysis comparing visual analog scale score at follow-up was superior among patients receiving surgery over medical treatment alone (mean difference -0.61, CI -0.90 to -0.25), while meta-analysis comparing freedom from pain in patients receiving medical treatment alone versus combined medical and surgical treatment demonstrated superior pain-free outcomes among surgical series (odds ratio 5.35, CI 2.27-12.60, P < .001), but was subject to heterogeneity among studies (I 2 = 56%, P = .13). Among all patients, freedom from pain was achieved in 79% of patients, and an excellent outcome was achieved in 73% of patients. CONCLUSION Medical management remains first-line treatment of infectious pyogenic spondylodiscitis. Surgery may be indicated for progressive pain, persistent infection on imaging, deformity or neurologic deficits. If surgery is required, reported literature shows potential for significant pain reduction, improved neurologic function and a high number of patients returning to a normal functional/work status.
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Affiliation(s)
- Davis G. Taylor
- University of Virginia, Charlottesville, VA, USA,Davis G. Taylor, Department of Neurological Surgery, University of Virginia, P.O. Box 800212, Charlottesville, VA 22908, USA.
| | | | - Durga R. Sure
- St. Mary’s Hospital, Essential Health Duluth Clinic, Duluth, MN, USA
| | | | | | | | | | | | - James Harrop
- Thomas Jefferson University, Philadelphia, PA, USA
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Luo CA, Tsai TT, Lu ML, Hsieh MK, Lai PL, Fu TS, Chen WJ, Chen LH, Niu CC. Factors related to post surgical neurologic improvement for cervical spine infection. Biomed J 2018; 41:306-313. [PMID: 30580794 PMCID: PMC6306300 DOI: 10.1016/j.bj.2018.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 07/27/2017] [Accepted: 07/31/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cervical spine infections are uncommon but potentially dangerous, having the highest rate of neurological compromise and resulting disability. However, the factors related to surgical success is multiple yet unclear. METHODS We retrospectively reviewed the medical records of 27 patients (16 men and 11 women) with cervical spine infection who underwent surgical treatment at Chang Gung Memorial Hospital, Linkou branch, between 2001 and 2014. The neurological status, by Frankel classification, was recorded preoperatively and at discharge. Group X had neurologic improvement of at least 1 grade, group Y had unchanged neurologic status, and group Z showed deterioration. We recorded the patient demographic data, presenting symptoms and signs, interval from admission to surgery, surgical procedure, laboratory data, perioperative antibiotic course, pathogens identified, coexisting medical disease, concomitant nonspinal infection, and clinical outcomes. We intended to evaluate the different characteristics of patients who improved neurologically after treatment. RESULTS The mean age of our cohort was 56.6 years. Anterior cervical discectomy and fusion was the most commonly performed surgical procedure (74.1%). The Frankel neurological status improved in 70.4% (group X, n = 19) and unchanged in 29.6% (group Y, n = 8). No patients worsened. Motor weakness was most common (96.3%) neurological deficit, followed by sensory abnormalities (37.0%), and bowel/urine incontinence (33.3%). The main difference in presentation between group X and group Y was neck pain (100% vs. 75.0%; p = .02), not fever. Group X had a shorter preoperative antibiotic course (p = .004), interval from admission to operation (p = .02), and hospital stay (p = .01). CONCLUSION Clinicians should be more suspicious in patients who present with neck pain and any neurological involvement even in those without fever while establishing early diagnosis. Earlier operative treatment in group X result in better neurologic recovery and shorter hospital stay due to disease improvement.
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Affiliation(s)
- Chi-An Luo
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Meng-Ling Lu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ming-Kai Hsieh
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Po-Liang Lai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Tsai-Sheng Fu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wen-Jer Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Lih-Huei Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chi-Chien Niu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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Eshra MA. Cervical corpectomy for sub-axial retro-vertebral body lesions. EGYPTIAN JOURNAL OF NEUROSURGERY 2018. [DOI: 10.1186/s41984-018-0004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Nigro L, Tarantino R, Donnarumma P, Santoro A, Delfini R. A case of cervical tuberculosis with severe kyphosis treated with a winged expandable cage after double corpectomy. JOURNAL OF SPINE SURGERY 2017; 3:304-308. [PMID: 28744518 DOI: 10.21037/jss.2017.06.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this case report, we demonstrate that the use of a winged expandable cage was able to obtain good clinical and radiological results in a case of cervical tuberculosis with severe kyphosis. However, case series will be necessary to affirm its validity as a stand-alone device for similar cases with high risk of instability.
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Affiliation(s)
- Lorenzo Nigro
- Division of Neurosurgery, Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Roberto Tarantino
- Division of Neurosurgery, Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Pasquale Donnarumma
- Division of Neurosurgery, Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Antonio Santoro
- Division of Neurosurgery, Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Roberto Delfini
- Division of Neurosurgery, Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
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Ghobrial GM, Franco D, Theofanis T, Margiotta PJ, Andrews E, Wilson JR, Harrop JS, Heller JE. Cervical Spondylodiscitis: Presentation, Timing, and Surgical Management in 59 Patients. World Neurosurg 2017; 103:664-670. [PMID: 28457929 DOI: 10.1016/j.wneu.2017.04.119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cervical spondylodiscitis is thought to carry a significant risk for rapid neurologic deterioration with a poor response to nonsurgical management. METHODS A retrospective surgical case series of the acute surgical management of cervical spondylodiscitis is reviewed to characterize the neurologic presentation and postoperative neurologic course in a relatively uncommon disease. RESULTS Fifty-nine patients were identified (mean age, 59 years [range, 18-83 years; SD ± 13.2 years]) from a single-institution neurosurgical database. The most common levels of radiographic cervical involvement were C4-C5, C5-C6, and C6-C7, in descending order. Overall, statistically significant clinical improvement was noted after surgery (P < 0.05). Spinal cord hyperintensity on T2-weighted magnetic resonance imaging was significantly associated with a worse preoperative neurologic grade (P = 0.036), but did not correlate with a relatively worse neurologic outcome by discharge. No significant difference was noted between potential preoperative predictors (organism cultured, presence of epidural abscess, tobacco use, early surgery within 24 hours of clinical presentation) and preoperative American Spinal Injury Association injury scale, with the exception of the duration between symptom onset and surgical intervention. A negative correlation between increased preoperative duration of symptoms and magnitude in motor improvement was observed. Relative to anteroposterior decompression and fusion, anterior treatment alone demonstrated a relatively greater effect in neurologic improvement. CONCLUSIONS Cervical spondylodiscitis is a rare disease that typically manifests with preoperative motor deficits. Surgery was associated with a significant improvement in motor score by hospital discharge. Significant predictors of neurologic improvement were not observed. Prolonged symptomatic duration was correlated with a significantly lower likelihood of motor score improvement.
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Affiliation(s)
- George M Ghobrial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA; Department of Neurological Surgery, University of Miami Hospital, Lois Pope Life Center, Miami, Florida, USA.
| | - Daniel Franco
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Thana Theofanis
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Philip J Margiotta
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Edward Andrews
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jefferson R Wilson
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - James S Harrop
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Joshua E Heller
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Oblique corpectomy for treatment of cervical spine epidural abscesses: Report on four cases. Neurol Neurochir Pol 2016; 50:491-496. [PMID: 27576671 DOI: 10.1016/j.pjnns.2016.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/19/2016] [Accepted: 08/08/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Spinal epidural abscesses (SEAs) in cervical locations are particularly life-threatening. Currently, SEAs are widely treated with bony decompression, followed by internal stabilization in purulent osteomyelitis. However, recently, a growing number of studies have reported minimally invasive approaches without internal fixation. PURPOSE We describe four patients with cervical SEAs that were evacuated by oblique corpectomy (OC) without fusion. METHODS This study included two women and two men (aged 44-90) that received operations for removing ventral cervical SEAs. All patients presented with progressively increasing myelopathy, and 3 had severe comorbid conditions. In all cases, a multilevel OC without fusion was performed. The amount of bone resection was tailored to fit the needs of granulation removal, with an effort to retain as much of the vertebral bodies as possible. Then, pus was evacuated and debridement of granulation was performed, followed by rinsing and drainage. RESULTS The neurological status of 3 patients improved significantly after surgery. At the last follow-up examination, one showed full recovery, and in two a minor residual deficit persisted. During mean follow-up of 5.5 years, no internal stabilization was necessary. The oldest patient was tetraplegic, and had several concomitant diseases. That patient died from sudden cardiac arrest on the third postoperative day. Oblique corpectomy did not affect the anterior or posterior column. Additionally, it provided a broad view of the ventral aspect of the spinal canal. CONCLUSIONS Oblique corpectomy allows appropriate spinal cord decompression and granulation removal in the case of cervical spine epidural abscess, without sacrificing spinal stability.
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Andrés-Cano P, Vela T, Cano C, García G, Vera JC, Andrés-García JA. Cervical Spondylodiscitis After Oxygen-Ozone Therapy for Treatment of a Cervical Disc Herniation: a Case Report and Review of the Literature. HSS J 2016; 12:278-283. [PMID: 27703423 PMCID: PMC5026656 DOI: 10.1007/s11420-016-9500-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/02/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Pablo Andrés-Cano
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, s/n, 41013 Sevilla, Spain
| | - Tomás Vela
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Puerta del Mar, Cádiz, Cádiz Spain
| | - Claudio Cano
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Puerta del Mar, Cádiz, Cádiz Spain
| | - Gaspar García
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Puerta del Mar, Cádiz, Cádiz Spain
| | - Juan Carlos Vera
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM USA
| | - Jose Antonio Andrés-García
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Puerta del Mar, Cádiz, Cádiz Spain
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Multilevel Corpectomy With Anterior Column Reconstruction and Plating for Subaxial Cervical Osteomyelitis. Spine (Phila Pa 1976) 2016; 41:E1088-E1095. [PMID: 26974830 DOI: 10.1097/brs.0000000000001557] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective case series. OBJECTIVE The aim of this study was to evaluate patients with cervical spine osteomyelitis who underwent multilevel (≥2) subaxial corpectomies and anterior column reconstruction and plating. SUMMARY OF BACKGROUND DATA Neglected multilevel subaxial cervical osteomyelitis is a potentially dangerous disease. As it is rare, early radiographic and clinical outcomes after multilevel anterior corpectomy and reconstruction for subaxial cervical osteomyelitis are incompletely defined. METHODS Adults who underwent multilevel corpectomy and anterior plating/reconstruction for subaxial cervical osteomyelitis at two institutions were reviewed. Analysis of patient demographics, operative details, and radiographic cervical alignment parameters [segmental kyphosis, cervical lordosis, C2-7 sagittal vertical axis (SVA)] was performed. RESULTS Nineteen patients [15 males, four females; average age 48 years (20-81 yrs)] met inclusion criteria. The majority had pre-operative neurologic deficits or was immunosuppressed. All were treated with ≥6 weeks of intravenous antibiotics following operation. All had anterior plating/reconstruction with titanium cages (expandable-6; mesh-6) or structural bone graft (fibular allogaft-6; tricortical iliac crest-1). The average number of corpectomies was 2.4 (2-4). The average numbers of levels fused anteriorly was 4.4 (4-6) and posteriorly was 6.3 (4-9). The majority of patients (74%) was treated with an anterior/posterior approach. Average follow-up was 16 ± 9 months. There was significant improvement in all cervical alignment parameters (segmental kyphosis, C2-7 SVA, cervical lordosis). No intraoperative complications occurred and no patient deteriorated neurologically postoperatively. Postoperative complications included anterior cage/graft dislodgement (n = 2), recurrent neck hematomas requiring revision (n = 1), epidural hematoma (n = 1), and wound infection (n = 1). Sixty percent of patients had persistent neurologic dysfunction at final follow-up. None required reoperation for recurrent infection or pseudarthrosis. CONCLUSION Although overall prognosis and neurologic recovery are guarded in medically fragile patients with multilevel subaxial cervical osteomyelitis, reconstruction with multilevel (≥2) corpectomy and anterior reconstruction/plating results in excellent restoration of cervical alignment and low rates of recurrent infection and pseudarthrosis. LEVEL OF EVIDENCE 4.
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One-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion in the surgical treatment of lumbo-sacral spinal tuberculosis in the aged. INTERNATIONAL ORTHOPAEDICS 2016; 40:1117-24. [DOI: 10.1007/s00264-016-3161-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/06/2016] [Indexed: 12/19/2022]
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Abstract
Spinal infection is rare. Clinical suspicion is important in patients with nonmechanical neck and/or back pain to make the proper diagnosis in early disease. Before planning surgery, a thorough evaluation of the spinal stability, alignment, and deformity is necessary. Timing of surgery, side of approach, appropriate surgical technique, and spinal instruments used are crucial. Biomechanical preservation of the spinal column during and after the infection is a significant issue. Postoperative spine infection is another entity of which spinal surgeons should be aware of. Proper septic conditions with meticulous planning of surgery are essential for successful spine surgery and better outcome.
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Affiliation(s)
- Derya Burcu Hazer
- Department of Neurosurgery, Mugla Sitki Kocman University School of Medicine, Orhaniye Mahallesi, Haluk Ozsoy Caddesi, Mugla 48000, Turkey
| | - Selim Ayhan
- Malatya State Hospital, Department of Neurosurgery, Firat Mahallesi, Hastane Caddesi, Malatya 44330, Turkey
| | - Selcuk Palaoglu
- Department of Neurosurgery, Hacettepe University School of Medicine, Sihhiye, Altindag, Ankara 06100, Turkey.
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Shaw KA, Boomsma SE, Johnson PC, Gloystein DM. Hemodialysis-Associated Spondylodiscitis of the Cervical Spine: A Case Report. JBJS Case Connect 2015; 5:e90. [PMID: 29252796 DOI: 10.2106/jbjs.cc.o.00037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A fifty-seven-year-old, hemodialysis-dependent man presented with a one-month history of progressive neck pain and paresthesias of the upper extremities. Radiographic examination demonstrated collapse of the C5 and C6 vertebrae with resultant kyphosis and spinal cord compression. CONCLUSION The patient underwent a staged anterior debridement with C5 and C6 corpectomies, cage placement, and plate fixation of C4 to C7, followed by a posterior arthrodesis from C4 to C7. He completed a six-week course of intravenous antibiotics for the treatment of Staphylococcus epidermidis spondylodiscitis, followed by suppressive oral antibiotics. At one year of follow-up, he had no residual neck pain or neurological signs or symptoms.
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Affiliation(s)
- K Aaron Shaw
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, 300 East Hospital Road, Fort Gordon, GA 30905.
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Surgical management in 40 consecutive patients with cervical spinal epidural abscesses: shifting toward circumferential treatment. Spine (Phila Pa 1976) 2015; 40:E949-53. [PMID: 25893350 DOI: 10.1097/brs.0000000000000942] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective database review of a prospectively maintained neurosurgical database. OBJECTIVE The surgical management of cervical spinal epidural abscesses (CSEA) is reviewed examining the shift from single to staged anteroposterior decompression and stabilization. SUMMARY OF BACKGROUND DATA CSEA management is guided by small case series. METHODS A retrospective review from 1997 to 2011 was conducted for patients with the diagnostic headings: cervical epidural abscess, infection, osteomyelitis, osteodiscitis, spondylodiscitis, and abscess. Comorbidities, risk factors, surgical approach, neurologic grade, and outcomes were recorded. RESULTS Forty consecutive patients (mean age 53 years, age range 23-74, SD ±14, 10 female) were identified with CSEA in the operative database from 1997 to 2010. Twenty one patients had a body mass index more than 25 (53%), 6 (15%) had diabetes mellitus, 6 (15%) had a prior malignancy with 2 having prior neck irradiation, and 9 (23%) used tobacco products. The most common risk factor associated with CSEA was intravenous drug abuse, found in 10 patients (25%). The most common level of discitis involvement was C6-C7 in 12 (30%) followed by C5-C6 disc in 11 (28%) and least often at C1-C2 level in 2(5%) and C7-T1 in 2(5%). The most common neurologic grades at presentation were AIS D in 20 (50%) followed by AIS E in 9 (28%). All patients received magnetic resonance imaging identifying 17 (43%) with dorsal, 12 ventral (30%), and 11 circumferential epidural abscesses (28%). The majority of patients underwent anterior followed by posterior decompression and stabilization (n = 26, 65%); 8 (20%) underwent a ventral approach and six underwent a dorsal approach (15%). Fusion was achieved in 39 of 40 (97.5%) and not significantly influenced halo use in 10 patients. CONCLUSIONS In this series, patients underwent acute evacuation and spinal cord decompression, and the shift toward staged treatment did not lead to an increased periprocedural complication rate. LEVEL OF EVIDENCE 3.
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Voelker A, von der Hoeh NH, Gulow J, Heyde CE. Cervical spondylodiscitis with epidural abscess after knife stab wounds to the neck: A case report. Injury 2015; 46:1684-8. [PMID: 26052055 DOI: 10.1016/j.injury.2015.05.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/31/2015] [Accepted: 05/16/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Cervical spondylodiscitis is usually caused by pyogenic infections, associated with retropharyngeal abscesses, or due to the swallowing of foreign bodies. No cases of cervical spondylodiscitis caused by a penetrating neck injury have been published in the literature. We describe a case of cervical spondylodiscitis after multiple knife stab wounds to the lateral soft tissue of the neck. MATERIALS AND METHODS Case report and review of the literature. RESULTS A 54-year-old patient was brought to our clinic with destructive spondylodiscitis C3/4 with paravertebral and epidural abscesses. He had been involved in a fight and had suffered multiple stab wounds to his neck with a knife 1 month prior. The initial CT scan had revealed one deeper wound canal behind the sternocleidomastoid muscle on the left side without any injury to the vessels. The wound was cleaned and an antibiotic therapy with cefuroxime was given for 1 week. After an uneventful and complete healing of the wound the patient developed severe neck pain. Inflammatory laboratory parameters were elevated, and a MRI of the neck revealed a distinct spondylodiscitis C3/4 with paravertebral and epidural abscess formations. Surgery was performed and included debridement, abscess drainage, decompression of the spinal canal, fusion of the C3/4 segment using an autologous iliac crest bone graft and a plate osteosynthesis. A course of calculated antibiotic therapy was administered for 8 weeks. Normal laboratory parameters and no radiological signs of an ongoing inflammatory process were observed during follow-up examinations. The C3/4 segment was consolidated. CONCLUSION Stab wound injuries to the neck not only bear the risk of injuries to the nerves, vessels and organs of the neck but also increase the risk of developing secondary spondylodiscitis. Specifically, cervical spondylodiscitis can result in distinct neurological symptoms, and surgical intervention should be performed in a timely manner.
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Affiliation(s)
- Anna Voelker
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
| | - Nicolas H von der Hoeh
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
| | - Jens Gulow
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
| | - Christoph-Eckhard Heyde
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
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Surgical treatment of patients with spondylodiscitis and neurological deficits caused by spinal epidural abscess (SEA) is a predictor of clinical outcome. ACTA ACUST UNITED AC 2014; 27:395-400. [PMID: 24136052 DOI: 10.1097/bsd.0000000000000030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The purpose of this study was to investigate the question whether surgical treatment of patients with spondylodiscitis and neurological deficits caused by a spinal epidural abscess (SEA) is a predictor of clinical outcome. SUMMARY OF BACKGROUND DATA Spondylodiscitis with an accompanying SEA is a serious medical condition that is associated with potentially high risk for long-term neurological morbidity. In the literature, up to 75% of patients suffer from neurological deficits related to SEA in spondylodiscitis. Independent of treatment, residual neurology persists at a high rate. METHODS A retrospective analysis of 135 patients admitted to our department due to a diagnosis of spondylodiscitis was performed. Presence of SEA was evaluated based on computed tomography and magnetic resonance imaging. Neurological status was documented on admission and at discharge according to the Frankel Score. In addition, our patient population was separated into group I without neurological deficits (Frankel E) and group II with abnormal Frankel A-D. Surgical and nonsurgical therapy was retrospectively evaluated. Data were statistically analyzed using the 2-sided Fisher exact test. RESULTS On admission, 102 patients were graded as Frankel E in group I. In group II, 15 were Frankel D, 8 Frankel C, 8 Frankel B, and 2 Frankel A. After treatment, 105 patients were Frankel E, 19 Frankel D, 4 Frankel C, 3 Frankel B, and none Frankel A. Four patients died because of severe comorbidities. In group II, 13 of 33 patients had a SEA. Twelve patients showed improvement in Frankel grade, 1 remained unchanged. Of the 20 patients in group II without a SEA, 11 improved and 9 remained unchanged. Twenty-eight of the 33 patients in group II were treated surgically. Patients in both groups with improved neurology showed an upgrade by 1 or 2 Frankel scores. There was no deterioration of neurology. The correlation between surgically treated patients with SEA in comparison with patients without SEA is considered to be statistically significant. CONCLUSION Surgical treatment of patients with spondylodiscitis and neurological deficits caused by SEA is a predictor of clinical outcome.
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Spondylodiscitis by drug-multiresistant bacteria: a single-center experience of 25 cases. Spine J 2014; 14:2826-34. [PMID: 24704675 DOI: 10.1016/j.spinee.2014.03.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/03/2014] [Accepted: 03/26/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although the incidence of pyogenic spinal infections is increasing, the ideal treatment of spondylodiscitis is still a controversially discussed issue. Furthermore, the proportion of multiresistant bacteria in spondylodiscitis is increasing, and treatment recommendations or reported results are missing for this especially difficult subset of patients. PURPOSE The aim of this study is to evaluate the surgical outcome and the postoperative antibacterial treatment regime. STUDY DESIGN Retrospective case series. PATIENT SAMPLE Patients treated for a spondylodiscitis from multiresistant bacteria at our department between 2006 and 2011. METHODS Data were gathered through review of patients' case notes, relevant imaging, and electronic records. Magnetic resonance imaging of the whole spine including gadolinium (Gd)-enhanced T1 sequences and computed tomography scans of the affected regions were obtained in all cases. OUTCOME MEASURES C-reactive protein (CRP) and complete blood cell count were analyzed in all cases using routine laboratory techniques. Neurologic deficits were classified according to the American Spinal Injury Association (ASIA) impairment scale. RESULTS Twenty-five patients were identified (15 gram-positive and 10 gram-negative drug-multiresistant bacteria). The mean age at presentation was 66 years, and 14 patients were male (56%). All patients presented with pain, and a neurologic deficit was present in 11 (44%) cases. An epidural abscess was found in 11 (44%) cases. At admission, CRP was elevated in all cases with a mean of 13±9.2 mg/dL. The main source of infection was previous spine surgery (36%). All patients in this series underwent surgical debridement of the infection and instrumentation of the spine. Postoperative intravenous antibiotics were administered for 19±8.6 days followed by 3±0.3 months of oral antibiotic therapy. Eradication of the infection was achieved ultimately in all surviving patients. Out of 11 patients with neurologic deficits, 4 had a full recovery, 4 improved incompletely, and 3 remained unchanged after surgery. CONCLUSIONS Staged surgical immobilization and instrumentation and optimal debridement at the interdiscal space and spinal canal is a reliable approach to achieve complete healing of spinal infection with multiresistant bacteria. A period of intravenous antibiotic therapy of 2 to 3 weeks followed by a 3-month oral antibiotic therapy seems appropriate for most cases.
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Hahn BS, Kim KH, Kuh SU, Park JY, Chin DK, Kim KS, Cho YE. Surgical Treatment in Patients with Cervical Osteomyelitis: Single Institute's Experiences. KOREAN JOURNAL OF SPINE 2014; 11:162-8. [PMID: 25346763 PMCID: PMC4206968 DOI: 10.14245/kjs.2014.11.3.162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/14/2014] [Accepted: 08/18/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study practical guidelines and strategies in the treatment of cervical osteomyelitis. METHODS We retrospectively reviewed 14 patients who underwent surgical treatment for cervical osteomyelitis from May 2000 to July 2008. We investigated their clinical course, antibiotic regimen, surgical methods, and laboratory and radiologic findings including X-ray, CT and MRI. RESULTS 5 patients had primary spondylodiscitis, 5 patients had post operative spondylodiscitis and 4 patients had tuberculosis in cervical spine. The causative microorganisms were MRSA (5), P. aeruginosa (1), Methicillin resistant coagulase negative streptococcus (1), P. aeruginosa changed to MRSA (1), and 2 patients showed no growth on culture studies. Patients were treated 13.8 weeks (range, 5.4-25.8) with IV antibiotics and then treated for 58.2 days (range, 13-106) with oral antibiotics. Antituberculotic medications were used for a mean of 383.8 days. Patients were treated with anterior debridement and fusion (5), irrigation and debridement (5), simultaneous cervical anterior interbody and transthoracic thoracic interbody fusion (1). 3 patients underwent the planned 2-staged operation, which included an anterior debridement with or without fusion for the 1(st) operation and posterior instrumentation for 2(nd) operation. 10 patients (71.4%) had neurologic deficits at the time of diagnosis and 7 patients (70%) among them improved post-operatively. CONCLUSION Anterior cervical spine surgery is the preferable treatment option in patients with neurological deterioration, extensive bony destruction with expected kyphotic deformity, and uncontrolled infection being managed only with antibiotics. Antibiotics are also important for thorough treatment.
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Affiliation(s)
- Bang Sang Hahn
- Department of Neurosurgery, The Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Hyun Kim
- Department of Neurosurgery, The Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Uk Kuh
- Department of Neurosurgery, The Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Yoon Park
- Department of Neurosurgery, The Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Kyu Chin
- Department of Neurosurgery, The Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keun-Su Kim
- Department of Neurosurgery, The Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Eun Cho
- Department of Neurosurgery, The Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
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Bydon M, De la Garza-Ramos R, Macki M, Naumann M, Sciubba DM, Wolinsky JP, Bydon A, Gokaslan ZL, Witham TF. Spinal instrumentation in patients with primary spinal infections does not lead to greater recurrent infection rates: an analysis of 118 cases. World Neurosurg 2014; 82:e807-14. [PMID: 24937598 DOI: 10.1016/j.wneu.2014.06.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/16/2014] [Accepted: 06/10/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We sought to compare outcomes between patients undergoing decompression only versus decompression and instrumented fusion for primary spinal infections. METHODS Records of patients with a diagnosis of primary spinal infection who underwent surgical management at our institution during a 10-year period were reviewed. Patients were divided into 2 cohorts based on treatment received (decompression alone vs. decompression and instrumentation). Our primary end points were complication rates, need for reoperation, recurrent infections, and resolution of symptom(s) at last follow-up. RESULTS A total of 118 patients underwent surgical management for primary spinal infections. Thirty-five patients presented with a cervical spine infection, 40 with a thoracic infection, and 43 with a lumbosacral infection. The mean age at presentation was 57.1 ± 13.5 years. Thirty-six patients underwent only decompression, and 82 underwent decompression and instrumented fusion. In the decompression-only group, 8.33% of patients had continued osteomyelitis/discitis compared with 9.76% of patients in the instrumented group (P = 0.807). Importantly, the reoperation rate was also similar between the decompression-only group (19.44%) and the instrumented group (17.07%; P = 0.756). Similarly, subanalyses based on infection location revealed no significant increase in rates of recurrent infection or reoperation in patients who underwent instrumentation. CONCLUSION Patients who received just decompression for spinal infection had similar reoperation and continued infection rates as patients who additionally underwent instrumentation, irrespective of infection location within the spine. These findings suggest that instrumentation of the infected spine may be a safe treatment modality and should be considered when the spinal integrity is compromised.
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Affiliation(s)
- Mohamad Bydon
- The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Rafael De la Garza-Ramos
- The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mohamed Macki
- The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Matthew Naumann
- The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Daniel M Sciubba
- The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Jean-Paul Wolinsky
- The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ali Bydon
- The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ziya L Gokaslan
- The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Timothy F Witham
- The Spinal Column Biomechanics and Surgical Outcomes Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
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Shiban E, Janssen I, Wostrack M, Krieg SM, Ringel F, Meyer B, Stoffel M. A retrospective study of 113 consecutive cases of surgically treated spondylodiscitis patients. A single-center experience. Acta Neurochir (Wien) 2014; 156:1189-96. [PMID: 24671549 DOI: 10.1007/s00701-014-2058-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 03/07/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Recommendations for the operative treatment of spondylodiscitis are still a controversial issue. METHODS A retrospective review identified 113 consecutive patients who underwent surgical debridement and instrumentation for spondylodiscitis between 2006 and 2010 at our department. RESULTS The mean age at presentation was 65 years; 78 patients were male (69 %). Distribution of the inflammation was lumbar in 68 (60 %), thoracic in 19 (17 %) and cervical in 20 (18 %) cases. Six patients (5 %) had two concomitant non-contiguous spondylodiscitis foci in different segments of the spine. Epidural abscess was found in 33 patients (29 %). One hundred four patients (92 %) had pain. Neurological deficit was found in 40 patients (35 %). In the thoracic and lumbar cases, dorsal instrumentation alone was considered sufficient in 26 cases; additional interbody fusion from the posterior was performed in 44 cases. A 360° instrumentation was performed in 22 cases. In the cervical cases, only ventral spondylodesis and plating were performed in eight cases, only dorsal instrumentation in five and 360° instrumentation in seven. Postoperative intravenous antibiotics were administered for 14.4 ± 9.3 (mean ± SD) days followed by 3.2 ± 0.8 (mean ± SD) months of oral antibiosis. Complete healing of the inflammation was achieved in 111 (98 %) cases. Two patients died because of septic shock, both with fulminant endocarditis. Pain resolved in all cases. Neurological deficits were completely resolved in 20 patients, and 14 patients had a partial recovery. CONCLUSION The results of our retrospective study show that surgical treatment of spondylodiscitis with a staged surgical approach (if needed) and a short 1-2-week period of intravenous antibiotics followed by 3 months of oral antibiotics is appropriate for most patients in whom conservative treatment has failed or is not advisable. Furthermore, surgical treatment of newly diagnosed spondylodiscitis might be recommended as an initial treatment option in many cases. Thereby the choice of fusion material (autologous bone, titanium, PEEK) seems less important.
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Cervical spondylodiscitis – A clinical analysis of surgically treated patients and review of the literature. Clin Neurol Neurosurg 2014; 117:86-92. [DOI: 10.1016/j.clineuro.2013.11.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 11/08/2013] [Accepted: 11/29/2013] [Indexed: 11/23/2022]
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Voelker A, von der Hoeh NH, Gulow J, Tschoeke SK, Heyde CE. Multifocal infections of the musculoskeletal system: description of a safe one-step procedure for eradication of associated spinal infections. Patient Saf Surg 2013; 7:30. [PMID: 24066659 PMCID: PMC3849748 DOI: 10.1186/1754-9493-7-30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 09/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the clinical outcome after radical surgical treatment of multifocal infections involving the spine. METHODS The study demonstrates a retrospective chart review of seven patients who had more than three different abscesses in the musculoskeletal system and at least one of them in the area of the spinal column. All patients had a sepsis. RESULTS Beside different musculoskeletal abscesses four patients had a spondylodiscitis in the cervical spine segments C4/5 or C5/6. Six patients had inflammatory processes in the lumbar spine with epidural abscesses, diffuse thoracolumbar paravertebral abscesses and a spondylodiscitis in different segments. In all cases we performed a radical surgical treatment of all related inflammatory focuses. Prompt radical surgical treatment of the spine included decompression, debridement and in the cases of spondylodiscitis a fusion of the involved segments. For more than one focus at the spine, a surgical one-step procedure was performed. An antibiotic therapy was administered for six to eight weeks. In follow up examinations no signs of ongoing inflammatory processes were seen in imaging studies or laboratory tests. CONCLUSIONS In the event of multiple abscesses of the musculoskeletal system involving the spine an early correct diagnosis and radical surgical treatment is recommended. We strongly favor a surgical single-stage procedure for treatment of multiple infections of the spine. In addition to a radical debridement and a sufficient decompression, the segmental fusion of affected areas in spondylodiscitis is essential. At the same time a surgical therapy of all other infected sites should be performed.
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Affiliation(s)
- Anna Voelker
- Department of Orthopaedic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
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Urrutia J, Zamora T, Campos M. Cervical pyogenic spinal infections: are they more severe diseases than infections in other vertebral locations? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:2815-20. [PMID: 24013780 DOI: 10.1007/s00586-013-2995-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/16/2013] [Accepted: 08/29/2013] [Indexed: 12/17/2022]
Abstract
PURPOSE Cervical spine pyogenic infections are unusual compared to other vertebral segments, but they can be associated to worse clinical outcomes. We compared all patients with cervical spine pyogenic infections to those with thoracolumbar involvement in terms of epidemiology, prognostic factors and clinical outcomes. METHODS We retrospectively reviewed all patients discharged from our institution with diagnosis of pyogenic spinal infections (PSI) during a 14-year period. Patients' demographics, etiologic agent, co-morbidities, site of infection, white blood cell count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) at time of presentation, neurological impairment and mortality were registered to compare clinical outcomes of patients with PSI affecting the cervical spine and other segments. RESULTS We studied 102 patients with PSI. Nineteen (18.6 %) had cervical involvement; 73.7 % of them were males, with a mean age of 65.22 years. 89.7 % of them presented spondylodiscitis; 12 patients (63.2 %) exhibited a one segment involvement (C5-C6 being the most common), and 11 patients presented an epidural abscess. Thirteen patients (68.4 %) exhibited neurological deficit. Seventeen patients (89.5 %) presented elevated ESR and CRP, while 12 patients (63.2 %) exhibited leukocytosis. The causative organism was identified in 17 patients (89.5 %). Despite similar baseline characteristics, compared to PSI in other locations, patients with cervical PSI presented significantly more neurological involvement (68.4 vs. 41 %; p = 0.03), they more often required surgical treatment (84.2 vs. 46.3 %; p < 0.01), and they had and increased mortality (21.1 % compared to 3.6 %; p = 0.02). CONCLUSION An early diagnosis and prompt treatment should be the goal treating cervical PSI, considering the potential devastating complications and increased mortality.
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Affiliation(s)
- Julio Urrutia
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Chile,
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Diagnostic value of erythrocyte sedimentation rate combined with C-reactive protein in postprocedure discitis. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31826ff048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang CS, Feng SW, Huang LJ, Yu JK, Chang MC, Wang ST, Liu CL. Atypical mycobacterial spondylitis as a challenging differential diagnosis to metastatic disease of the spine: a case report. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 23 Suppl 2:S135-9. [PMID: 23412200 DOI: 10.1007/s00590-012-1068-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 08/01/2012] [Indexed: 11/26/2022]
Abstract
Disseminated Mycobacterium avium complex (MAC) infection is rarely seen in patients without acquired immune deficiency syndrome. A disseminated MAC infection presenting with symptoms that mimic tumor metastasis had not previously been reported. Few disseminated MAC infections have been reported, and all image patterns in these cases indicated destructive lesions. We present a case involving a tumor-like disseminated MAC infection with spondylitis in a 68-year-old man whose symptoms started with severe lower back pain and fever. Treatment for malignancy was performed initially but soon stopped after tissue proving MAC infection. Symptoms then improved dramatically after a four-drug combined anti-nontuberculous mycobacteria treatment.
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Affiliation(s)
- Chien-Shun Wang
- Department of Orthopedics and Traumatology, Veterans General Hospital-Taipei, National Yang-Ming University School of Medicine, 201, Section 2, Shih-Pai Road, Taipei, Taiwan, Republic of China
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Gorensek M, Kosak R, Travnik L, Vengust R. Posterior instrumentation, anterior column reconstruction with single posterior approach for treatment of pyogenic osteomyelitis of thoracic and lumbar spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22:633-41. [PMID: 22922802 DOI: 10.1007/s00586-012-2487-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 07/30/2012] [Accepted: 08/14/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Surgical treatment of thoracolumbar osteomyelitis consists of radical debridement, reconstruction of anterior column either with or without posterior stabilization. The objective of present study is to evaluate a case series of patients with osteomyelitis of thoracic and lumbar spine treated by single, posterior approach with posterior instrumentation and anterior column reconstruction. METHODS Seventeen patients underwent clinical and radiological evaluation pre and postoperatively with latest follow-up at 19 months (8-56 months) after surgery. Parameters assessed were site of infection, causative organism, angle of deformity, blood loss, duration of surgery, ICU stay, deformity correction, time to solid bony fusion, ambulatory status, neurologic status (ASIA impairment scale), and functional outcome (Kirkaldy-Willis criteria). RESULTS Mean operating time was 207 min and average blood loss 1,150 ml. Patients spent 2 (1-4) days in ICU and were able to walk unaided 1.6 (1-2) days after surgery. Infection receded in all 17 patients postoperatively. Solid bony fusion occurred in 15 out of 17 patients (88 %) on average 6.3 months after surgery. Functional outcome was assessed as excellent or good in 82 % of cases. Average deformity correction was 8 (1-18) degrees, with loss of correction of 4 (0-19) degrees at final follow-up. CONCLUSIONS Single, posterior approach addressing both columns poses safe alternative in treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine. It proved to be less invasive resulting in faster postoperative recovery.
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Affiliation(s)
- M Gorensek
- Department of Orthopedic Surgery, Spine Surgery Unit, University Medical Centre, Ljubljana, Slovenia
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Di Martino A, Papapietro N, Lanotte A, Russo F, Vadalà G, Denaro V. Spondylodiscitis: standards of current treatment. Curr Med Res Opin 2012; 28:689-99. [PMID: 22435926 DOI: 10.1185/03007995.2012.678939] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Spinal infections are an important clinical problem that often require aggressive medical therapy, and sometimes even surgery. Known risk factors are advanced age, diabetes mellitus, rheumatoid arthritis, immunosuppression, alcoholism, long-term steroid use, concomitant infections, poly-trauma, malignant tumor, and previous surgery or invasive procedures (discography, chemonucleolysis, and surgical procedures involving or adjacent to the intervertebral disc space). The most common level of involvement is at the lumbar spine, followed by the thoracic, cervical and sacral levels: lesions at the thoracic spine tend to lead more frequently to neurological symptoms. OBJECTIVE The aim of the current paper is to describe current evidence-based standards of therapy in the management of SD by emphasizing pharmacological therapy and principles and indications for bracing and surgery. METHODS A PubMed and Google Scholar search using various forms and combinations of the key words: spondylodiscitis, spine, infection, therapy, surgery, radiology, treatment. Reference citations from publications identified in the literature search were reviewed. Publications highlighted in this article were extracted based on relevancy to established, putative, and emerging diagnostic and therapeutic standards, either conservative (antibiotic therapy and bracing) or surgical. FINDINGS To date, conservative therapy, based on targeted antibiotic therapy plus bracing, represents the mainstay in the management of SD. Proper diagnosis and tailored therapy can improve clinical results and decrease the chance of failure. Surgery should be an option only for patients with complications of this disease, namely deformity, neural compression and neurological compromise. Current standards in the setting of SD are continuously evolving, as can be seen in the recent advances in the field of radiological diagnostics, and the use of growth factors and cell-therapy strategies to promote infection eradication and bone healing after surgery.
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Affiliation(s)
- Alberto Di Martino
- Center for Integrated Research, Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200 Rome 00128, Italy.
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Abstract
PURPOSE To report outcomes of 7 patients with bacterial spondylodiscitis treated through a posterior approach. METHODS Five men and 2 women aged 40 to 80 years underwent one-stage posterior interbody debridement and instrumentation for single-segment bacterial spondylodiscitis of lumbar (n=5) or thoracic (n=2) vertebrae. The Oswestry Disability Score, the Frankel classification, the Cobb angle, and the visual analogue scale (VAS) for pain as well as bone union on radiographs were assessed. RESULTS Patients were followed up for 19 to 36 months. None had relapses or complications. Postoperatively, 5 patients had no pain or used analgesics only occasionally; their VAS scores varied from 0 to 20. The remaining 2 patients had residual symptoms and received regular peripheral pain medication and opiates; their VAS scores ranged from 30 to 50. The mean Oswestry Disability Score improved to 21 (range, 12-38). The mean Cobb angle improved from 13.1 to 11.1 degrees. The segments were probably fused in 5 patients and questionable in 2. CONCLUSION Posterior debridement and instrumentation was adequate for single-segment spondylodiscitis and achieved good outcomes.
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Affiliation(s)
- Stefan Endres
- Department of Orthopaedic Surgery, Elisabeth-Klinik Bigge/Olsberg, Olsberg, Germany.
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