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Zore NV, Sharath HV, Gangwani N. Physiotherapeutic Rehabilitation for a Geriatric Patient With Discitis Associated With Pott's Spine: A Case Report. Cureus 2024; 16:e57083. [PMID: 38681364 PMCID: PMC11052698 DOI: 10.7759/cureus.57083] [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: 02/19/2024] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Discitis linked to Pott's spine is an infrequent yet severe issue, especially difficult to manage among elderly individuals due to age-related bodily changes and concurrent health issues. This report details the successful physiotherapy-based recovery of a senior patient afflicted with discitis related to Pott's spine. The individual, a 61-year-old man, presented symptoms including intense back pain, restricted movement, and neurological issues. The diagnosis was confirmed via imaging scans, indicating spinal tuberculosis and vertebral disc involvement. Treatment embraced a comprehensive approach involving medication alongside physiotherapy. The physiotherapeutic regimen aimed at pain alleviation, enhancing spinal flexibility, strengthening weakened muscles, and promoting functional autonomy. Techniques such as manual therapy, targeted exercises, and patient education were employed. Despite the challenges posed by the patient's age and existing conditions, significant enhancements in pain management, mobility, and everyday functioning were noted during the rehabilitation journey. This case underscores the significance of prompt diagnosis, collaborative care, and personalized physiotherapeutic interventions in attaining positive outcomes for elderly patients grappling with discitis associated with Pott's spine. Further investigation is needed to delineate optimal rehabilitation approaches for this intricate condition among the elderly.
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Affiliation(s)
- Nandini V Zore
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU) Sawangi Meghe, Wardha, IND
| | - H V Sharath
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU) Sawangi Meghe, Wardha, IND
| | - Nikita Gangwani
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU) Sawangi Meghe, Wardha, IND
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James R, Jarvis R, Featherstone J, Bullock N. Disseminated E. coli urinary tract infection resulting in septic arthritis of the glenohumeral joint. Urol Case Rep 2023; 50:102537. [PMID: 37621388 PMCID: PMC10445441 DOI: 10.1016/j.eucr.2023.102537] [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: 08/04/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
An 89-year-old male with a background of metastatic transitional cell carcinoma presented acutely with new hydronephrosis and deranged renal function secondary to high pressure chronic urinary retention. A recent urine culture was positive for Escherichia coli (E.coli). Co-incidentally, the patient's primary presenting symptom was right shoulder pain following recent low velocity trauma. X-ray demonstrated air density within the glenohumeral joint, with Magnetic Resonance Imaging (MRI) confirming features of septic arthritis. Surgical debridement was undertaken with tissue microscopy and culture identifying the presence of E. coli, confirming the diagnosis of disseminated urinary tract infection.
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Affiliation(s)
- Rhodri James
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Ruth Jarvis
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Nicholas Bullock
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK
- Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK
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Ikenaga S, Yunaiyama D, Yasutomi M, Nakamura I, Okubo M, Saguchi T, Nakai M, Saito K. Usefulness of Percutaneous Drainage in Determining the Causative Microorganism in Patients with Spondylodiscitis: A Retrospective Cross-Sectional Study. J Belg Soc Radiol 2023; 107:51. [PMID: 37457675 PMCID: PMC10348065 DOI: 10.5334/jbsr.3127] [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: 03/04/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose To determine the usefulness of CT-guided percutaneous drainage for the causative microorganism detection in patients with spondylodiscitis. Materials and Methods Data of patients who underwent CT-guided percutaneous drainage for spondylodiscitis from January 2014 to April 2022 were extracted from the radiological database of our hospital and investigated. The administration rate of antibiotics prior to blood culture and CT-guided percutaneous drainage (CTPD) were analyzed. The detection rate of microorganisms via blood culture and CT-guided percutaneous drainage were compared using the Mann-Whitney's U test with the SPSS software. Results In this study, a total of 30 (20 male and 10 female) patients were analyzed. A total of 13 patients (43%) were administered antibiotics prior to blood culture. Of them, microorganisms were detected via blood culture in only one patient (7%). A total of 25 patients (83%) were administered antibiotics prior to CTPD. Of them, the causative microorganisms in 19 patients (76%) were detected. Overall, the causative microorganism could be detected in 24 out of 26 patients (92%) via CT-guided percutaneous drainage. There was a statistical significance in the detection rate of microorganisms between blood culture and CTPD (P = 0.004) in favor of CTPD. Conclusion CT-guided percutaneous drainage showed a high positive rate of microorganism detection in patients with spondylodiscitis regardless of antibiotic administration prior to the procedure. CT-guided percutaneous drainage can be a solution for the detection of the causative microorganism in spondylodiscitis patients who received antibiotics before obtaining any culture.
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Affiliation(s)
- Shoichi Ikenaga
- Department of Radiology, Tokyo Medical University, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Daisuke Yunaiyama
- Department of Radiology, Tokyo Medical University, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Mika Yasutomi
- Department of Radiology, Tokyo Medical University, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Itaru Nakamura
- Department of Infection Prevention and Control, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Mitsuru Okubo
- Department of Radiology, Tokyo Medical University, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Toru Saguchi
- Department of Radiology, Tokyo Medical University, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Motoki Nakai
- Department of Radiology, Tokyo Medical University, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Baryeh K, Anazor F, Iyer S, Rajagopal T. Spondylodiscitis in adults: diagnosis and management. Br J Hosp Med (Lond) 2022; 83:1-9. [DOI: 10.12968/hmed.2021.0448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Spondylodiscitis is often diagnosed late in its course because its symptoms are vague. The incidence in adults increases with age, being seen most commonly in men in their 50s and 60s, so the presence of other medical conditions or infections can make it more difficult to identify spondylodiscitis. Diagnosis is made based on clinical suspicion, raised levels of inflammatory markers, a positive blood or tissue biopsy culture and radiological findings. Once a diagnosis is confirmed, treatment must be started promptly. The mainstay of treatment is medical management, with antibiotics tailored to the relevant organism, as well as immobilisation. Where surgery is indicated, the aims are debridement of infected tissue, tissue sampling, neural decompression and stabilisation. Spondylodiscitis is associated with high rates of mortality and morbidity and should be treated promptly to ensure the best outcome.
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Affiliation(s)
- Kwaku Baryeh
- Department of Trauma and Orthopaedics, Royal Berkshire Hospital, Reading, UK
- Department of Medical Education, West Middlesex University Hospital, Middlesex, UK
| | - Fitzgerald Anazor
- Department of Trauma and Orthopaedics, Royal Berkshire Hospital, Reading, UK
| | - Shabnam Iyer
- Department of Microbiology, Royal Berkshire Hospital, Reading, UK
| | - Trichy Rajagopal
- Department of Trauma and Orthopaedics, Royal Berkshire Hospital, Reading, UK
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Bernard E, Enelis B, Nurmukhametov R, Ramirez MDJE, Dosanov M, Shirshov I, Efe IE, Ramirez Pena IJ, Barrientos Castillo RE. Surgical Management of Lumbar Hardware Failure Due to Recurrent Postoperative Spondylodiscitis: Case Report. Cureus 2022; 14:e27457. [PMID: 36060329 PMCID: PMC9420540 DOI: 10.7759/cureus.27457] [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] [Accepted: 07/29/2022] [Indexed: 11/24/2022] Open
Abstract
Spondylodiscitis is a rare bacterial infection of the vertebrae and intervertebral discs that causes inflammation and follows a destructive course. When conservative management fails, surgical management requires immediate debridement of the infective focus, with decompression and stabilization through a ventral approach. The most frequently involved locations are the lumbar spine (58%), thoracic (30%), and cervical (11%) regions. Gram-positive organisms such as Staphylococcus aureus and Streptococcus species are the most commonly isolated organisms (67% and 24%, respectively). Pathophysiologically, infectious spondylodiscitis begins in the anterior portion of the vertebral body, due to its rich vascular supply, and then spreads to the rest of the vertebral body and along the medullary spaces. In this study, we report the management of recurrent lumbar postoperative spondylodiscitis with transforaminal lumbar interbody fusion (TLIF) hardware failure in a 62-year-old female.
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Larrieu-Jimenez P, Crenshaw N, Gonzalez JM, Ortega J. Progressive Lower Back Pain With New-Onset Symptoms. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Shofwan S, Liem L, Janitra G, Basuki N, Rhatomy S. Discitis Following Radiofrequency Nucleoplasty: A Case Report. Anesth Pain Med 2020; 10:e110322. [PMID: 34150577 PMCID: PMC8207849 DOI: 10.5812/aapm.110322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction Radiofrequency nucleoplasty is a minimally invasive procedure to treat chronic low back pain, especially mild degenerative disc diseases. Discitis after radiofrequency nucleoplasty is a rare case. Case Presentation A 62-year-old male patient with a chief complaint of 10 years low back pain, gradually worsening for the last two years, a history of hypertension, chronic kidney disease, and routine dialysis twice a week, referred to the center. He underwent a lumbar medial branch block using radiofrequency and radiofrequency nucleoplasty procedure of lumbar 4-5 (L4-L5). Three weeks after the intervention, he could not move his legs, associated with urinary and fecal incontinence. MRI (magnetic resonance imaging) of the lumbar spine was performed, and the results indicated hyperintensity in L4-L5, suspicious of discitis. Laminectomy at L4 and L5 was performed. Eight months after surgery, the patient could feel and lift legs, and urinary and fecal incontinence was also controlled. Conclusions Early diagnosis of discitis is critical and challenging. Delay in diagnosis may lead to treatment delay and the development of neurological deficits. Comprehensive treatment with bed rest, antimicrobial therapy, and sensible application of timely surgery are essentials to an optimal outcome.
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Affiliation(s)
- Said Shofwan
- Department of Anesthesiology and Intensive Therapy, Sultan Agung Islamic Hospital, Medical Faculty, Sultan Agung Islamic University, Semarang, Central Java, Indonesia
| | - Liong Liem
- Consultant Pain Management Amsterdam UMC, Universitair Medische Centra (VUmc), Amsterdam, Netherlands
| | - Grady Janitra
- Department of Anesthesiology and Intensive Therapy, Sultan Agung Islamic Hospital, Medical Faculty, Sultan Agung Islamic University, Semarang, Central Java, Indonesia
| | - Nur Basuki
- Department of Anesthesiology and Intensive Therapy, Klaten Islamic Hospital, Klaten, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Corresponding Author: Sholahuddin Rhatomy, Department of Orthopedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
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Screven R, Noureldine MHA, Krafft PR, Alikhani P. Expandable Titanium Cages in the Emergent Treatment of Severe Spinal Deformity Secondary to Osteomyelitis: A Series of Three Complex Cases. Asian J Neurosurg 2020; 15:397-404. [PMID: 32656140 PMCID: PMC7335120 DOI: 10.4103/ajns.ajns_28_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/26/2020] [Accepted: 03/11/2020] [Indexed: 12/19/2022] Open
Abstract
The literature lacks robust evidence on the benefits versus risks of instrumenting and fusing the spinal column in the setting of active osteomyelitis. We report three patients with vertebral osteomyelitis and subsequent severe and complex kyphotic deformities. Patients 1 and 2 had previous instrumentation that required revision because of hardware failure in the thoracic and thoracolumbar regions, respectively. Patient 3 developed a severe cervical kyphotic deformity at 2 months after being diagnosed and treated with antibiotics for osteomyelitis, necessitating emergent instrumentation and fusion. All the three patients are doing very well so far. Spinal instrumentation and fusion for correction of kyphotic deformity is sometimes necessary in the context of active osteomyelitis and should be done emergently and without hesitation when spinal cord injury from spinal instability is of concern.
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Affiliation(s)
- Ryan Screven
- Department of Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Mohammad Hassan A Noureldine
- Department of Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Johns Hopkins University School of Medicine, Saint Petersburg, Florida, USA
| | - Paul R Krafft
- Department of Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Puya Alikhani
- Department of Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine, Tampa, USA
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Atesok K, Vaccaro A, Stippler M, Striano BM, Carr M, Heffernan M, Theiss S, Papavassiliou E. Fate of Hardware in Spinal Infections. Surg Infect (Larchmt) 2019; 21:404-410. [PMID: 31855116 DOI: 10.1089/sur.2019.206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Removal of hardware with irrigation and debridement in patients with surgical site infections (SSIs) is performed commonly. However, the removal of hardware from patients with SSIs after spinal procedures is controversial. Moreover, primary spinal infections such as spondylodiscitis may require instrumentation along with surgical debridement. The purpose of this article was to evaluate critically and summarize the available evidence related to retention of hardware in patients with deep SSIs, and the use of instrumentation in surgical treatment of primary spinal infections. Methods: A literature search utilizing PubMed database was performed. Studies reporting the management of deep SSIs after instrumented spinal procedures, and of primary spinal infections using instrumentation published in peer-reviewed journals were included. Identified publications were evaluated for relevance, and data were extracted from the studies deemed relevant. Results: Because SSIs occur typically during the early post-operative period before stable bony fusion has been achieved, the removal of instrumentation may be associated with instability of the spinal column, pseudarthrosis, progressive deformity, pain, loss of function, and deterioration in the activities of daily living (ADL). Hence, early SSIs after spinal instrumentation are usually treated without removal of hardware. Moreover, primary spinal infections such as spondylodiscitis may require surgical debridement and instrumentation in cases with associated instability. Conclusions: Retaining or using instrumentation in patients with SSIs after spinal procedures or in patients with primary spinal infections, respectively, are commonly practiced in the field of spine surgery. Further evidence is required for the development of definitive algorithms to guide spine surgeons in decision making regarding the fate of instrumentation in the treatment of spinal infections.
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Affiliation(s)
- Kivanc Atesok
- Department of Neurosurgery, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Alexander Vaccaro
- Department of Orthopedic Surgery, Thomas Jefferson University, The Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Martina Stippler
- Department of Neurosurgery, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Brendan M Striano
- Department of Neurosurgery, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael Carr
- Department of Neurosurgery, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael Heffernan
- Department of Orthopaedic Surgery, Childrens Hospital of New Orleans, LSU Health Science Center, New Orleans, Louisiana, USA
| | - Steven Theiss
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Efstathios Papavassiliou
- Department of Neurosurgery, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Ackerman T, Singer-Jordan J, Shani A, Rahamimov N. Intra-discal drain insertion for culture and drainage of pyogenic spondylodiscitis: A one-step diagnostic and therapeutic procedure. Interv Neuroradiol 2019; 26:105-110. [PMID: 31657261 DOI: 10.1177/1591019919885557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pyogenic spondylodiscitis is diagnosed in recent years at higher rates due to the aging population, increased survival of chronic and immune suppressed patients, and the higher rate of invasive procedures leading to bacterial seeding or direct contamination of the disc space. Treatment guidelines encourage bacterial sampling before initiation of antibiotic therapy, and drainage of pus collections. We present our experience with percutaneous CT-guided drain insertion into the disc space itself as a one-step procedure for both culturing and subsequent continuous drainage of the infected disc space. MATERIALS AND METHODS We retrospectively reviewed all cases of pyogenic spondylodiscitis admitted to our spine surgery unit during the past five years and treated with CT-guided percutaneous drain insertion into the infected disc space. All patients were followed until complete resolution of the infection. RESULTS We retrieved electronic records of 12 patients, none presenting with neurological compression symptoms. Cultures taken at the time of drain insertion were positive in 10 patients (83.3%), much higher than the reported yield for needle aspiration (14-48%) and comparable to the yield of open biopsy. In all patients complete resolution of the infection was reached, determined by clinical, laboratory, and imaging parameters. CONCLUSIONS Our retrospective case series demonstrates the feasibility and effectiveness of intra-discal CT-guided drainage of an infected disc space. The procedure does not add much burden to current practice as disc-space sampling for culture is commonly performed anyway, and adds the benefit of direct drainage of the pus at its source.
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Affiliation(s)
| | | | - Adi Shani
- Department of Orthopedics B and Spine Surgery, Galilee Medical Center, Nahariya, Israel
| | - Nimrod Rahamimov
- Bar-Ilan Medical School, Tsfat, Israel
- Department of Orthopedics B and Spine Surgery, Galilee Medical Center, Nahariya, Israel
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