1
|
Kang J, Xia X, Shang R, Wang X, Cao P, Wang J, Zhang J, Feng W, Wei J, Hu Q. Bilateral Endoscopic Debridement Combined with Local Antituberculosis Drugs for Thoracic Tuberculosis with Large Paravertebral Abscess: A Multicenter Study with 4-year Follow-Up. World Neurosurg 2024; 185:e1160-e1168. [PMID: 38499243 DOI: 10.1016/j.wneu.2024.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Paravertebral abscess represents a prevalent manifestation of thoracic tuberculosis, often necessitating surgical intervention. In this study, we introduced a novel approach by employing bilateral endoscopic debridement (BED) to address large Paravertebral abscesses associated with thoracic tuberculosis, a method not previously proposed in the literature. The clinical efficacy was examined through a comprehensive 4-year follow-up. METHODS We conducted a retrospective analysis on patients diagnosed with thoracic tuberculosis and paravertebral abscess who underwent BED combined with local antituberculosis drugs (BED + LAD) between February 2015 and February 2019. A total of 29 eligible patients (12 males and 17 females) with a median (interquartile ranges) of 59.0(16.5) years were included in the study. All patients received the BED + LAD treatment. After the surgery, the patients were treated with a 4-drug antituberculosis therapy (Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol). All relevant indicators were meticulously recorded and analyzed. RESULTS The surgical procedures were successfully completed for all subjects, with an average intraoperative bleeding volume of (25.2 ± 8.9) ml, an average surgical time of (68.4 ± 14.0) minutes, an average fluoroscopy frequency of (21.7 ± 8.2) times, an average hospital stay of (14.2 ± 4.3) days, and an average medication period of (42.1 ± 9.6) weeks. All subjects completed at least a 4-year follow-up period. At the final follow-up, ESR and CRP levels returned to normal, and there was no significant increase in the Cobb angle (P>0.05). CONCLUSIONS The application of BED + LAD in the treatment of thoracic tuberculosis and paravertebral abscess proved to be a safe, effective, and feasible approach.
Collapse
Affiliation(s)
- Jian Kang
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Xiujia Xia
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Rong'an Shang
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Xiaoming Wang
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Panju Cao
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Junfeng Wang
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Jie Zhang
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Wanli Feng
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Jianmin Wei
- Minimally Invasive Spine Department, Xi'an International Medical Center Hospital, Xi'an, Shaanxi, China
| | - Qiaolong Hu
- First Department of Orthopedics, Yulin Second Hospital, Yu Lin, Shaanxi, China.
| |
Collapse
|
2
|
Li-Di L, Song Z, Yang L, Zhen-Shan L, Yuan-Zhe J, Shao-Kun Z. Surgical Treatment of Brucellar Cervical Epidural Abscess. World Neurosurg 2024; 183:e838-e845. [PMID: 38218437 DOI: 10.1016/j.wneu.2024.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVES Brucellar cervical epidural abscess (CEA) is a rare condition with potentially permanent neurological damage if left untreated. This study aims to define the clinical presentation of brucellar CEA and evaluate the outcome of surgical treatment, specifically decompression and fusion surgery. The findings will contribute to understanding whether all patients with brucellar CEA could benefit from this surgical intervention. METHODS A retrospective study on brucellar spondylitis was conducted at the First Hospital of Jilin University from August 2018 to August 2022. During this period, a total of 37 patients were diagnosed with brucellar spondylitis at the hospital. Out of the 37 cases, six patients (16.2%) were confirmed to have CEA through cervical magnetic resonance imaging examination and serology test results.. RESULTS Six patients were diagnosed with brucellar CEA (16.2%), of whom 5 successfully underwent anterior cervical decompression and fusion surgery. One patient had a large prevertebral abscess that could only be drained. In combination with effective antibiotic therapy, the clinical performance of the 5 patients who underwent surgery improved after the surgery. The remaining one patient required delayed surgery due to instability of the cervical spine. The follow-up period of all the 6 patients was 6 months. CONCLUSIONS Brucellosis should be considered as a potential cause of CEA, especially in endemic areas. Timely detection and effective management of this condition are crucial in order to minimize the associated morbidity and mortality. For patients with detectable brucellar CEA, we recommend decompression and fusion surgery.
Collapse
Affiliation(s)
- Liu Li-Di
- Department of Spine Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun, China
| | - Zhao Song
- Department of Spine Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun, China
| | - Liu Yang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Lv Zhen-Shan
- Department of Spine Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun, China
| | - Jin Yuan-Zhe
- Department of Spine Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun, China
| | - Zhang Shao-Kun
- Department of Spine Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun, China.
| |
Collapse
|
3
|
Rezvani M, Veisi S, Sourani A, Ahmadian H, Foroughi M, Mahdavi SB, Nik Khah R. Spondylodiscitis instrumented fusion, a prospective case series on a standardized neurosurgical protocol with long term follow up. Injury 2024; 55:111164. [PMID: 37923678 DOI: 10.1016/j.injury.2023.111164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE To investigate the fusion construct properties, construct length, intervertebral prosthesis (IVP) selection, bone grafting methods, complications management, and follow-up outcomes of spondylodiscitis fusion. METHOD This case series was conducted in Al-Zahra University referral hospital from March 2016 to November 2021. All the surgery-eligible patients were enrolled. Those who did not participate or failed the neurosurgical intervention were excluded. A unified neurosurgical protocol was defined. After operation and follow-up, all variables were documented. IBM SPSS v.26 was used for data analysis. P-value ≤ 0.05 was considered significant. RESULT Ninety-two patients were reviewed in the final analysis with 65.2 % males. The mean age was 55.07 ± 14.22 years old. The most frequent level of pathology and surgery was the lumbar spine (48.9 %). Short and long constructs were almost equally used (57.6 and 42.4 %, respectively). Bone graft mixture was the dominant IVP (75 %). The most frequent persistent postoperative symptom was back pain (55.4 %), while the neurological deficits resolution rate was 76.7 %. The fusion rate was 92.3 %. Proximal junctional kyphosis incidence was 16.3 % and had a significant association with on-admission neurological symptoms, thoracic and thoracolumbar junction involvements (p < 0.05). Follow-up Oswestry disability index scores showed 44.6 % of the patients had mild or no functional disabilities. Advanced age, On-admission deficits, comorbidities, titanium cages, and poor fusion status were associated with poor functional outcomes and higher mortality rates (P < 0.05). CONCLUSION The introduced neurosurgical protocol could effectively achieve acceptable SD treatment, spine stabilization, and fusion with low long-term surgical complications. Autologous bone graft mixture in comparison to titanium cages showed a higher fusion rate with a lower mortality rate. Patients with older age, neurological symptoms, and comorbidities are expected to experience less favorable clinical outcomes.
Collapse
Affiliation(s)
- Majid Rezvani
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shaahin Veisi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Arman Sourani
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran; Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamed Ahmadian
- Department of Neurosurgery, Babol University of Medical Sciences, Mazandaran, Iran
| | - Mina Foroughi
- Isfahan Medical Students' Research Committee (IMSRC), Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sadegh Baradaran Mahdavi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Student Research Committee, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan, Iran
| | - Roham Nik Khah
- Isfahan Medical Students' Research Committee (IMSRC), Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
4
|
Lindsay SE, Gehling H, Ryu WHA, Yoo J, Philipp T. Posterior Fixation Without Debridement for Vertebral Body Osteomyelitis and Discitis: A 10-Year Retrospective Review. Int J Spine Surg 2023; 17:771-778. [PMID: 37586747 PMCID: PMC10753329 DOI: 10.14444/8541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Surgical treatment of vertebral osteomyelitis, discitis, and epidural abscesses is indicated in the setting of failure of antibiotic therapy, neurological deficits, epidural abscess, or spinal instability/deformity. Historically, surgical treatment mandated aggressive debridement and spinal stabilization. However, there is growing evidence that direct debridement may not be necessary and may contribute to morbidity. The purpose of this study was to evaluate the efficacy of posterior instrumentation without debridement in treating spinal infections. METHODS A retrospective medical record review was performed to identify patients treated with posterior instrumentation for spontaneous spinal infections. Success of treatment was determined based on postoperative ambulatory status, surgical complications, and need for revision surgery. RESULTS Twenty-seven patients treated with posterior-only long-segmented rigid fixation without formal debridement of infected material were included. The most common indications for surgical intervention included spinal instability (67%), neurologic compromise (67%), and failure of prolonged antibiotic treatment (63%). There were no recurrent deep infections in 21 of 22 patients who had long-term follow-up. Four patients required revision surgery, and 3 additional patients requested elective hardware removal. Postoperatively, 70% were ambulatory with no assistive devices postoperatively. CONCLUSIONS Vertebral osteomyelitis/discitis are challenging medical problems. Single-stage long-segment fusion without formal debridement combined with antibiotics is effective in the management of spontaneous spinal infections. CLINICAL RELEVANCE The present study suggests that acute instrumentation without anterior debridement is associated with a resolution of infection and improvements in neurologic deficits in patient with spontaneous spine infections. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Sarah E Lindsay
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| | - Hanne Gehling
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| | - Won Hyung A Ryu
- Department of Neurosurgery, Oregon Health and Science University, Portland, OR, USA
| | - Jung Yoo
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| | - Travis Philipp
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
5
|
Dayer R, De Marco G, Vazquez O, Tabard-Fougère A, Cochard B, Gavira N, Di Laura Frattura G, Guanziroli Pralong N, Steiger C, Ceroni D. Laboratory diagnostics for primary spinal infections in pediatric and adult populations: a narrative review. N Am Spine Soc J 2023; 16:100270. [PMID: 37767011 PMCID: PMC10520565 DOI: 10.1016/j.xnsj.2023.100270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023]
Abstract
Primary spinal infection (PSI) is a generic term covering a heterogeneous group of infections that can affect the vertebral body, intervertebral disks, the content of the medullary cavity, and adjacent paraspinal tissues. Patients' characteristics can vary significantly, notably according to their age, and some of these characteristics undoubtedly play a primordial role in the occurrence of a PSI and in the type of offending pathogen. Before approaching the subject of laboratory diagnostics, it is essential to define the characteristics of the patient and their infection, which can then guide the physician toward specific diagnostic approaches. This review critically examined the roles and usefulness of traditional and modern laboratory diagnostics in supporting clinicians' decision-making in cases of pediatric and adult primary spinal infection (PSI). It appears impossible to compare PSIs in children and adults, whether from an epidemiological, clinical, bacteriological, or biological perspective. The recipients are really too different, and the responsible germs are closely correlated to their age. Secondly, the interpretation of traditional laboratory blood tests appears to contribute little guidance for clinicians attempting to diagnose a PSI. Biopsy or needle aspiration for bacterial identification remains a controversial subject, as the success rates of these procedures for identifying causative organisms are relatively uncertain in pediatric populations.Using nucleic acid amplification assays (NAAAs) on biopsy samples has been demonstrated to be more sensitive than conventional cultures for diagnosing PSI. Recent advances in next-generation sequencing (NGS) are particularly interesting for establishing a microbiological diagnosis of a PSI when standard cultures and NAAAs have failed to detect the culprit. We can even imagine that plasma metagenomic NGS using plasma (known as "liquid biopsy") is a diagnostic approach that can detect not only pathogens circulating in the bloodstream but also those causing focal infections, and thus eliminate the need for source sample collection using costly invasive surgical procedures.
Collapse
Affiliation(s)
- Romain Dayer
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Giacomo De Marco
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Oscar Vazquez
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Anne Tabard-Fougère
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Blaise Cochard
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Nathaly Gavira
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Giorgio Di Laura Frattura
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Nastassia Guanziroli Pralong
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Christina Steiger
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Dimitri Ceroni
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| |
Collapse
|
6
|
Inoue T, Kobayashi N, Baba N, Ide M, Higashi T, Inaba Y. Predictors of conversion surgery after conservative treatment for pyogenic spondylitis. J Orthop Sci 2023:S0949-2658(23)00313-5. [PMID: 37945500 DOI: 10.1016/j.jos.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Patient demographic and clinical characteristics may be factors associated with the success of conservative treatment for pyogenic spondylitis. The ability of imaging findings at initial diagnosis to predict patient outcomes remains unclear. The aim of this study was to investigate the risk factors associated with conversion surgery after conservative treatment for pyogenic spondylitis, with a special focus on the initial computed tomography (CT) findings. METHODS This study enrolled 35 patients with pyogenic spondylitis who underwent CT and magnetic resonance imaging (MRI) at diagnosis and were followed-up for more than 6 months. Patients were diagnosed by MRI, and the degree of bone destruction was assessed on CT cross-sectional images. Vertebral body destruction was classified as grades 0 (almost normal), 1 (endplate irregularity), 2 (vertebral body destruction not involving the posterior wall), and 3 (destruction involving the posterior wall). Patients were divided into four groups based on grade of bone destruction and their clinical characteristics were compared. RESULTS 1, 11, 11, and 12 patients were classified as grades 0, 1, 2, and 3, respectively. Univariate analysis showed no significant differences in the demographic and clinical characteristics of the four groups. Eighteen (51.4 %) patients had been treated surgically, with the rate of surgical treatment being significantly higher in patients with grade 3 (83.3 %) than in those with grades 0 + 1 (25 %) and grade 2 (45.5 %) (P < 0.05). Multivariate analysis showed that epidural abscess on MRI (odds ratio [OR] 10.8, 95 % confidence interval [CI] 1.68-69.7), grade 3 bone destruction on CT (OR 3.97, 95 % CI 1.21-13.0), and C-reactive protein (CRP) improvement rate after 1 week of treatment (OR 0.95, 95 % CI 0.91-0.99) were risk factors for surgery. CONCLUSIONS Early surgical treatment should be considered for patients with pyogenic spondylitis who present with an epidural abscess on MRI and bone destruction extending to the posterior wall on CT at the time of diagnosis.
Collapse
Affiliation(s)
- Tetsuhiko Inoue
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Minami, Yokohama, Kanagawa, Japan
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Minami, Yokohama, Kanagawa, Japan.
| | - Noriyuki Baba
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Minami, Yokohama, Kanagawa, Japan
| | - Manabu Ide
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Minami, Yokohama, Kanagawa, Japan
| | - Takayuki Higashi
- Department of Orthopaedic Surgery, Yokosuka Kyosai Hospital, Yonegahamadori, Yokosuka, Kanagawa, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Kanazawa, Yokohama, Kanagawa, Japan
| |
Collapse
|
7
|
Hagel V, Dymel F, Werle S, Barrera V, Farshad M. Combined endoscopic and microsurgical approach for the drainage of a multisegmental thoracolumbar epidural abscess: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23230. [PMID: 37931248 PMCID: PMC10631545 DOI: 10.3171/case23230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/21/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Spinal epidural abscess is a rare but serious infectious disease that can rapidly develop into a life-threatening condition. Therefore, the appropriate treatment is indispensable. Although conservative treatment is justifiable in certain cases, surgical treatment needs to be considered as an alternative early on because of complications such as (progressive) neurological deficits or sepsis. However, traditional surgical techniques usually include destructive approaches up to (multilevel) laminectomies. Such excessive approaches do have biomechanical effects potentially affecting the long-term outcomes. Therefore, minimally invasive approaches have been described as alternative strategies, including endoscopic approaches. OBSERVATIONS The authors describe a surgical technique involving a combination of two minimally invasive approaches (endoscopic and microsurgical) to drain a multisegmental (thoracolumbar) abscess using the physical phenomenon of continuous pressure difference to minimize collateral tissue damage. LESSONS The combination of minimally invasive approaches, including the endoscopic technique, may be an alternative in draining selected epidural abscesses while achieving a similar amount of abscess removal and causing less collateral approach damage in comparison with more traditional techniques.
Collapse
Affiliation(s)
- Vincent Hagel
- University Spine Center Zürich, Balgrist University Hospital, Zürich, Switzerland; and
- Spine Center, Asklepios Hospital Lindau, Lindau, Germany
| | - Felix Dymel
- Spine Center, Asklepios Hospital Lindau, Lindau, Germany
| | - Stephan Werle
- Spine Center, Asklepios Hospital Lindau, Lindau, Germany
| | - Vera Barrera
- Spine Center, Asklepios Hospital Lindau, Lindau, Germany
| | - Mazda Farshad
- University Spine Center Zürich, Balgrist University Hospital, Zürich, Switzerland; and
| |
Collapse
|
8
|
Tanaviriyachai T, Choovongkomol K, Pornsopanakorn P, Jongkittanakul S, Piyapromdee U, Sudprasert W. Factors Affecting Neurological Deficits in Thoracic Tuberculous Spondylodiscitis. Int J Spine Surg 2023; 17:645-651. [PMID: 37553257 PMCID: PMC10623663 DOI: 10.14444/8522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Thoracic spinal tuberculosis (TB) causes destruction of the spine and compression of the adjacent spinal cord. This study aimed to identify the risk factors for neurological deterioration in patients with thoracic spinal TB to guide decision-making regarding immediate surgery before the onset of weakness. METHODS Demographic, clinical, laboratory, and radiologic (x-ray and magnetic resonance imaging) data of 115 patients with active thoracic spinal TB were retrospectively analyzed. Patients with neurological status categorized as Frankel grades A, B, or C (n = 71) were classified as the neurological deficit group, while those with neurological status categorized as Frankel grades D and E (n = 44) constituted the control group. Univariate and multivariate logistic regression analyses were used to predict the risk factors for neurological deficits. RESULTS The mean patient age was 57.2 years. The most common lesion location was the distal thoracic region (T9-L1; 62.6%). Paradiscal involvement was the most common form of involvement (73%). In the univariate analysis, the significant risk factors associated with neurological worsening were overweight (body mass index [BMI] >25), C-reactive protein level > 20 mg/L, panvertebral involvement, loss of cerebrospinal fluid posterior to the cord, cord signal changes, and canal compromise. The multivariate analysis revealed that only BMI >25 (adjusted OR = 16.18; 95% CI 1.60-163.64; P = 0.018), cord signal changes (adjusted OR = 7.42; 95% CI 1.85-29.74; P = 0.005), and canal encroachment >50% ( adjusted OR = 51.86; 95% CI 5.53-486.24; P = 0.001) were independent risk factors for predicting the risk of neurological deficits. CONCLUSIONS Overweight (BMI >25), cord signal changes, and canal compromise >50% significantly predicted neurological deficits in patients with thoracic spinal TB. Prompt spinal surgery should be considered before progressive worsening of the neurological condition in patients with all of these risk factors. CLINICAL RELEVANCE Predictive factors for neurological deficits in thoracic spinal TB were determined. Overweight, cord signal changes, and canal compromise >50% showed predictive value. These factors can help identify patients who require early surgical intervention. LEVEL OF EVIDENCE: 3
Collapse
Affiliation(s)
- Terdpong Tanaviriyachai
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Kongtush Choovongkomol
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Patchara Pornsopanakorn
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Sarut Jongkittanakul
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Urawit Piyapromdee
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Weera Sudprasert
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| |
Collapse
|
9
|
Al Tobing SD, Malau VD. Anterior and posterior fusion via a posterior and costotransversectomy approach for thoracic spinal tuberculosis: A case report. Int J Surg Case Rep 2023; 111:108698. [PMID: 37757733 PMCID: PMC10539854 DOI: 10.1016/j.ijscr.2023.108698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Left untreated, spinal tuberculosis can lead to irreversible neurological deficit in patients, lowering quality of life. Combination of antitubercular drugs and surgical approach is important in managing spinal tuberculosis. We report a case of thoracic spinal tuberculosis treated by anterior and posterior fusion via a posterior and costotransversectomy approach. PRESENTATION OF CASE A 38 years-old woman diagnosed with paraplegia due to spinal tuberculosis of the thoracic vertebra (Th8) with Frankel A grade for spinal function. Pre-op kyphotic angle was 27.2°. Antitubercular drugs prescribed did not improve paraplegia symptom. Thoracal X-ray and MRI showed pathological fracture on Th8 and paravertebral abscess along anterior corpus of the Th6-9. We performed Sapardan's alternative VI approach that consists of debridement and abscess evacuation, decompression by laminectomy of the Th8, flavectomy and costotransversectomy of the Th8, posterior stabilization of the Th6-7 and Th9-10, and interbody fusion of the Th8. One month postoperative follow up showed improvement on motor function and sensory function. Post op kyphotic angle was 26.7°. CLINICAL DISCUSSION Adequate debridement followed by costotransversectomy, interbody fusion and surgical stabilization relieves pain, improves neurologic function, and prevents deformity of spinal tuberculous patient. CONCLUSION Although costotransversectomy approach is rarely used in surgical management of spinal TB, it is beneficial in cases with massive abscess involvement since it provides better view to collect and drain massive abscess.
Collapse
Affiliation(s)
- S Dohar Al Tobing
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Indonesia
| | - Vino Daniel Malau
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Indonesia.
| |
Collapse
|
10
|
Alshami A, Alkharat B, Alwattar Z, Safadi MF. Pyogenic Spondylodiscitis Following Nonspinal Cesarean Section. Cureus 2023; 15:e45966. [PMID: 37900374 PMCID: PMC10600641 DOI: 10.7759/cureus.45966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Pyogenic spondylodiscitis is an uncommon bacterial infection of the intervertebral disc and the vertebral endplates. It usually affects elderly patients with comorbidities but may be also seen after surgical procedures in young patients, mostly after spinal interventions and genitourinary procedures. This article describes a rare case of pyogenic spondylodiscitis in a young female patient after a cesarean section without spinal anesthesia. The patient presented with a three-month history of lower back pain, and the inflammatory markers were elevated. The magnetic resonance imaging showed the involvement of the L5-S1 disc space and the adjacent vertebral bodies. The diagnosis was confirmed with needle aspiration of purulent material. The patient was treated with antibiotics for a total of six weeks. After a follow-up of about one year, the patient showed slight degenerative vertebral changes with no signs of residual infection. This case highlights the importance of the early recognition of pyogenic spondylodiscitis as one cause of postoperative back pain after urogenital procedures, even without spinal anesthesia. Only a few similar cases were reported in the literature.
Collapse
Affiliation(s)
- Amani Alshami
- Rheumatology Department, Al-Badr International Hospital, Ibb, YEM
| | - Banan Alkharat
- Infectious Disease Department, Al-Mowasat University Hospital, Damascus University, Damascus, SYR
| | - Zeina Alwattar
- Internal Medicine Department, Al Razi Hospital, Homs, SYR
| | - Mhd Firas Safadi
- General and Visceral Surgery Department, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, DEU
| |
Collapse
|
11
|
Wang Y, Chen C, Peng L, Wang P. Fluoroscopy guided transpedicular abscess infusion and drainage in thoracic-lumbar spondylitis with prevertebral abscess. Int Orthop 2023; 47:2295-2300. [PMID: 37335315 DOI: 10.1007/s00264-023-05866-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE To evaluate the effectiveness of fluoroscopy guided transpedicular abscess infusion and drainage in thoracic-lumbar spondylitis with prevertebral abscess. METHODS We retrospectively reviewed 14 patients with infectious spondylitis with prevertebral abscesses from January 2019 to December 2022. All patients underwent fluoroscopy guided transpedicular abscess infusion and drainage. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analog scale (VAS), Macnab criteria, and magnetic resonance imaging (MRI) were compared before and after the operation to evaluate clinical outcomes. RESULTS Among the 14 patients with prevertebral abscesses, 64.29% (9/14) involved the lumbar spine and 35.71% (5/14) involved the thoracic spine. The ESR, CRP, and VAS scores decreased from 87.34 ± 9.21, 93.01 ± 11.17, and 8.38 ± 0.97 preoperatively to 12.35 ± 1.61, 8.52 ± 1.19, and 2.02 ± 0.64 at the final follow-up, respectively. MRI at the final follow-up showed the disappearance of the prevertebral abscess compared with that in the preoperative group (66.95 ± 12.63 mm in diameter). Ten patients achieved an "excellent" outcome, while the remaining four patients obtained a "good" outcome according to the Macnab criteria. CONCLUSION Fluoroscopy guided transpedicular abscess infusion and drainage is a safe and minimally invasive procedure for the management of thoracic-lumbar spondylitis with a prevertebral abscess.
Collapse
Affiliation(s)
- Yuanhao Wang
- Department of Spine Surgery, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, China
| | - Cong Chen
- Department of Spine Surgery, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, China
| | - Lei Peng
- Department of Spine Surgery, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, China
| | - Peng Wang
- Department of Spine Surgery, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, China.
| |
Collapse
|
12
|
Rava A, Mercurio M, Gargiulo G, Fusini F, Boasso G, Galasso O, Gasparini G, Massè A, Girardo M. Conservative treatment of spinal tuberculosis in a retrospective cohort study over 20-year period: high eradication rate and successful health status can be expected. Ann Jt 2023; 8:34. [PMID: 38529251 PMCID: PMC10929317 DOI: 10.21037/aoj-22-54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/19/2023] [Indexed: 03/27/2024]
Abstract
Background Tuberculosis (TB) which mainly cause lung primarily TB, can also affect the musculoskeletal system. Spine involvement occurs in 50% of the cases and neurologic deficit and kyphotic deformity may occur. The choice of conservative or surgical management of spinal TB in the absence of neurologic deficits remains controversial. The aim of the present study was to investigate the outcome and the success rate of conservative treatment and to provide evidence for the timing of treatment for spinal TB in adult patients. Methods Consecutive enrolled adult patients were conservatively treated from January 2000 to January 2020 for spinal TB in a tertiary care Orthopedic and Trauma Center-Spine Surgery Unit in Turin. Patients were conservatively treated with antibiotics and orthoses and followed up for at least 12 months. Clinical, radiological, laboratory and microbiological tests were performed for all the patients and demographic data, risk factors, comorbidity, clinical symptoms such as peripheral neurological deficit, and vertebral level involved were recorded. Treatment success was considered as no disease recurrence after 1 year of follow-up. Patients underwent successful conservative treatment were also evaluated with the self-perceived quality of life [36-Item Short Form (SF-36)] survey. Results A total of 132 patients (59 women and 73 men) suffering from spinal TB with a mean age at presentation of 49 years (range, 32-68 years) were treated. The mean follow-up was 43 months (range, 12-82 months). In 80 cases, there was a single vertebra involvement while multiple levels were involved in 52 cases. Sixty-nine (52%) patients presented spondylitis without involvement of the disk and 63 (48%) patients presented a spondylitis with disk involvement. Conservative treatment was effective in 113 patients (86%) which showed inter-somatic fusion with stability of the spine. The mean period of antibiotic therapy was 12 months (range, 8-15 months). Patients wear spinal orthosis for at least 12 weeks. The physical component summary (PCS)-36 (48.9±10.0) and mental component summary (MCS) (46.5±7.0) summary scores at follow-up were comparable to the normative values (P=0.652 and P=0.862, respectively). Painful deformity occurred in 25 patients (19%). Conclusions Conservative treatment is effective treatment for spinal TB and may avoid surgical intervention in the absence of neurologic deficits.
Collapse
Affiliation(s)
- Alessandro Rava
- Department of Orthopaedic and Traumatology, Spine Surgery Unit, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, “Magna Græcia” University, “Mater Domini” University Hospital, Catanzaro, Italy
| | - Giosuè Gargiulo
- Department of Orthopaedic and Traumatology, Spine Surgery Unit, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, Mondovì (CN), Italy
| | - Gabriele Boasso
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, “Magna Græcia” University, “Mater Domini” University Hospital, Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, “Magna Græcia” University, “Mater Domini” University Hospital, Catanzaro, Italy
| | - Alessandro Massè
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Massimo Girardo
- Department of Orthopaedic and Traumatology, Spine Surgery Unit, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, Turin, Italy
| |
Collapse
|
13
|
Dowling Montalva Á, de Araujo Santana Junior RN, Molina M. Full Endoscopic Treatment for a Fibrosis Complication after Psoas Abscess. J Pers Med 2023; 13:1166. [PMID: 37511779 PMCID: PMC10381222 DOI: 10.3390/jpm13071166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/22/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Psoas abscess is a challenging disease that may sometimes lead to a devastating prognosis. Early diagnosis and treatment are mandatory for better results in their treatments and to avoid complications. PURPOSE There is no article regarding a fibrosis treatment of the psoas muscle with a psoas abscess that is treated with full endoscopic debridement (FED). STUDY DESIGN a case report and literature review. RESULT we successfully treated this case, who suffered from psoas fibrosis with a clinical and MRI diagnosis, with full endoscopic debridement. CONCLUSIONS FED is a viable alternative to open debridement for this rare complication of a psoas muscle abscess.
Collapse
Affiliation(s)
- Álvaro Dowling Montalva
- DWS Spine Clinic Center, CENTRO EL ALBA-Cam. El Alba 9500, Of. A402, Región Metropolitana, Las Condes 9550000, Chile
- Department of Orthopaedic Surgery, Faculdade de Medicina de Ribeirão Preto (FMRP) da Universidade de São Paulo (USP), Ribeirão Preto 14040-900, Brazil
| | - Rui Nei de Araujo Santana Junior
- Spirituality and Pain Committee of the Brazilian Society for the Study of Pain (SBED) Health Technologies and Medical Education, São Paulo 04014-012, Brazil
- Bahiana School of Medicine and Public Health, Salvador 40290-000, Brazil
| | - Marcelo Molina
- Instituto Traumatológico de Santiago, Clínica Alemana, Santiago 7560801, Chile
| |
Collapse
|
14
|
Park J, Han S, Jeon Y, Hong JY. Spinal epidural abscess as predicting factor for the necessity of early surgical intervention in patients with pyogenic spondylitis. BMC Musculoskelet Disord 2023; 24:586. [PMID: 37464374 DOI: 10.1186/s12891-023-06703-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 07/06/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Pyogenic spondylitis is a condition with low incidence that can lead to neurological sequelae and even life-threatening conditions. While conservative methods, including antibiotics and bracing, are considered the first-line treatment option for pyogenic spondylitis, it is important to identify patients who require early surgical intervention to prevent progressive neurologic deficits or deterioration of the systemic condition. Surgical treatment should be considered in patients with progressive neurologic deficits or deteriorating systemic condition. However, currently, there is a lack of treatment guidelines, particularly with respect to whether surgical treatment is necessary for pyogenic spondylitis. This study aims to analyze the radiological epidural abscess on MRI and clinical factors to predict the need for early surgical intervention in patients with pyogenic spondylitis and provide comprehensive insight into the necessity of early surgical intervention in these patients. METHODS This study retrospectively reviewed 47 patients with pyogenic spondylitis including spondylodiscitis, vertebral osteomyelitis, epidural abscess, and/or psoas abscess. All patients received plain radiographs, and a gadolinium-enhanced magnetic resonance imaging (MRI) scan. All patients have either tissue biopsies and/or blood cultures for the diagnosis of a pathogen. Demographic data, laboratory tests, and clinical predisposing factors including comorbidities and concurrent other infections were analyzed. RESULTS We analyzed 47 patients, 25 of whom were female, with a mean age of 70,7 years. MRI revealed that 26 of 47 patients had epidural abscesses. The surgical group had a significantly higher incidence of epidural abscess than the non-surgical group (p = 0.001). In addition, both CRP and initial body temperature (BT) were substantially higher in the surgical group compared to the non-surgical group. There was no significant difference between the surgical group and the non-surgical group in terms of age, gender, comorbidities, and concurrent infectious disorders, as well as the number of affected segments and affected spine levels. However, the surgical group had lengthier hospital stays and received more antibiotics. CONCLUSION The presence of an epidural abscess on MRI should be regarded crucial in the decision-making process for early surgical treatment in patients with pyogenic spondylitis in order to improve clinical outcomes.
Collapse
Affiliation(s)
- Jiwon Park
- Department of Orthopedics, Korea University Ansan Hospital, Ansan, 123, Jeokgeum-ro, Danwon-gu, 15355, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, 170 Jomaru- ro, 14584, Bucheon, Gyeonggi-do, Republic of Korea
| | - Yeong Jeon
- Department of Orthopedics, Korea University Ansan Hospital, Ansan, 123, Jeokgeum-ro, Danwon-gu, 15355, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Jae-Young Hong
- Department of Orthopedics, Korea University Ansan Hospital, Ansan, 123, Jeokgeum-ro, Danwon-gu, 15355, Ansan-si, Gyeonggi-do, Republic of Korea.
| |
Collapse
|
15
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
16
|
Blecher R, Frieler S, Qutteineh B, Pierre CA, Yilmaz E, Ishak B, Glinski AV, Oskouian RJ, Kramer M, Drexler M, Chapman JR. Who Needs Surgical Stabilization for Pyogenic Spondylodiscitis? Retrospective Analysis of Non-Surgically Treated Patients. Global Spine J 2023; 13:1550-1557. [PMID: 34530628 PMCID: PMC10448100 DOI: 10.1177/21925682211039498] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective case series analysis. OBJECTIVE To identify relevant clinical and radiographic markers for patients presenting with infectious spondylo-discitis associated with spinal instability directly related to the infectious process. METHODS We evaluated patients presenting with de-novo intervertebral discitis or vertebral osteomyelitis /discitis (VOD) who initiated non-surgical treatment. Patients who failed conservative treatment and required stabilization surgery within 90 days were defined as "failed treatment group" (FTG). Patients who experienced an uneventful course served as controls and were labeled as "nonsurgical group" (NSG). A wide array of baseline clinical and radiographic parameters was retrieved and compared between 2 groups. RESULTS Overall 35 patients had initiated non-surgical treatment for VOD. 25 patients had an uneventful course (NSG), while 10 patients failed conservative treatment ("FTG") within 90 days. Factors found to be associated with poorer outcome were intra-venous drug abuse (IVDA) as well as the presence of fever upon initial presentation. Radiographically, involvement of the same-level facets and the extent of caudal and rostral VB involvement in both MRI and CT were found to be significantly associated with poorer clinical and radiographic outcome. CONCLUSIONS We show that clinical factors such as IVDA status and fever as well as the extent of osseous and posterior element involvement may prove to be helpful in favoring surgical treatment early on in the management of spinal infections.
Collapse
Affiliation(s)
- Ronen Blecher
- Swedish Neuroscience Institute, Seattle, WA, USA
- Assuta University Hospital Ashdod, Ben Gurion University of the Negev, Beersheba, Israel
| | | | | | | | - Emre Yilmaz
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Basem Ishak
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | | | | | - Moti Kramer
- Assuta University Hospital Ashdod, Ben Gurion University of the Negev, Beersheba, Israel
| | - Michael Drexler
- Assuta University Hospital Ashdod, Ben Gurion University of the Negev, Beersheba, Israel
| | | |
Collapse
|
17
|
Zhong Y, Tang B, Zhang Z, Sheng Y, Li C, Guo J, Luo S, Yao H, Wan Z. Clinical efficacy and imaging analysis for the surgical treatment of thoracolumbar infections in elderly patients: a retrospective study. Sci Rep 2023; 13:10341. [PMID: 37365248 DOI: 10.1038/s41598-023-36985-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Few reports have been conducted to comparing surgical results and safety evaluations between the different types of infections in geriatric patients with thoracolumbar infections. The aim of this study is to investigate the safety and efficacy of surgical treatment for thoracolumbar infections in elderly patients. 21 patients with pyogenic spondylodiscitis (PS) and 26 patients with tuberculous spondylodiscitis (TS) were enrolled in the study. All patients were treated using one-stage posterior debridement, decompression, and pedicle screw fixation. Comparison of operative safety parameters between the two groups. Clinical efficacy was evaluated using visual analogue scale (VAS) score, the American Spinal Injury Association (ASIA) grade, the short form (SF)-36 survey and Oswestry disability index (ODI) to determine patient quality of life pre- and post-operatively. Hospitalisation and intensive care unit duration in the PS group were significantly shorter than in the TS group (P < 0.05). The total incidence of post-operative complications for both groups was 44.7%. More complications occurred in the TS group, but the difference was not significant. The scores of VAS, ODI and SF-36 of all 47 patients were significantly improved compared with those before operation.The VAS and SF-36 scores (physical component) were significantly better in the PS group 6 months post-operatively, and the SF-36 (mental component) scores were significantly better in the PS group at the 1-year follow-up. Neurological status in both groups improved post-operatively, and 83% of patients reported satisfactory results based on the modified MacNab standard. Imaging results showed that bone graft fusion improved in both groups at 6 months, 1 year and at the final follow-up. One-stage posterior debridement, decompression, interbody fusion, and internal fixation can be considered a safe and effective method of treating spinal infections in the elderly. This method can improve nerve function, reconstruct spinal stability, and enhance the quality of life of elderly patients. Both PS and TS who underwent surgery achieve similar clinical and radiological results.
Collapse
Affiliation(s)
- Yanlong Zhong
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Benyu Tang
- Department of Orthopedics, The People's Hospital of Yi Chun City, Yichun, 336000, Jiangxi, People's Republic of China
| | - Zizhen Zhang
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Yonghong Sheng
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Chao Li
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Jia Guo
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Shiwei Luo
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Haoqun Yao
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Zongmiao Wan
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China.
| |
Collapse
|
18
|
Scorzin JE, Potthoff AL, Lehmann F, Banat M, Borger V, Schuss P, Bode C, Vatter H, Schneider M. Postoperative prolonged mechanical ventilation in patients with surgically treated pyogenic spondylodiscitis: a surrogate endpoint for early postoperative mortality. Neurosurg Rev 2023; 46:113. [PMID: 37160534 PMCID: PMC10169897 DOI: 10.1007/s10143-023-02016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/12/2023] [Accepted: 04/28/2023] [Indexed: 05/11/2023]
Abstract
Surgical procedures with spinal instrumentation constitute a prevalent and occasionally highly indicated treatment modality in patients with pyogenic spondylodiscitis (PSD). However, surgical therapy might be associated with the need of prolonged postoperative intensive care medicine which in turn might impair intended operative benefit. Therefore, we analyzed prolonged mechanical ventilation (PMV) as an indicator variable for such intensive care treatment with regard to potential correlations with mortality in this vulnerable patient cohort. Between 2012 and 2018, 177 consecutive patients received stabilization surgery for PSD at the authors' neurosurgical department. PMV was defined as postoperative mechanical ventilation of more than 24 h. A multivariable analysis was performed to identify independent predictors for 30-day mortality. Twenty-three out of 177 patients (13%) with PSD suffered from postoperative PMV. Thirty-day mortality rate was 5%. Multivariable analysis identified "spinal empyema" (p = 0.02, odds ratio (OR) 6.2, 95% confidence interval (CI) 1.3-30.2), "Charlson comorbidity index (CCI) > 2" (p = 0.04, OR 4.0, 95% CI 1.0-15.5), "early postoperative complications (PSIs)" (p = 0.001, OR 17.1, 95% CI 3.1-96.0) and "PMV > 24 hrs" (p = 0.002, OR 13.0, 95% CI 2.7-63.8) as significant and independent predictors for early postoperative mortality. The present study indicates PMV to significantly correlate to elevated early postoperative mortality rates following stabilization surgery for PSD. These results might entail further scientific efforts to investigate PMV as a so far underestimated negative prognostic factor in the surgical treatment of PSD.
Collapse
Affiliation(s)
- Jasmin E Scorzin
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany.
| | | | - Felix Lehmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Mohammed Banat
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
- Department of Neurosurgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Christian Bode
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | |
Collapse
|
19
|
Thavarajasingam SG, Subbiah Ponniah H, Philipps R, Neuhoff J, Kramer A, Demetriades AK, Shiban E, Ringel F, Davies B. Increasing incidence of spondylodiscitis in England: An analysis of the national health service (NHS) hospital episode statistics from 2012 to 2021. Brain Spine 2023; 3:101733. [PMID: 37383429 PMCID: PMC10293225 DOI: 10.1016/j.bas.2023.101733] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/14/2023] [Accepted: 03/29/2023] [Indexed: 06/30/2023]
Abstract
Background Spondylodiscitis is a potentially life-threatening infection of the intervertebral disk and adjacent vertebral bodies, with a mortality rate of 2-20%. Given the aging population, the increase in immunosuppression, and intravenous drug use in England, the incidence of spondylodiscitis is postulated to be increasing; however, the exact epidemiological trend in England remains unknown. Objective The Hospital Episode Statistics (HES) database contains details of all secondary care admissions across NHS hospitals in England. This study aimed to use HES data to characterise the annual activity and longitudinal change of spondylodiscitis in England. Methods The HES database was interrogated for all cases of spondylodiscitis between 2012 and 2019. Data for the length of stay, waiting time, age-stratified admissions, and 'Finished Consultant Episodes' (FCEs), which correspond to a patient's hospital care under a lead clinician, were analysed. Results In total, 43135 FCEs for spondylodiscitis were identified between 2012 and 2022, of which 97.1% were adults. Overall admissions for spondylodiscitis have risen from 3 per 100,000 population in 2012/13 to 4.4 per 100,000 population in 2020/21. Similarly, FCEs have increased from 5.8 to 10.3 per 100,000 population, in 2012-2013 and 2020/21 respectively. The highest increase in admissions from 2012 to 2021 was recorded for those aged 70-74 (117% increase) and aged 75-59 (133% increase), among those of working age for those aged 60-64 years (91% increase). Conclusion Population-adjusted admissions for spondylodiscitis in England have risen by 44% between 2012 and 2021. Healthcare policymakers and providers must acknowledge the increasing burden of spondylodiscitis and make spondylodiscitis a research priority.
Collapse
Affiliation(s)
- Santhosh G. Thavarajasingam
- Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Academic Neurosurgery, Addenbroke's Hospital, Cambridge University Hospital NHS Healthcare Trust, United Kingdom
- Imperial Brain & Spine Initiative, London, United Kingdom
- Spondylodiscitis Study Group, EANS Spine Section, European Association of Neurolosurgical Societies (EANS), Germany
| | - Hariharan Subbiah Ponniah
- Faculty of Medicine, Imperial College London, London, United Kingdom
- Imperial Brain & Spine Initiative, London, United Kingdom
| | | | - Jonathan Neuhoff
- Center for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik Frankfurt Am Main, Germany
- Spondylodiscitis Study Group, EANS Spine Section, European Association of Neurolosurgical Societies (EANS), Germany
| | - Andreas Kramer
- Department of Neurosurgery, Universitätsmedizin Mainz, Mainz, Germany
- Spondylodiscitis Study Group, EANS Spine Section, European Association of Neurolosurgical Societies (EANS), Germany
| | - Andreas K. Demetriades
- Edinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Division of Clinical Neurosciences, NHS Lothian, Edinburgh University Hospitals, Edinburgh, United Kingdom
- Spondylodiscitis Study Group, EANS Spine Section, European Association of Neurolosurgical Societies (EANS), Germany
| | - Ehab Shiban
- Department of Neurosurgery, Universitätsklinikum Augsburg, Augsburg, Germany
- Spondylodiscitis Study Group, EANS Spine Section, European Association of Neurolosurgical Societies (EANS), Germany
| | - Florian Ringel
- Department of Neurosurgery, Universitätsmedizin Mainz, Mainz, Germany
- Spondylodiscitis Study Group, EANS Spine Section, European Association of Neurolosurgical Societies (EANS), Germany
| | - Benjamin Davies
- Department of Academic Neurosurgery, Addenbroke's Hospital, Cambridge University Hospital NHS Healthcare Trust, United Kingdom
- Spondylodiscitis Study Group, EANS Spine Section, European Association of Neurolosurgical Societies (EANS), Germany
| |
Collapse
|
20
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
21
|
Wang G, Long J, Zhuang Y, Leng X, Zhang Y, Liu L, Fu J, Chen Y, Li C, Zhou Y, Huang B, Feng C. Application of metagenomic next-generation sequencing in the detection of pathogens in spinal infections. Spine J 2023; 23:859-867. [PMID: 36773890 DOI: 10.1016/j.spinee.2023.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND CONTEXT The precise diagnosis and treatment of spinal infections (SI) remains challenging for spine surgeons. Identifying the pathogens of SI through metagenomic next-generation sequencing (mNGS) may be a key approach to addressing this challenge. PURPOSE To evaluate the accuracy and applicability of mNGS in determining the etiology of SI. STUDY DESIGN Diagnostic test study. PATIENT SAMPLE Twenty-five patients who had a clinical suspicion of SI and underwent mNGS testing. OUTCOME MEASURES The specificity, sensitivity, and time cost of mNGS and bacterial culture were compared. Clinical outcomes were assessed using the numeric rating scale (NRS) score, Oswestry Disability Index (ODI), and the Japanese Orthopedic Association (JOA) score. Demographic data and laboratory results (blood cell count (WBC), erythrocyte sedimentation rate (ESR), neutrophil percentage (NEUT%), and C-reactive protein level (CRP) were also evaluated. METHODS In this retrospective study, samples were obtained from 25 eligible patients via surgery or CT-guided puncture and subjected to histopathological examination, bacterial culture, and mNGS. The sensitivity and specificity of the bacterial cultures and mNGS were calculated with respect to the histopathological results as a reference. Postoperative antibiotics or antituberculosis drugs were administered on the basis of mNGS results, combined with clinical manifestations, imaging examination, and histopathology. The changes of clinical outcomes and laboratory results after treatment were observed. RESULTS Of the 25 patients, 21 had a positive pathology, of which 10 showed a tuberculous pathology, and the remaining 11 showed a nontuberculous inflammatory pathology. The sensitivity of mNGS was higher than that of the bacterial culture. However, the difference in specificity between bacterial culture and mNGS was not significant. Moreover, the time needed to perform mNGS was significantly lower than that of bacterial culture and pathology. All patients were followed up for more than three months, and CRP and NEUT% significantly decreased by three months after treatment. There was no significant difference in WBC and ESR. The ODI, NRS and JOA scores were significantly improved after treatment. CONCLUSION Metagenomic next-generation sequencing technology can play an important role in the detection of pathogens in SI and should be further investigated and applied in future studies.
Collapse
Affiliation(s)
- Guanzhong Wang
- Department of Orthopedics Southwest Hospital, Army Medical University, Gaotanyan St No.30, Chongqing 400038, People's Republic of China
| | - Jiang Long
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main St Shapingba, Chongqing 400037, People's Republic of China
| | - Yong Zhuang
- Department of Orthopedics, Affiliated Hospital of Guizhou Medical University, 28 Guiyi St Yunyan District, Guiyang 550004, People's Republic of China
| | - Xue Leng
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main St Shapingba, Chongqing 400037, People's Republic of China
| | - Yaqing Zhang
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main St Shapingba, Chongqing 400037, People's Republic of China
| | - Libangxi Liu
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main St Shapingba, Chongqing 400037, People's Republic of China
| | - Jiawei Fu
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main St Shapingba, Chongqing 400037, People's Republic of China
| | - Yu Chen
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main St Shapingba, Chongqing 400037, People's Republic of China
| | - Changqing Li
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main St Shapingba, Chongqing 400037, People's Republic of China
| | - Yue Zhou
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main St Shapingba, Chongqing 400037, People's Republic of China
| | - Bo Huang
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main St Shapingba, Chongqing 400037, People's Republic of China
| | - Chencheng Feng
- Department of Orthopedics Xinqiao Hospital, Army Medical University, 183 Xinqiao Main St Shapingba, Chongqing 400037, People's Republic of China.
| |
Collapse
|
22
|
Hsieh MK, Lee DM, Li YD, Peng CC, Tsai TT, Lai PL, Chen WP, Tai CL. Biomechanical evaluation of position and bicortical fixation of anterior lateral vertebral screws in a porcine model. Sci Rep 2023; 13:454. [PMID: 36624133 DOI: 10.1038/s41598-023-27433-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023] Open
Abstract
Although an anterior approach with anterior lateral screw fixation has been developed for stabilizing the thoracolumbar spine clinically, screw loosening still occurs. In this novel in vitro study, we attempted to elucidate the optimal screw position in the lateral lumbar vertebra and the effect of bicortical fixation. A total of 72 fresh-frozen lumbar vertebrae from L1-6 were harvested from 12 mature pigs and randomly assigned to two modalities: bicortical fixation (n = 36) and unicortical fixation (n = 36). Six groups of screw positions in the lateral vertebral body in each modality were designated as central-anterior, central-middle, central-posterior, lower-anterior, lower-middle, and lower- posterior; 6 specimens were used in each group. The correlations between screw fixation modalities, screw positions and axial pullout strength were analyzed. An appropriate screw trajectory and insertional depth were confirmed using axial and sagittal X-ray imaging prior to pullout testing. In both bicortical and unicortical fixation modalities, the screw pullout force was significantly higher in the posterior or middle position than in the anterior position (p < 0.05), and there was no significant differences between the central and lower positions. The maximal pullout forces from the same screw positions in unicortical fixation modalities were all significantly lower, decreases that ranged from 32.7 to 74%, than those in bicortical fixation modalities. Our study using porcine vertebrae showed that screws in the middle or posterior position of the lateral vertebral body had a higher pullout performance than those in the anterior position. Posteriorly positioned lateral vertebral screws with unicortical fixation provided better stability than anteriorly positioned screws with bicortical fixation.
Collapse
|
23
|
Kim WJ, Park C, Sarraf K. Management of vertebral osteomyelitis in adults. Br J Hosp Med (Lond) 2023; 84:1-5. [PMID: 36708343 DOI: 10.12968/hmed.2022.0362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Vertebral osteomyelitis is a condition that predominantly affects older men with chronic comorbidities, such as diabetes, renal and hepatic failure, or immunosuppression. Symptoms develop insidiously and a high index of suspicion is required to diagnose the condition; this is achieved through serological testing and imaging. The mainstay of treatment is long-term antibiotic therapy, lasting a minimum of 6 weeks; however, surgical debridement with stabilisation is required when conservative treatment is proving ineffective and infection progresses. It is critically important that sufficient treatment is provided for those experiencing vertebral osteomyelitis, as not doing so could lead to severe neurological compromise and death.
Collapse
Affiliation(s)
- Woo Jae Kim
- Department of Trauma and Orthopaedics, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Chang Park
- Department of Trauma and Orthopaedics, Northwest Thames Rotation, London, UK
| | - Khaled Sarraf
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
24
|
Abboud T, Krolikowska-Fluori M, Melich P, Rohde V, Schatlo B. Postoperative Quality of Life in Patients with Pyogenic Spondylodiscitis. J Neurol Surg A Cent Eur Neurosurg 2023; 84:65-68. [PMID: 35878619 DOI: 10.1055/s-0042-1750176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pyogenic spondylodiskitis affects a fragile patient population frequently fraught with severe comorbidities. Data on long-term outcomes, especially for patients undergoing surgery, are scarce. The aim of this study was to assess the long-term quality of life after surgical instrumentation. METHODS Data of 218 patients who were treated for spondylodiskitis at our institution between January 2008 and July 2017 were reviewed. In-hospital death and mortality rates at 1 year and follow-up were assessed. A survey was conducted using the following questionnaires: Oswestry Disability Index (ODI), Short Form Work Ability Index (SF-WAI), 36-Item Short Form Health Survey (SF-36), and Short Form McGill Pain Questionnaire (SF-MPQ). We investigated the correlation between the assessed variables and clinical data including patient age, comorbidity score at admission, number of operated levels, corpectomy, and length of hospital stay. RESULTS In-hospital mortality rate was 1.8% and 1-year mortality rate was 5.5%. At the final follow-up (mean 7 ± 6 years), the mortality rate was 45.4%. Seventy-four patients were lost to follow-up or refused to participate in the study. Forty-four patients responded to the survey and had a mean age of 73 years and mean follow-up of 7 ± 2 years. In the ODI questionnaire, disability grades were classified as minimal (23%), moderate (21%), severe (19%), complete (33%), and bed bound (4%). We found a significant correlation between inability to return to work and severe disability on ODI (p < 0.001), as well as a low score on any component of the SF-36 (p < 0.05). CONCLUSION Despite low in-hospital and 1-year mortality rates, patients with surgically treated pyogenic spondylodiskitis are prone to long-term limitation in all domains of quality of life, especially in physical health and work ability.
Collapse
Affiliation(s)
- Tammam Abboud
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | | | - Patrick Melich
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Bawarjan Schatlo
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
25
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
26
|
Behmanesh B, Gessler F, Duetzmann S, Seifert V, Weise L, Setzer M. Quality of Life Following Surgical and Conservative Therapy of Pyogenic Spinal Infection: A Study of Long-term Outcome in 210 Patients. J Neurol Surg A Cent Eur Neurosurg 2023; 84:14-20. [PMID: 33690878 DOI: 10.1055/s-0041-1722965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECT The management and recommendations for treatment strategies of pyogenic spinal infection are still a highly controversial issue. The purpose of this study was to evaluate patient's quality of life (QoL) after surgical and conservative treatment of spinal infection. MATERIALS AND METHODS We conducted a retrospective, single-center study. All patients treated between 2009 and 2016 were included in this study. For evaluation of QoL, we recorded each patient's satisfaction according to the 36-Item Short Form Health Survey (SF-36) questionnaire. Scores were compared with a U.S. standard population. RESULTS Two hundred and ten adult patients with spondylodiskitis were identified. Of these, 155 (74%) underwent surgery and 55 (26%) were treated conservatively. The mean overall age was 68.6 (23-98) years. Seventy-two patients were females and 138 patients were males. The mean outcome values in the surgical group did not reach the level of the normative sample in one of eight items, whereas the conservative group revealed a reduced QoL in all items. Intergroup comparison revealed significant differences in all items (p < 0.05). CONCLUSION In the patient population we investigated, QoL in surgically treated patients was better than that in conservatively managed patients.
Collapse
Affiliation(s)
- Bedjan Behmanesh
- Department of Neurosurgery, Goethe University Frankfurt, Schleusenweg, Frankfurt, Germany
| | - Florian Gessler
- Department of Neurosurgery, Goethe University Frankfurt, Schleusenweg, Frankfurt, Germany
| | - Stephan Duetzmann
- Department of Neurosurgery, Goethe-Universitat Frankfurt am Main Fachbereich 16 Medizin, Schleusenweg, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe-Universitat Frankfurt am Main Fachbereich 16 Medizin, Schleusenweg, Frankfurt, Germany
| | - Lutz Weise
- Department of Neurosurgery, Goethe-Universitat Frankfurt am Main Fachbereich 16 Medizin, Schleusenweg, Frankfurt, Germany
| | - Matthias Setzer
- Department of Neurosurgery, Goethe-Universitat Frankfurt am Main Fachbereich 16 Medizin, Schleusenweg, Frankfurt, Germany
| |
Collapse
|
27
|
Schatlo B, Rohde V, Abboud T, Janssen I, Melich P, Meyer B, Shiban E. The Role of Diskectomy in Reducing Infectious Complications after Surgery for Lumbar Spondylodiscitis. J Neurol Surg A Cent Eur Neurosurg 2023; 84:3-7. [PMID: 35453163 DOI: 10.1055/a-1832-9092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Surgery for pyogenic Spondylodiscitis as an adjunct to antibiotic therapy is an established treatment. However, the technique and extent of surgical debridement remains a matter of debate. Some propagate diskectomy in all cases. Others maintain that stand-alone instrumentation is sufficient. METHODS We reviewed charts of patients who underwent instrumentation for pyogenic Spondylodiscitis with a minimum follow-up of 1 year. Patients were stratified according to whether they underwent diskectomy plus instrumentation or posterior instrumentation alone. Outcome measures included the need for surgical revision due to recurrent epidural intraspinal infection, wound revision, and construct failure. RESULTS In all, 257 patients who underwent surgery for pyogenic Spondylodiscitis were identified. Diskectomy and interbody procedure (group A) was performed in 102 patients, while 155 patients underwent instrumentation surgery for Spondylodiscitis without intradiskal debridement (group B). The mean age was 67 ± 12 years, and 102 patients (39.7%) were females. No significant differences were found in the need for epidural abscess recurrence therapy (group A [2.0%] and 5 cases in group B [3%; p = 0.83]) and construct failure (p = 0.575). The need for wound revisions showed a tendency toward higher rates in the posterior instrumentation-only group, which failed to reach significance (p = 0.078). CONCLUSIONS Overall, intraspinal relapse of surgically treated pyogenic diskitis was low in our retrospective series. The choice of surgical technique was not associated with a significant difference. However, a somewhat higher rate of wound infections requiring revision in the group where no diskectomy was performed has to be weighed against a longer duration of surgery in an already ill patient population.
Collapse
Affiliation(s)
- Bawarjan Schatlo
- Department of Neurosurgery, University Medicine Göttingen Georg-August-University of Göttingen, Göttingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, University Medicine Göttingen Georg-August-University of Göttingen, Göttingen, Germany
| | - Tammam Abboud
- Department of Neurosurgery, University Medicine Göttingen Georg-August-University of Göttingen, Göttingen, Germany
| | - Insa Janssen
- Department of Neurosurgery, Hospital of the Technical University Munich, Munich, Germany.,Department of Neurosurgery, Faculté de Médecine, University Hospital Geneva, Geneva, Switzerland
| | - Patrick Melich
- Department of Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Hospital of the Technical University Munich, Munich, Germany
| | - Ehab Shiban
- Department of Neurosurgery, Hospital of the Technical University Munich, Munich, Germany.,Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany
| |
Collapse
|
28
|
Sato Y, Hashimoto K, Matsuda M, Onoki T, Kamimura M, Takahashi K, Onoda Y, Chiba D, Mori Y, Kanno H, Yamamoto N, Aizawa T. A modified minimally invasive surgery for thoracic pyogenic spondylitis: Percutaneous pedicle screw fixation in combination with a vertebral debridement in a separate posterolateral approach-A case report. Clin Case Rep 2022; 10:e6710. [PMID: 36483872 PMCID: PMC9723481 DOI: 10.1002/ccr3.6710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
In this report, we present a successfully treated case of intractable thoracic pyogenic spondylitis using one-step curettage/bone grafting of spinal anterior segment and less-contaminated percutaneous spinal posterior fixation via separated posterior approaches, which was not compatible with conventional spinal instruments.
Collapse
Affiliation(s)
- Yuki Sato
- Department of Orthopaedic SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Ko Hashimoto
- Department of Orthopaedic SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | | | - Takahiro Onoki
- Department of Orthopaedic SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Masayuki Kamimura
- Department of Orthopaedic SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Kohei Takahashi
- Department of Orthopaedic SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Yoshito Onoda
- Department of Orthopaedic SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Daisuke Chiba
- Department of Orthopaedic SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Yu Mori
- Department of Orthopaedic SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Haruo Kanno
- Department of Orthopaedic SurgeryTohoku Medical and Pharmaceutical UniversitySendaiJapan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Toshimi Aizawa
- Department of Orthopaedic SurgeryTohoku University Graduate School of MedicineSendaiJapan
| |
Collapse
|
29
|
Kreutzträger M, Lübstorf T, Ekkernkamp A, Blex C, Schwab JM, Kopp MA, Auhuber T, Wüstner G, Liebscher T. Spinal infection with intraspinal abscess or empyema and acute myelopathy: comparative analysis of diagnostics, therapy, complications and outcome in primary care. Eur J Trauma Emerg Surg 2022; 48:4745-4754. [PMID: 35657387 PMCID: PMC9712376 DOI: 10.1007/s00068-022-02001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/06/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This study on pyogenic spinal infections with intraspinal epidural involvement (PSI +) compared the outcome of patients with spinal cord injury (SCI) to those without (noSCI) taking diagnostic algorithm, therapy, and complications into account. METHODS Patients were enrolled in an ambispective study (2012-2017). Diagnostic and therapeutic algorithms, complications, and neurological outcome were analyzed descriptively. Survival was analyzed applying Kaplan-Meier method and Cox regression. RESULTS In total, 134 patients with a median (IQR) age of 72 (61-79) years were analyzed. Baseline characteristics were similar between the SCI (n = 55) and noSCI (n = 79). A higher percentage of endocarditis (9% vs. 0%; p = 0.03) was detected in the noSCI group. The majority (81%) received combinatorial therapy including spinal surgery and antibiotic treatment. The surgery complication rate was 16%. At discharge, improvement in neurologic function was present in 27% of the SCI patients. Length of stay, duration of ventilation and the burden of disease-associated complications were significantly higher in the SCI group (e.g., urinary tract infection, pressure ulcers). Lethality risk factors were age (HR 1.09, 95% CI 1.02-1.16, p = 0.014), and empyema/abscess extension (≥ 3 infected spinal segments, HR 4.72, 95% CI 1.57-14.20, p = 0.006), dominating over additional effects of Charlson comorbidity index, SCI, and type of treatment. The overall lethality rate was 11%. CONCLUSION PSI + are associated with higher in-hospital mortality, particularly when multiple spinal segments are involved. However, survival is similar with (SCI) or without myelopathy (noSCI). If SCI develops, the rate of disease complications is higher and early specialized SCI care might be substantial to reduce complication rates.
Collapse
Affiliation(s)
- Martin Kreutzträger
- Treatment Centre for Spinal Cord Injuries, BG Hospital Unfallkrankenhaus Berlin, Trauma Hospital Berlin, Warener Straße 7, 12683, Berlin, Germany.
- Department of Neurology and Experimental Neurology, Spinal Cord Injury Research, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Tom Lübstorf
- Department of Neurology and Experimental Neurology, Spinal Cord Injury Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Axel Ekkernkamp
- Trauma Surgery and Orthopedics Clinic, BG Hospital Unfallkrankenhaus, Berlin, Germany
| | - Christian Blex
- Department of Neurology and Experimental Neurology, Spinal Cord Injury Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan M Schwab
- Department of Neurology and Experimental Neurology, Spinal Cord Injury Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Spinal Cord Injury Division, Department of Neurology, Belford Center for Spinal Cord Injury, The Ohio State University, Wexner Medical Center, Columbus, OH, 43210, USA
- Department of Neuroscience, The Neurological Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, 43210, USA
- Department of Physical Medicine and Rehabilitation, The Neurological Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, 43210, USA
| | - Marcel A Kopp
- Department of Neurology and Experimental Neurology, Spinal Cord Injury Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, QUEST - Center for Transforming Biomedical Research, Berlin, Germany
| | - Thomas Auhuber
- Medical Management, Trauma Hospital Berlin, Berlin, Germany
- University of the German Statutory Accident Insurance (HGU), Bad Hersfeld, Germany
| | - Grit Wüstner
- BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany
| | - Thomas Liebscher
- Treatment Centre for Spinal Cord Injuries, BG Hospital Unfallkrankenhaus Berlin, Trauma Hospital Berlin, Warener Straße 7, 12683, Berlin, Germany
- Department of Neurology and Experimental Neurology, Spinal Cord Injury Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
30
|
Chen ZH, Wang X, Zhang Y, Wu ST, Wu YH, Shi Q, Zhang BK, Xu JG, Chen XH, Lian XF. Percutaneous Transforaminal Endoscopic Debridement and Drainage with Accurate Pathogen Detection for Infectious Spondylitis of the Thoracolumbar and Lumbar Spine. World Neurosurg 2022; 164:e1179-e1189. [PMID: 35660670 DOI: 10.1016/j.wneu.2022.05.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE In this study, we aimed to analyze the clinical outcomes of percutaneous transforaminal endoscopic debridement and drainage (PTEDD) with accurate pathogen detection for patients with infectious spondylitis of the thoracolumbar and lumbar spines. METHODS From January 2017 to February 2019, a consecutive series of 43 patients with infectious spondylitis of the thoracolumbar and lumbar spine were surgically treated with PTEDD. Organism culture, next-generation DNA sequencing, and pathological examination of the sample extracted from the infectious site were performed for accurate microbiological diagnosis. All patients were followed up for 24-36 months. Clinical and radiological outcomes were analyzed preoperatively and postoperatively. RESULTS Surgeries were completed successfully on all 43 patients under local infiltration anesthesia. Positive culture of the responsible organism was obtained in 33 cases (76.7%). Among the 43 patients who underwent next-generation DNA sequencing, 42 (97.7%) had positive results. Corresponding antibiotic medication was given based on the pathogen detection. The modified Macnab criteria were found to be excellent in 32 patients (74.4%) and good in 11 (25.6%). Postoperative magnetic resonance imaging showed that the abscess and infectious area were reduced significantly at 3 months and had disappeared or almost disappeared at the final follow-up. Spontaneous fusion was obtained in 30 patients (69.8%). No patients required revision or conversion to open debridement and reconstruction. CONCLUSIONS For patients with infectious spondylitis of the thoracolumbar and lumbar spine, PTEDD is an effective and safe treatment. Next-generation DNA sequencing is a much more sensitive method for detecting the responsible organisms.
Collapse
Affiliation(s)
- Zhi-Heng Chen
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xin Wang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yi Zhang
- Department of Infectious Diseases, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Sheng-Ting Wu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ying-Hao Wu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qiang Shi
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Bao-Kun Zhang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jian-Guang Xu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiao-Hua Chen
- Department of Infectious Diseases, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiao-Feng Lian
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| |
Collapse
|
31
|
Ishihara S, Funao H, Isogai N, Ishihara M, Saito T, Ishii K. Minimally Invasive Spine Stabilization for Pyogenic Spondylodiscitis: A 23-Case Series and Review of Literature. Medicina (B Aires) 2022; 58:754. [PMID: 35744017 PMCID: PMC9229113 DOI: 10.3390/medicina58060754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives: The incidence of pyogenic spondylodiscitis has been increasing due to the aging of the population. Although surgical treatment is performed for refractory pyogenic spondylodiscitis, surgical invasiveness should be considered. Recent minimally invasive spine stabilization (MISt) using percutaneous pedicle screw (PPS) can be a less invasive approach. The purpose of this study was to evaluate surgical results and clinical outcomes after MISt with PPS for pyogenic spondylodiscitis. Materials and Methods: Clinical data of patients who underwent MISt with PPS for pyogenic spondylitis were analyzed. Results: Twenty-three patients (18 male, 5 female, mean age 67.0 years) were retrospectively enrolled. The mean follow-up period was 15.9 months after surgery. The causative organism was identified in 16 cases (69.6%). A mean number of fixed vertebrae was 4.1, and the estimated blood loss was 145.0 mL. MISt with PPS was successfully performed in 19 of 23 patients (82.6%). Four cases (17.4%) required additional anterior debridement and autologous iliac bone graft placement. CRP levels had become negative at an average of 28.4 days after surgery. There was no major perioperative complication and no screw or rod breakages during follow-up. Conclusions: MISt with PPS would be a less invasive approach for pyogenic spondylodiscitis in elderly or immunocompromised patients.
Collapse
|
32
|
Navarro-navarro R, Suárez-cabañas A, Fernández-varela T, Lorenzo-rivero J, Montesdeoca-ara A. [Translated article] Analysis of results of open and percutaneous disc biopsy in the diagnosis of spondylodiscitis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:T189-T199. [DOI: 10.1016/j.recot.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
33
|
Navarro-Navarro R, Suárez-Cabañas A, Fernández-Varela T, Lorenzo-Rivero J, Montesdeoca-Ara A. Análisis de los resultados de la biopsia discal abierta y percutánea en el diagnóstico de la espondilodiscitis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:189-199. [DOI: 10.1016/j.recot.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/20/2021] [Accepted: 09/24/2021] [Indexed: 12/01/2022] Open
|
34
|
Rezvani M, Sabouri M, Aminmansour B, Tabesh H, Shafiei M, Mahmoodkhani M, Rahmani P, Falahpour S, Sourani A, Mahdavi SB. Atlantoaxial instability and cervical noninfectious spondylodiscitis in a patient with Wegener’s granulomatosis: A case report. Clin Case Rep 2022; 10:e05675. [PMID: 35387290 PMCID: PMC8978785 DOI: 10.1002/ccr3.5675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
Abstract
A 61‐year‐old male patient with Wegener's granulomatosis was admitted due to neck pain and quadriparesis. Clinical evaluation showed severe cervical noninfectious spondylodiscitis, myelopathy, sagittal imbalance, and atlantoaxial instability. A combined anterior and posterior approach was implemented. Postoperative clinical evaluation showed improved neurologic status.
Collapse
Affiliation(s)
- Majid Rezvani
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Masih Sabouri
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Bahram Aminmansour
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Homayoun Tabesh
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Mehdi Shafiei
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Mehdi Mahmoodkhani
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Peiman Rahmani
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Soheil Falahpour
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Arman Sourani
- Department of Neurosurgery School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Sadegh Baradaran Mahdavi
- Department of Physical Medicine and Rehabilitation School of Medicine Student Research Committee Child Growth and Development Research Center Research Institute for Primordial Prevention of Non‐Communicable Disease Isfahan University of Medical Sciences Isfahan Iran
| |
Collapse
|
35
|
Tang X, Li J, Wang C, Liu F, Guo J, Tan J, Song Q, Cao H, Zhang Y. Antibiotic-loaded calcium sulfate beads in spinal surgery for patients with spondylodiscitis: a clinical retrospective study. BMC Musculoskelet Disord 2022; 23:270. [PMID: 35305603 PMCID: PMC8934445 DOI: 10.1186/s12891-022-05230-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Various surgical techniques for treating spondylodiscitis have been proposed, but the optimal surgical treatment remains controversial. In this study, we propose a new procedure that is implanting antibiotic-loaded calcium sulfate (CS) beads into the disc after debridement using the Quadrant channel combined with percutaneous fixation through a single-stage posterolateral approach for the treatment of spondylodiscitis. Thus, the purpose of this study is to assess the safety and efficacy of this procedure. Methods This study collected the data of 32 patients with spine spondylodiscitis and was surgically treated in our department from July 2015 to August 2020. The Demographic data included age, gender, involved segment, and complications were collected. The intra-operative details, results of culture, functional outcome, radiologic outcome, and length of hospital stay, laboratory examination were recorded. Results The mean age of the 32 patients was 61.1 ± 9.7 years old. The mean operative time was 135.0 ± 30.6 minutes, and the mean blood loss was 243.4 ± 92.1 ml. The positive rate of culture was 72%. The mean Visual analogue scale (VAS) and Oswestry Disability Index (ODI) score significantly improved from 7.5 to 1.6 and from 65% to 10%. Cobb angle was significantly improved and could be maintained at final follow-up. New bone formation was observed in all patients. There were no recurrences of infection in our study. Conclusions The posterolateral debridement and percutaneous fixation combined with antibiotic-loaded calcium sulfate beads filling are effective in the treatment of spondylodiscitis in terms of infection control, early mobilization, and recovery.
Collapse
|
36
|
Chen J, Xuan T, Lu Y, Lin X, Lv Z, Chen M. Outcome of one-stage percutaneous endoscopic debridement and lavage combined with percutaneous pedicle screw fixation for lumbar pyogenic spondylodiscitis. J Orthop Surg (Hong Kong) 2022; 29:23094990211065579. [PMID: 34911406 DOI: 10.1177/23094990211065579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study assessed the therapeutic effect of one-stage percutaneous endoscopic debridement and lavage (PEDL) combined with percutaneous pedicle screw fixation (PPSF) in the treatment of lumbar pyogenic spondylodiscitis. METHODS From March 2017 to October 2019, 51 patients diagnosed with pyogenic spondylodiscitis underwent PPSF followed by PEDL in our department. Biopsy specimens were examined for microorganisms and evaluated histopathologically. Clinical outcomes were assessed by physical examination, routine serological testing, visual analogue scale (VAS), Oswestry Disability Index (ODI) and imaging studies. RESULTS Of the enrolled patients, the operation time ranged from 90 min to 114 min every level with an average of 102 min, and the average drainage time ranged from 6 days to 10 days with an average of 7.4 days. All patients who complained of lower back pain symptoms were more relieved than before surgery. Causative pathogens were identified in 20 of 51 biopsy specimens; Staphylococcus aureus was the most prevalent. However, there were eight patients with postoperative complications. The mean follow-up was 25.0 ± 3.8 (range: 20-32) months. Inflammatory markers showed that infection was controlled. The VAS and ODI improved significantly. At the last follow-up, magnetic resonance imaging showed that the infected lesions had disappeared. CONCLUSION PEDL supplementing PPSF may be useful for patients with single-level lumbar pyogenic spondylodiscitis, as it is minimally invasive, especially for patients who cannot undergo conventional open surgery due to poor health or advanced age.
Collapse
Affiliation(s)
- Jianquan Chen
- Guangzhou University of Chinese Medicine, Guangzhou, PR China
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Tianhang Xuan
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Yao Lu
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Xinyuan Lin
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Zhouming Lv
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| | - Maoshui Chen
- Department of Orthopaedics, Guang Dong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, Guangdong, China
| |
Collapse
|
37
|
Hosameldin A, Hussein M, Abdelhalim E, Shehab M, Osman A. Surgical management of spontaneous thoracic and lumbar spondylodiscitis by fixation and debridement. Surg Neurol Int 2022; 13:44. [PMID: 35242410 PMCID: PMC8888297 DOI: 10.25259/sni_1236_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Spondylodiscitis could be considered one of the most disturbing challenges that face neurosurgeons due to variety of management strategies. The lumbar region was highly affected then dorsal region with higher percentage for lesion in L4/5 (25%) followed by T11/12 and L5/S1 (15%). In our study, we discuss the efficacy of debridement and fixation in cases of spontaneous thoracic and lumbar spondylodiscitis. Methods: This retrospective study included 40 patients with spontaneous thoracic or lumbar spondylodiscitis indicated for surgical intervention in the period from March 2019 to February 2021. All patients were subjected to thorough history taking, neurological examination, and investigations. The patients were operated on through posterior approach by debridement and posterior transpedicular screws fixation and fusion. Results: Clinical assessment early postoperative revealed 75% of cases showed full motor power and 20% showed improvement in motor power, for sensory assessment, 85% showed improvement, the mean visual analog scale (VAS) score was of 3.65 ± 0.87. After 3 months postoperatively, 95% of cases were full motor power with sensory and autonomic (sphincteric) improvement. The mean VAS score was 2.5 ± 0.68. After 6 months postoperative, the clinical assessment revealed that 95% of cases were full motor power with sensory manifestation improvement, and 95% of them were continent. The mean VAS score was 1±0.85. Culture results showed that 65% of samples were negative culture, 15% had methicillin-resistant Staphylococcus aureus, and 10% had Escherichia coli with a single case of Pseudomonas and another one of fungal (Candida albicans). Postoperative 90% of cases showed improvement in erythrocyte sedimentation rate results and 95% of cases showed improvement in C-reactive protein results. Conclusion: Management of spontaneous thoracic and lumbar spondylodiscitis by surgical debridement and posterolateral open transpedicular fixation seems to be effective and safe method despite the presence of infection. We found that the clinical condition of our patients showed significant improvement with this addressed approach.
Collapse
Affiliation(s)
- Ahmed Hosameldin
- Department of Neurosurgery, Fayoum University Hospitals, Fayoum University, Fayoum, Egypt
| | - Mohammed Hussein
- Department of Neurosurgery, Fayoum University Hospitals, Fayoum University, Fayoum, Egypt
| | - Ehab Abdelhalim
- Department of Neurosurgery, Cairo University, Cairo, Cairo, Egypt
| | - Mohammed Shehab
- Department of Neurosurgery, Cairo University, Cairo, Cairo, Egypt
| | - Ashraf Osman
- Department of Neurosurgery, Fayoum University Hospitals, Fayoum University, Fayoum, Egypt
| |
Collapse
|
38
|
Heuer A, Strahl A, Viezens L, Koepke LG, Stangenberg M, Dreimann M. The Hamburg Spondylodiscitis Assessment Score (HSAS) for Immediate Evaluation of Mortality Risk on Hospital Admission. J Clin Med 2022; 11:jcm11030660. [PMID: 35160110 PMCID: PMC8836753 DOI: 10.3390/jcm11030660] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 01/25/2023] Open
Abstract
(1) Background: Patients with spondylodiscitis often present with unspecific and heterogeneous symptoms that delay diagnosis and inevitable therapeutic steps leading to increased mortality rates of up to 27%. A rapid initial triage is essential to identify patients at risk for a complicative disease course. We therefore aimed to develop a risk assessment score using fast available parameters to predict in-hospital mortality of patients admitted with spondylodiscitis. (2) Methods: A retrospective data analysis of 307 patients with spondylodiscitis recruited from 2013 to 2020 was carried out. Patients were grouped according to all-cause mortality. Via logistic regression, individual patient and clinical characteristics predictive of mortality were identified. A weighted sum score to estimate a patient's risk of mortality was developed and validated in a randomly selected subgroup of spondylodiscitis patients. (3) Results: 14% of patients with spondylodiscitis died during their in-hospital stay at a tertiary center for spinal surgery. Univariate and logistic regression analyses of parameters recorded at hospital admission showed that age older than 72.5 years, rheumatoid arthritis, creatinine > 1.29 mg/dL and CRP > 140.5 mg/L increased the risk of mortality 3.9-fold, 9.4-fold, 4.3-fold and 4.1-fold, respectively. S. aureus detection increased the risk of mortality by 2.3-fold. (4) Conclusions: The novel Hamburg Spondylodiscitis Assessment Score (HSAS) shows a good fit identifying patients at low-, moderate-, high- and very high risk for in hospital mortality on admission (AUC: 0.795; p < 0.001). The implementation of the HSAS into clinical practice could ease identification of high-risk patients using readily available parameters alone, improving the patient's safety and outcome.
Collapse
Affiliation(s)
- Annika Heuer
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.V.); (L.-G.K.); (M.S.); (M.D.)
- Correspondence:
| | - André Strahl
- Division of Orthopedics, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Lennart Viezens
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.V.); (L.-G.K.); (M.S.); (M.D.)
| | - Leon-Gordian Koepke
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.V.); (L.-G.K.); (M.S.); (M.D.)
| | - Martin Stangenberg
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.V.); (L.-G.K.); (M.S.); (M.D.)
| | - Marc Dreimann
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (L.V.); (L.-G.K.); (M.S.); (M.D.)
| |
Collapse
|
39
|
Dreimann M, Ryang YM, Schoof B, Thiessen D, Eicker SO, Strube P, Stangenberg M. Destructive per continuitatem spondylodiscitis after endovascular abdominal or thoracic aneurysm repair (EVAR/TEVAR): rare and untreatable? Arch Orthop Trauma Surg 2022; 142:591-8. [PMID: 33206206 DOI: 10.1007/s00402-020-03672-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/27/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Very few publications have previously described spondylodiscitis as a potential complication of endovascular aortic procedures (EVAR/TEVAR). We present to our knowledge the first case series of spondylodiscitis following EVAR/TEVAR based on our data base. Particular focus was laid on the complexity of disease treatment and grave outcome perspectives from a spine surgeon's point of view in this seriously affected patient group. MATERIALS AND METHODS A retrospective analysis and chart review was performed for 11 out of 284 consecutive spondylodiscitis patients who underwent EVAR/TEVAR procedure and developed destructive per continuitatem spondylodiscitis. RESULTS All 11 patients had single or more level destructive spondylodiscitis adjacent to the thoracic/lumbar stent graft. In mean, four surgeries were performed per patient to treat this rare complication. Six out of eleven patients (55%) died within 6 months of first identification of per continuitatem spondylodiscitis. In four patients due to persisting infection of the graft and recurrence of the abscess formation, a persisting fistula from anterior approach to the skin was applied. CONCLUSIONS Destructive per continuitatem spondylodiscitis is a rare and severe complication post-EVAR/TEVAR. Clinical and imaging features of anterior paravertebral disease and anterior vertebral body involvement suggest direct continuous spread of the graft infection to the adjacent vertebral column. The mortality rate of these severe infections is extremely high and treatment with a permanent fistula may be one salvage procedure.
Collapse
|
40
|
Brinkmann J, Zeißler EC, Scharrenberg JS, Schenk J, Majjouti M, Oberste M, Yagdiran A, Scheyerer MJ, Jung N, Siewe J, Mahabir E. The diagnostic value of cytokines for the discrimination of vertebral osteomyelitis and degenerative diseases of the spine. Cytokine 2021; 150:155782. [PMID: 34933239 DOI: 10.1016/j.cyto.2021.155782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/24/2021] [Accepted: 12/04/2021] [Indexed: 11/03/2022]
Abstract
Vertebral osteomyelitis (VO) is a primary infection of the endplates of the vertebral bodies with secondary infection of the adjacent intervertebral discs. Diagnosis is often delayed due to unspecific symptoms and a lack of specific infection markers. In this prospective study, we determined the suitability of 27 cytokines for the discrimination of VO and degenerative diseases of the spine and compared its diagnostic potential in relation to the C-reactive protein (CRP), which is widely used as a non-specific inflammation marker in clinical diagnostics. The patients included in this study underwent surgical stabilization of the lumbar and/or thoracic spine with removal of 1 or more affected intervertebral discs, as therapy for VO (n = 16) or for erosive osteochondrosis (EO, control group, n = 20). We evaluated the cytokine and CRP concentrations before (pre-OP = -20-0d where 0 means the day of surgery) and after surgery (post-OP) on days 3-5, 6-11, 40-56, and 63-142. Compared to the control patients pre-OP, a significantly higher elevation of the 4 cytokines IL-6, IL-8, IL-12 (p70), and VEGF as well as CRP were found in the VO patients, showing an area under the curve > 0.80 pre-OP. No significant differences were observed between VO patients with high and low virulent bacteria with respect to all 5 elevated biomarkers. This is the first prospective study in which a broad spectrum of 27 cytokines was analysed via multiplex assay using sera from patients with and without VO. Our results show that, in addition to CRP, 4 different cytokines were significantly altered in VO but not control patients. The results implicate that these candidate cytokines may be used in a multiplex assay for discrimination between VO and degenerative diseases of the spine.
Collapse
Affiliation(s)
- Julia Brinkmann
- Comparative Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Straße 21, 50931 Cologne, Germany
| | - Eva-Carina Zeißler
- Comparative Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Straße 21, 50931 Cologne, Germany
| | - Jan Simon Scharrenberg
- Comparative Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Straße 21, 50931 Cologne, Germany
| | - Julia Schenk
- Comparative Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Straße 21, 50931 Cologne, Germany
| | - Mohamed Majjouti
- Comparative Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Straße 21, 50931 Cologne, Germany
| | - Max Oberste
- Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Straße 10, 50931 Cologne, Germany
| | - Ayla Yagdiran
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Kerpener Straße 62, 50937 Cologne, Germany
| | - Max J Scheyerer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Kerpener Straße 62, 50937 Cologne, Germany
| | - Norma Jung
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Kerpener Straße 62, 50937 Cologne, Germany
| | - Jan Siewe
- Faculty of Medicine and University Hospital of Cologne, Joseph-Stelzmann-Straße 20, 50931 Cologne, Germany
| | - Esther Mahabir
- Comparative Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Straße 21, 50931 Cologne, Germany.
| |
Collapse
|
41
|
Stoop N, Zijlstra H, Ponds NHM, Wolterbeek N, Delawi D, Kempen DHR. Long-term quality of life outcome after spondylodiscitis treatment. Spine J 2021; 21:1985-1992. [PMID: 34174437 DOI: 10.1016/j.spinee.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/18/2021] [Accepted: 06/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spondylodiscitis is the most common spinal infection of which the incidence has increased and the peak prevalence is between 50 and 70 years of age. Spondylodiscitis is often a complication of a distant infection. Early diagnosis can be challenging, and although improvements in diagnostic techniques and modern therapy have diminished the mortality of the disease, current literature about the outcome of spondylodiscitis is scarce. PURPOSE To evaluate the long-term clinical outcome of patients who suffered from spondylodiscitis. STUDY DESIGN A two-center cross-sectional study. PATIENT SAMPLE Patients with spondylodiscitis in two large teaching hospitals in the Netherlands between 2003 and 2017. OUTCOME MEASURES Visual Analogue Scale (VAS) for back pain, Oswestry Disability Index (ODI) for function, and Short Form 36 (SF-36) for general quality of life of spondylodiscitis patients. METHOD Eligible patients were identified from electronic patient databases and completed multiple patient reported outcome measures after obtaining informed consent. General demographic and clinical information (age, sex, medical history) were extracted from the patient records. SF-36 domain scores of spondylodiscitis patients were compared with a nationwide population sample. RESULTS 183 patients were treated for spondylodiscitis; additional questionnaires were received from 82 patients. After a median follow-up of 63 months, the overall mortality was 28%. The mean VAS for back pain was 3.5, and the mean ODI score was 22. In all SF-36 domains a significantly lower score was found in the spondylodiscitis group compared with a normative national Dutch cohort. There was a strong correlation between back pain and ODI scores (ρ=0.81, p<.05). CONCLUSIONS Our study confirms that spondylodiscitis is a disease causing a profound impact on back pain, function and quality of life. The results suggest that chronic back pain is a debilitating problem, as it has an extensive influence on daily activities and social and psychological well-being, causing significant disability.
Collapse
Affiliation(s)
- Nicky Stoop
- Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands; Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Hester Zijlstra
- Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands; Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Noa H M Ponds
- Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - Nienke Wolterbeek
- Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands.
| | - Diyar Delawi
- Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | | |
Collapse
|
42
|
Decker S, Schröder BM, Stübig T, Sehmisch S. [Common infectious challenges of the thoracic and lumbar spine : Spondylodiscitis and postoperative wound infection]. Unfallchirurg 2021; 125:33-40. [PMID: 34850257 DOI: 10.1007/s00113-021-01108-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/24/2022]
Abstract
Spondylodiscitis and postoperative wound infections are the most frequent infectious diseases of the thoracic and lumbar spine. Every spinal surgeon will come into contact with such patients during his or her career. Knowledge particularly of the diagnostics, conservative and surgical treatment as well as microbiological considerations of antibiotic treatment are therefore of particular importance and are explained in this article.
Collapse
Affiliation(s)
- Sebastian Decker
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Bennet Mathis Schröder
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Timo Stübig
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Stephan Sehmisch
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| |
Collapse
|
43
|
Park SC, Chang SY, Gimm G, Mok S, Kim H, Chang BS, Lee CK. Involvement of L5-S1 level as an independent risk factor for adverse outcomes after surgical treatment of lumbar pyogenic spondylitis: A multivariate analysis. J Orthop Surg (Hong Kong) 2021; 29:23094990211035570. [PMID: 34350794 DOI: 10.1177/23094990211035570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To identify the independent risk factors for adverse outcomes and determine the effect of L5-S1 involvement on the outcome of surgical treatment of lumbar pyogenic spondylitis (PS). METHODS A retrospective analysis was performed for all consecutive patients who underwent surgery for lumbar PS between November 2004 and June 2020 at a single institution. The patients were divided into two groups based on the outcomes: good and adverse (treatment failure, relapse, or death). Treatment failure was defined as persistent or worsening pain with C-reactive protein (CRP) reduction less than 25% from preoperative measurement or requiring additional debridement. Relapse was defined as the reappearance of symptoms and signs with an elevated white blood cell count, erythrocyte sedimentation rate, and CRP after the first period of treatment. Binary logistic regression analyses were performed to identify the independent risk factors for adverse outcomes. RESULTS Twenty-four (21.2%) of the 113 patients were classified as having adverse outcomes: treatment failure, relapse, and death occurred in 15, 7, and 2 patients, respectively. The involvement of L5-S1 (adjusted odds ratio [aOR] = 6.561, P = 0.004), Methicillin-resistant Staphylococcus aureus (MRSA) infection (aOR = 6.870, P = 0.008), polymicrobial infection (aOR = 12.210, P = 0.022), and Charlson comorbidity index (CCI; P = 0.005) were identified as significant risk factors for adverse outcomes. CONCLUSION Involvement of L5-S1, MRSA, polymicrobial infection, and CCI were identified as independent risk factors for adverse outcomes after surgical treatment of lumbar PS. Because L5-S1 is anatomically demanding to access anteriorly, judicious access and thorough debridement are recommended in patients requiring anterior debridement of L5-S1.
Collapse
Affiliation(s)
- Sung Cheol Park
- Department of Orthopedic Surgery, 58927Seoul National University Hospital, Seoul, South Korea
| | - Sam Yeol Chang
- Department of Orthopedic Surgery, 58927Seoul National University Hospital, Seoul, South Korea
| | - GeunWu Gimm
- Department of Orthopedic Surgery, 58927Seoul National University Hospital, Seoul, South Korea
| | - Sujung Mok
- Department of Orthopedic Surgery, 58927Seoul National University Hospital, Seoul, South Korea
| | - Hyoungmin Kim
- Department of Orthopedic Surgery, 58927Seoul National University Hospital, Seoul, South Korea
| | - Bong-Soon Chang
- Department of Orthopedic Surgery, 58927Seoul National University Hospital, Seoul, South Korea
| | - Choon-Ki Lee
- Department of Orthopedic Surgery, Chamjoeun Hospital, Gwangju, South Korea
| |
Collapse
|
44
|
Mercurio M, Sanzo V, Rava A, Galasso O, Gasparini G. Spondylodiscitis After Endovascular Aortic Repair Due to Noninvasive Listeriosis: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00113. [PMID: 34516457 DOI: 10.2106/jbjs.cc.21.00212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CASE An 83-year-old man suffered progressive lower back pain 4 weeks after an endovascular aortic repair (EVAR) procedure. Computed tomography showed L4 vertebral body collapse and abnormal soft tissue-like density swelling with increased uptake on 18F-fluoro-D-glucose (FDG) positron emission tomography (PET)/CT. Listeria monocytogenes was identified from ultrasound-guided fine-needle aspiration. Ultrasound-guided drainage of the retroperitoneal abscess and intravenous antibiotic therapy with ampicillin and gentamicin resulted in the rapid relief of symptoms. CONCLUSION Spondylodiscitis after EVAR requires a timely diagnosis. Uncommon organisms such as L. monocytogenes must be suspected, even in focal infections without signs of listeriosis. Conservative treatment with preservation of the graft should be considered as long as close follow-up evaluations are performed.
Collapse
Affiliation(s)
- Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini University Hospital, Catanzaro, Italy
| | - Valentina Sanzo
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini University Hospital, Catanzaro, Italy
| | - Alessandro Rava
- Department of Orthopedic and Traumatology, CTO Hospital, University of Turin, Turin, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini University Hospital, Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini University Hospital, Catanzaro, Italy
| |
Collapse
|
45
|
Janssen IK, Jörger AK, Barz M, Sarkar C, Wostrack M, Meyer B. Minimally invasive posterior pedicle screw fixation versus open instrumentation in patients with thoracolumbar spondylodiscitis. Acta Neurochir (Wien) 2021; 163:1553-1560. [PMID: 33655377 DOI: 10.1007/s00701-021-04744-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/27/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Due to the aging society, the incidence of pyogenic spondylodiscitis is still rising. Although surgical treatment for spondylodiscitis in general is increasingly accepted, an optimal surgical strategy for treatment of pyogenic spinal infection has not yet been established. The aim of this study was to investigate the suitability of percutaneous posterior pedicle screw fixation for surgical treatment in patients with spondylodiscitis of the thoracolumbar spine. METHODS We conducted a retrospective review of a consecutive cohort of patients undergoing surgical treatment for spondylodiscitis of the thoracolumbar spine between January 2017 and December 2019. We assessed intraoperative and clinical data, comparing for the classic open and the percutaneous approach. In total, we analyzed 125 cases (39 female, 86 male). The mean age was 69.49 years ± 12.63 years. RESULTS Forty-seven (37.6%) patients were operated on by a percutaneous approach for pedicle screw fixation, and 78 (62.4%) received open surgery. There was no significant difference in the mean age of patients between both groups (p= 0.57). The time of surgery for percutaneous fixation was statistically significantly shorter (p= 0.03). Furthermore, the estimated intraoperative blood loss was significantly lower in the minimally invasive group (p < 0.001). No significant difference could be observed regarding the recurrence rate of spondylodiscitis and the occurrence of surgical site infections (p= 0.2 and 0.5, respectively). CONCLUSION Percutaneous posterior pedicle screw fixation appears to be a feasible option for the surgical treatment of a selected patient group with spondylodiscitis of the thoracic and lumbar spine.
Collapse
|
46
|
Zheng Q, Ying X, Jin Y, Zhu B, Shen J, Wang Y, Zheng M, Liu F. Treatment of single-segment suppurative spondylitis with the transforaminal endoscopic focal cleaning and drainage. J Spinal Cord Med 2021; 44:267-275. [PMID: 31180827 PMCID: PMC7952067 DOI: 10.1080/10790268.2019.1617921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Objective: To evaluate the clinical value of the transforaminal endoscopic focal cleaning and drainage for suppurative spondylitis.Design: Retrospective study.Participants: Twenty-one patients with single-segment suppurative spondylitis.Interventions: All patients were treated with the transforaminal endoscopic focal cleaning and drainage.Outcome Measures: The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured before and after the operation. Visual analogue scale (VAS) was used to evaluate the relief of pain symptoms. Neurological function American Spinal Injury Association (ASIA) grade was used to evaluate the recovery of neurological function. The postoperative clinical efficacy of the patients was evaluated using the Kirkaldy-Willis functional scoring criteria. The stability of the spine and the recurrence of infection were evaluated by imaging data.Results: Postoperative bacteriological culture results showed positive in 15 cases and no bacteria growth in 6 cases. Besides, 16 cases were pathologically diagnosed. The ESR, CRP, and VAS scores at 2 weeks postoperatively and at the last follow-up were significantly improved compared with those at pre-operation. At the last follow-up, the clinical outcome was excellent in 17 cases, good in 3 cases, and fair in 1 case, according to the Kirkaldy-Willis functional scoring criteria; and the ASIA grade returned to normal. There was no significant difference in the Cobb angle between the last follow-up and the pre-operation. There was no recurrence of infection during the follow-up period.Conclusion: The transforaminal endoscopic focal cleaning and drainage is a minimally invasive, effective and safe surgical procedure for suppurative spondylitis.
Collapse
Affiliation(s)
- Qi Zheng
- Department of Orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People’s Republic of China
| | - Xiaozhang Ying
- Department of Orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People’s Republic of China,Correspondence to: Xiaozhang Ying, Department of Orthopedics, Hangzhou Red Cross Hospital, No. 208, Huancheng East Road, Hangzhou, Zhejiang310003, People’s Republic of China. E-mail:
| | - Yanghui Jin
- Department of Orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People’s Republic of China
| | - Bo Zhu
- Department of Orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People’s Republic of China
| | - Jian Shen
- Department of Orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People’s Republic of China
| | - Yifan Wang
- Department of Orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People’s Republic of China
| | - Mingfeng Zheng
- Department of Orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People’s Republic of China
| | - Fei Liu
- Department of Orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People’s Republic of China
| |
Collapse
|
47
|
Wang Z, Truong VT, Shedid D, Newman N, Mc Graw M, Boubez G. One-stage oblique lateral corridor antibiotic-cement reconstruction for Candida spondylodiscitis in patients with major comorbidities: Preliminary experience. Neurochirurgie 2021; 67:157-164. [PMID: 33450269 DOI: 10.1016/j.neuchi.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/29/2020] [Accepted: 12/25/2020] [Indexed: 11/28/2022]
Abstract
Fungal spondylodiscitis is rare (0.5%-1.6% of spondylodiscitis) and mainly caused by Candida albicans. Surgical intervention in spondylodiscitis patients is indicated for compression of neural elements, spinal instability, severe kyphosis, failure of conservative management and intractable pain. However, there is no evidence-based optimal surgical approach for spondylodiscitis. There have been only case reports of surgical treatment for Candida spondylodiscitis. We evaluated the preliminary results of the efficacy and safety of one-stage debridement via oblique lateral corridor with interbody fusion (OLIF) using stand-alone cement reconstruction after debridement for the treatment of Candida spondylodiscitis in patients with major co-morbidities. Five patients (4 males, 1 female, mean age: 64.2 years) suffering from Candida albicans lumbar spondylodiscitis who underwent this procedure were studied. Their predominant symptoms were unremitting back and leg pain and all had pre and postoperative anti-fungal therapy under microbiologist supervision. The operative time ranged from 137minutes to 260minutes (mean: 213.4minutes). The mean blood loss was 160mL (range: 100-200mL). There were no perioperative complications. At follow-up all showed major improvement in pain and ambulatory status. CT scan showed radiological stability for all patients at 6-12 months. Our preliminary results showed stand-alone anterior debridement and spinal re-construction with cement through mini-open OLIF approach might be a safe and effective option for patients with spinal fungal infection and major comorbidities.
Collapse
Affiliation(s)
- Z Wang
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, 1051 Sanguinet Street, Montreal, QC H2X 3E4 Canada
| | - V T Truong
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, 1051 Sanguinet Street, Montreal, QC H2X 3E4 Canada.
| | - D Shedid
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, 1051 Sanguinet Street, Montreal, QC H2X 3E4 Canada
| | - N Newman
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, 1051 Sanguinet Street, Montreal, QC H2X 3E4 Canada
| | - M Mc Graw
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, 1051 Sanguinet Street, Montreal, QC H2X 3E4 Canada
| | - G Boubez
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, 1051 Sanguinet Street, Montreal, QC H2X 3E4 Canada
| |
Collapse
|
48
|
Ibrahim F, Elkhateeb TM, Abd El-Rady A, Zayan M. Transforaminal Posterior Approach Is Effective for Treatment of Lower Thoracic Spine Spondylodiscitis. HSS J 2020; 16:515-520. [PMID: 33380990 PMCID: PMC7749920 DOI: 10.1007/s11420-019-09688-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/18/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with lower-thoracic spine pathologies that affect anterior column stability and compress the neural tissues need anterior decompression and reconstruction. Anterior approaches result in long-term morbidities. Posterior laminectomy and fixation alone may not be sufficient to maintain spine stability. QUESTIONS/PURPOSES To evaluate the results of a posterior-only transforaminal thoracic interbody fusion approach for patients with thoracic disc space infection in terms of the improvement in neurologic status, resolution of infection, correction of kyphotic deformity, and assessment of post-operative complications. METHODS A prospective study was done on 40 patients with lower thoracic spine spondylodiscitis. All patients were assessed with pre-operative imaging. Neurologic assessment was performed using the American Spinal Injury Association (ASIA) Impairment Scale and functionally by the modified Japanese Orthopedic Association (JOA) scale. Pre-operative and post-operative white blood cell count, erythrocyte sedimentation rate, and C-reactive protein levels were compared. All patients were operated on through a posterior approach using the transforaminal thoracic interbody fusion for decompression, reconstruction, and anterior fusion. RESULTS Mean age of patients was 49 years; mean operative period was 188 min; mean blood loss was 611 mL. Twelve patients' ASIA scores improved and only two patients' scores declined. One patient died 11 months post-operatively due to septicemia. The mean follow-up period was 27.8 months. The modified JOA score improved from 6.3 ± 1.6 to 9.5 ± 0.6. The local kyphosis angle was improved from 13.8 to 6.9° post-operatively, with insignificant loss of correction at the end of follow-up. Thirty-eight out of 40 patients had solid anterior fusion at the end of follow-up. CONCLUSION The clinical outcomes of this study showed that the transforaminal thoracic interbody approach is effective for both decompression and anterior reconstruction of the lower thoracic spine in patients with spondylodiscitis.
Collapse
Affiliation(s)
- Fady Ibrahim
- Department of Orthopedic, Spine Surgery, Faculty of Medicine, Ain Shams University, Abbasseya, Cairo Egypt
| | - Tameem Mohamed Elkhateeb
- Department of Orthopedic, Spine Surgery, Faculty of Medicine, Ain Shams University, Abbasseya, Cairo Egypt
| | - Abdelrady Abd El-Rady
- Department of Orthopedic, Spine Surgery, Faculty of Medicine, Ain Shams University, Abbasseya, Cairo Egypt
| | - Mohammed Zayan
- Department of Orthopedic, Spine Surgery, Faculty of Medicine, Ain Shams University, Abbasseya, Cairo Egypt
| |
Collapse
|
49
|
Ahsan K, Hasan S, Khan SI, Zaman N, Almasri SS, Ahmed N, Chaurasia B. Conservative versus operative management of postoperative lumbar discitis. J Craniovertebr Junction Spine 2020; 11:198-209. [PMID: 33100770 PMCID: PMC7546051 DOI: 10.4103/jcvjs.jcvjs_111_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 07/20/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Treatment option of postoperative discitis (POD) is either conservative or operative, but till date, there are no established validated protocols of the treatment of postoperative lumbar discitis. Aim: The aim of this study was to assess the outcome of conservative versus operative management of POD following single-level lumbar discectomy. Methods: We prospectively studied a total of 38 cases of POD. The patients were diagnosed clinically, radiologically, and by laboratory investigations and followed up with serial erythrocyte sedimentation rate (ESR), C-reactive protein, X-ray, computed tomography (CT), and magnetic resonance imaging. Demographic data, clinical variables, length of hospital stay, duration of antibiotic treatment, and posttreatment complications were collected, and pre- and postoperative assessment was done using the Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) score. Functional outcome of the study was measured by the modified criteria of Kirkaldy–Willis. Results: VAS score for pain was significantly decreased in both groups after treatment. However, posttreatment differences were not statistically significant. In posttreatment mean JOA score, differences were not statistically significant in both groups except the mean difference (−0.47) of restriction of daily activities, which was statistically significant (95% confidence interval: −0.88–−0.07, P = 0.025, unpaired t-test). About 73.7% and 84.2% of the patients had a satisfactory functional outcome in conservative and operative management groups, respectively, at the end of 12-month follow-up. Conclusions: Operative management yielded better outcomes than traditional conservative treatment in terms of functional outcomes, length of hospital stays, and duration of antibiotic treatment as determined by both the pain and daily activity levels.
Collapse
Affiliation(s)
- Kamrul Ahsan
- Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sariful Hasan
- Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shahidul Islam Khan
- Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Naznin Zaman
- Department of Anesthesiology, Sarkari Karmachari Hospital, Dhaka, Bangladesh
| | | | - Nazmin Ahmed
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| |
Collapse
|
50
|
Bettag C, Abboud T, von der Brelie C, Melich P, Rohde V, Schatlo B. Do we underdiagnose osteoporosis in patients with pyogenic spondylodiscitis? Neurosurg Focus 2020; 49:E16. [DOI: 10.3171/2020.5.focus20267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPyogenic spondylodiscitis affects a fragile patient population. Surgical treatment in cases of instability entails instrumentation, and loosening of this instrumentation is a frequent occurrence in pyogenic spondylodiscitis. The authors therefore attempted to investigate whether low bone mineral density (BMD)—which is compatible with the diagnosis of osteoporosis—is underdiagnosed in patients with pyogenic spondylodiscitis. How osteoporosis was treated and how it affected implant stability were further analyzed.METHODSCharts of patients who underwent operations for pyogenic spondylodiscitis were retrospectively reviewed for clinical data, prior medical history of osteoporosis, and preoperative CT scans of the thoracolumbar spine. In accordance with a previously validated high-fidelity opportunistic CT assessment, average Hounsfield units (HUs) in vertebral bodies of L1 and L4 were measured. Based on the validation study, the authors opted for a conservative cutoff value for low BMD, being compatible with osteoporosis ≤ 110 HUs. Baseline and outcome variables, including implant failure and osteoporosis interventions, were entered into a multivariate logistic model for statistical analysis.RESULTSOf 200 consecutive patients who underwent fusion surgery for pyogenic spondylodiscitis, 64% (n = 127) were male and 66% (n = 132) were older than 65 years. Seven percent (n = 14) had previously been diagnosed with osteoporosis. The attenuation analysis revealed HU values compatible with osteoporosis in 48% (95/200). The need for subsequent revision surgery due to implant failure showed a trend toward an association with estimated low BMD (OR 2.11, 95% CI 0.95–4.68, p = 0.067). Estimated low BMD was associated with subsequent implant loosening (p < 0.001). Only 5% of the patients with estimated low BMD received a diagnosis and pharmacological treatment of osteoporosis within 1 year after spinal instrumentation.CONCLUSIONSRelying on past medical history of osteoporosis is insufficient in the management of patients with pyogenic spondylodiscitis. This is the first study to identify a substantially missed opportunity to detect osteoporosis and to start pharmacological treatment after surgery for prevention of implant failure. The authors advocate for routine opportunistic CT evaluation for a better estimation of bone quality to initiate diagnosis and treatment for osteoporosis in these patients.
Collapse
Affiliation(s)
- Christoph Bettag
- 1Department of Neurosurgery, Georg-August University of Göttingen; and
| | - Tammam Abboud
- 1Department of Neurosurgery, Georg-August University of Göttingen; and
| | | | - Patrick Melich
- 1Department of Neurosurgery, Georg-August University of Göttingen; and
- 2Department of Neurosurgery, University Hospital Cologne, Germany
| | - Veit Rohde
- 1Department of Neurosurgery, Georg-August University of Göttingen; and
| | - Bawarjan Schatlo
- 1Department of Neurosurgery, Georg-August University of Göttingen; and
| |
Collapse
|