1
|
Ling-Shan C, Zheng-Qiu Z, Jing L, Rui Z, Li-Fang L, Zhi-Tao W, Zhong-Qiu W. Magnetic resonance imaging features for differentiating tuberculous from pyogenic spondylitis: a meta-analysis. Skeletal Radiol 2024; 53:697-707. [PMID: 37843585 DOI: 10.1007/s00256-023-04459-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/04/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To perform a meta-analysis comparing the MRI features of tuberculous and pyogenic spondylitis, using histopathological results and/or blood culture as the standard reference. MATERIALS AND METHODS PubMed, Embase, Web of Science, and Cochrane Library were searched for English-language studies on the MRI features of tuberculous and pyogenic spondylitis published between January 2010 and February 2023. Risk for bias and concerns regarding applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled MRI features' proportions were calculated using a bivariate random-effects model. RESULTS Thirty-two studies met the inclusion criteria: 21 for tuberculous spondylitis, three for pyogenic spondylitis, and eight for both. Of the nine informative MRI features comparing tuberculous spondylitis to pyogenic spondylitis, involvement of ≥ 2 vertebral bodies (92% vs. 88%, P = .004), epidural extension (77% vs. 25%, P < .001), paravertebral collection (91% vs. 84%, P < .001), subligamentous spread (93% vs. 24%, P < .001), thin and regular abscess wall (94% vs. 18%, P < .001), vertebral collapse (68% vs. 24%, P < .001), and kyphosis (39% vs. 3%, P < .01) were more suggestive of tuberculous spondylitis, while disc signal change (82% vs. 95%, P < .001) and disc height loss (22% vs. 59%, P < .001) were more suggestive of pyogenic spondylitis. CONCLUSION Involvement of ≥ 2 vertebral vertebral bodies, soft tissue attribution, thin and regular abscess wall, vertebral collapse, and kyphosis were MRI features more common in tuberculous spondylitis, while disc signal change and height loss were more common in pyogenic spondylitis.
Collapse
Affiliation(s)
- Chen Ling-Shan
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, No. 155, Hanzhong Road, Nanjing, 210029, Jiangsu Province, China
| | - Zhu Zheng-Qiu
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China
| | - Li Jing
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, No. 155, Hanzhong Road, Nanjing, 210029, Jiangsu Province, China
| | - Zhao Rui
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, No. 155, Hanzhong Road, Nanjing, 210029, Jiangsu Province, China
| | - Ling Li-Fang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, No. 155, Hanzhong Road, Nanjing, 210029, Jiangsu Province, China
| | - Wang Zhi-Tao
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, No. 155, Hanzhong Road, Nanjing, 210029, Jiangsu Province, China
| | - Wang Zhong-Qiu
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, No. 155, Hanzhong Road, Nanjing, 210029, Jiangsu Province, China.
| |
Collapse
|
2
|
Yasin P, Yimit Y, Abliz D, Mardan M, Xu T, Yusufu A, Cai X, Sheng W, Mamat M. MRI-based interpretable radiomics nomogram for discrimination between Brucella spondylitis and Pyogenic spondylitis. Heliyon 2024; 10:e23584. [PMID: 38173524 PMCID: PMC10761805 DOI: 10.1016/j.heliyon.2023.e23584] [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: 05/12/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
Background Pyogenic spondylitis (PS) and Brucella spondylitis (BS) are commonly seen spinal infectious diseases. Both types can lead to vertebral destruction, kyphosis, and long-term neurological deficits if not promptly diagnosed and treated. Therefore, accurately diagnosis is crucial for personalized therapy. Distinguishing between PS and BS in everyday clinical settings is challenging due to the similarity of their clinical symptoms and imaging features. Hence, this study aims to evaluate the effectiveness of a radiomics nomogram using magnetic resonance imaging (MRI) to accurately differentiate between the two types of spondylitis. Methods Clinical and MRI data from 133 patients (2017-2022) with pathologically confirmed PS and BS (68 and 65 patients, respectively) were collected. We have divided patients into training and testing cohorts. In order to develop a clinical diagnostic model, logistic regression was utilized to fit a conventional clinical model (M1). Radiomics features were extracted from sagittal fat-suppressed T2-weighted imaging (FS-T2WI) sequence. The radiomics features were preprocessed, including scaling using Z-score and undergoing univariate analysis to eliminate redundant features. Furthermore, the Least Absolute Shrinkage and Selection Operator (LASSO) was employed to develop a radiomics score (M2). A composite model (M3) was created by combining M1 and M2. Subsequently, calibration and decision curves were generated to evaluate the nomogram's performance in both training and testing groups. The diagnostic performance of each model and the indication was assessed using the receiver operating curve (ROC) with its area under the curve (AUC). Finally, we used the SHapley Additive exPlanations (SHAP) model explanations technique to interpret the model result. Results We have finally selected 9 significant features from sagittal FS-T2WI sequences. In the differential diagnosis of PS and BS, the AUC values of M1, M2, and M3 in the testing set were 0.795, 0.859, and 0.868. The composite model exhibited a high degree of concurrence with the ideal outcomes, as evidenced by the calibration curves. The nomogram's possible clinical application values were indicated by the decision curve analysis. By using SHAP values to represent prediction outcomes, our model's prediction results are more understandable. Conclusions The implementation of a nomogram that integrates MRI and clinical data has the potential to significantly enhance the accuracy of discriminating between PS and BS within clinical settings.
Collapse
Affiliation(s)
- Parhat Yasin
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Yasen Yimit
- Department of Radiology, The First People’s Hospital of Kashi Prefecture, Kashi, Xinjiang, 844000, China
| | - Dilxat Abliz
- Department of Orthopedic, The Eighth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Muradil Mardan
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Department of Spine Center, Shanghai, 200092, China
| | - Tao Xu
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Aierpati Yusufu
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Xiaoyu Cai
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Weibin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Mardan Mamat
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| |
Collapse
|
3
|
Nishikawa T, Saburi M, Nagamatsu K, Uraisami K, Takata H, Miyazaki Y, Ohtsuka E. [ Pyogenic spondylitis after Corynebacterium striatum blood stream infection following allogeneic hematopoietic stem cell transplantation for malignant lymphoma]. Rinsho Ketsueki 2024; 65:243-248. [PMID: 38684434 DOI: 10.11406/rinketsu.65.243] [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] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Patient 1 was a 70-year-old woman with refractory diffuse large B-cell lymphoma who received allogeneic peripheral blood stem cell transplantation from an HLA-haploidentical related donor. Upper back pain appeared on day63, and Th8-Th9 pyogenic spondylitis was diagnosed based on magnetic resonance imaging (MRI). Blood culture on day14 identified Corynebacterium striatum as the causative bacteria of blood stream infection (BSI). The pyogenic spondylitis resolved after treatment with daptomycin for 2 months. Patient 2 was a 65-year-old man with relapsed angioimmunoblastic T-cell lymphoma who received bone marrow transplantation from an HLA-DR single-antigen-mismatched unrelated donor. Lower back pain appeared on day30, and L4-L5 pyogenic spondylitis was diagnosed based on MRI. Blood culture was negative. Daptomycin and clindamycin were selected for treatment based on the drug susceptibility of bacteria that had caused pre-engraftment BSI (Escherichia coli on day3 and Corynebacterium striatum on day9), and the pyogenic spondylitis resolved after 6 months of this treatment. Pyogenic spondylitis should be considered in the differential diagnosis of back pain accompanied by BSI before engraftment in allogeneic hematopoietic stem cell transplant recipients.
Collapse
Affiliation(s)
| | | | - Kentaro Nagamatsu
- Department of Hematology, Oita City Medical Association's Almeida Memorial Hospital
| | | | | | | | | |
Collapse
|
4
|
Masuda S, Shimizu T, Sono T, Tamaki Y, Onishi E, Takemoto M, Odate S, Kimura H, Izeki M, Tomizawa T, Tsubouchi N, Fujibayashi S, Otsuki B, Murata K, Matsuda S. Recurrence rate after posterior percutaneous screw fixation without anterior debridement for pyogenic spondylitis compared with conservative treatment: a propensity score-matched analysis. Eur Spine J 2023; 32:4265-4271. [PMID: 37278875 DOI: 10.1007/s00586-023-07800-7] [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: 03/27/2023] [Revised: 05/03/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE Previous studies have shown that percutaneous pedicle screw (PPS) posterior fixation without anterior debridement for pyogenic spondylitis can improve patient quality of life compared with conservative treatment. However, data on the risk of recurrence after PPS posterior fixation compared with conservative treatment is lacking. The aim of this study was to compare the recurrence rate of pyogenic spondylitis after PPS posterior fixation without anterior debridement and conservative treatment. METHODS The study was conducted under a retrospective cohort design in patients hospitalized for pyogenic spondylitis between January 2016 and December 2020 at 10 affiliated institutions. We used propensity score matching to adjust for confounding factors, including patient demographics, radiographic findings, and isolated microorganisms. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for recurrence of pyogenic spondylitis during the follow-up period in the matched cohort. RESULTS 148 patients (41 in the PPS group and 107 in the conservative group) were included. After propensity score matching, 37 patients were retained in each group. PPS posterior fixation without anterior debridement was not associated with an increased risk of recurrence compared with conservative treatment with orthosis (HR, 0.80; 95% CI, 0.18-3.59; P = 0.77). CONCLUSIONS In this multi-center retrospective cohort study of adults hospitalized for pyogenic spondylitis, we found no association in the incidence of recurrence between PPS posterior fixation without anterior debridement and conservative treatment.
Collapse
Affiliation(s)
- Soichiro Masuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Sono
- Department of Orthopaedic Surgery, Fukui Red Cross Hospital, Fukui, Japan
| | - Yasuyuki Tamaki
- Department of Orthopaedic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan
| | - Eijiro Onishi
- Department of Orthopaedic Surgery, Kobe Central General Hospital, Kobe, Japan
| | - Mitsuru Takemoto
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Seiichi Odate
- Department of Orthopaedic Surgery, Gakkentoshi Hospital, Kyoto, Japan
| | - Hiroaki Kimura
- Department of Orthopaedic Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Masanori Izeki
- Department of Orthopaedic Surgery, Kansai Electric Power Hospital, Osaka, Japan
| | - Takuya Tomizawa
- Department of Orthopaedic Surgery, Tenri Hospital, Nara, Japan
| | - Naoya Tsubouchi
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
5
|
Yasin P, Mardan M, Abliz D, Xu T, Keyoumu N, Aimaiti A, Cai X, Sheng W, Mamat M. The Potential of a CT-Based Machine Learning Radiomics Analysis to Differentiate Brucella and Pyogenic Spondylitis. J Inflamm Res 2023; 16:5585-5600. [PMID: 38034044 PMCID: PMC10683663 DOI: 10.2147/jir.s429593] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023] Open
Abstract
Background Pyogenic spondylitis (PS) and Brucella spondylitis (BS) are common spinal infections with similar manifestations, making their differentiation challenging. This study aimed to explore the potential of CT-based radiomics features combined with machine learning algorithms to differentiate PS from BS. Methods This retrospective study involved the collection of clinical and radiological information from 138 patients diagnosed with either PS or BS in our hospital between January 2017 and December 2022, based on histopathology examination and/or germ isolations. The region of interest (ROI) was defined by two radiologists using a 3D Slicer open-source platform, utilizing blind analysis of sagittal CT images against histopathological examination results. PyRadiomics, a Python package, was utilized to extract ROI features. Several methods were performed to reduce the dimensionality of the extracted features. Machine learning algorithms were trained and evaluated using techniques like the area under the receiver operating characteristic curve (AUC; confusion matrix-related metrics, calibration plot, and decision curve analysis to assess their ability to differentiate PS from BS. Additionally, permutation feature importance (PFI; local interpretable model-agnostic explanations (LIME; and Shapley additive explanation (SHAP) techniques were utilized to gain insights into the interpretabilities of the models that are otherwise considered opaque black-boxes. Results A total of 15 radiomics features were screened during the analysis. The AUC value and Brier score of best the model were 0.88 and 0.13, respectively. The calibration plot and decision curve analysis displayed higher clinical efficiency in the differential diagnosis. According to the interpretation results, the most impactful features on the model output were wavelet LHL small dependence low gray-level emphasis (GLDN). Conclusion The CT-based radiomics models that we developed have proven to be useful in reliably differentiating between PS and BS at an early stage and can provide a reliable explanation for the classification results.
Collapse
Affiliation(s)
- Parhat Yasin
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, People’s Republic of China
| | - Muradil Mardan
- School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China
| | - Dilxat Abliz
- Department of Orthopedic, The Eighth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, People’s Republic of China
| | - Tao Xu
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, People’s Republic of China
| | - Nuerbiyan Keyoumu
- Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, People’s Republic of China
| | - Abasi Aimaiti
- Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, People’s Republic of China
| | - Xiaoyu Cai
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, People’s Republic of China
| | - Weibin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, People’s Republic of China
| | - Mardan Mamat
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, People’s Republic of China
| |
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
|
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
|
8
|
Zhai K, Wang L, Wu AF, Qian Y, Huang WM. Pregnancy and lactation-associated osteoporosis with pyogenic spondylitis: A case report. World J Clin Cases 2023; 11:4187-4193. [PMID: 37388803 PMCID: PMC10303623 DOI: 10.12998/wjcc.v11.i17.4187] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND This case report presents a patient with pyogenic spondylitis (PS) associated with lactation-related osteoporosis during pregnancy. The 34-year-old female patient experienced low back pain for one month, beginning one month postpartum, with no history of trauma or fever. Dual-energy X-ray absorptiometry of the lumbar spine revealed a Z-score of -2.45, leading to a diagnosis of pregnancy and lactation-associated osteoporosis (PLO). The patient was advised to cease breastfeeding and take oral calcium and active vitamin D. Despite these interventions, her symptoms worsened, and she had difficulty walking one week later, prompting her to revisit our hospital.
CASE SUMMARY Lumbar magnetic resonance imaging (MRI) scans showed abnormal signals in the L4 and L5 vertebral bodies and intervertebral space, while an enhancement scan displayed abnormal enhanced high signals around the L4/5 intervertebral disc, suggesting a lumbar infection. A needle biopsy was performed for bacterial culture and pathological examination, culminating in a final diagnosis of pregnancy and lactation-related osteoporosis with PS. Following treatment with anti-osteoporotic medications and antibiotics, the patient’s pain gradually subsided, and she returned to normal life within five months. PLO is a rare condition that has garnered increasing attention in recent years. Spinal infections during lactation in pregnancy are also relatively uncommon.
CONCLUSION Both conditions primarily manifest as low back pain but require distinct treatments. In clinical practice, when diagnosing patients with pregnancy and lactation-associated osteoporosis, the possibility of spinal infection should be considered. A lumbar MRI should be conducted as needed to prevent delays in diagnosis and treatment.
Collapse
Affiliation(s)
- Kai Zhai
- Department of Orthopedics, 960 Hospital of PLA, Jinan 250031, Shandong Province, China
| | - Lei Wang
- Department of Orthopedics, 960 Hospital of PLA, Jinan 250031, Shandong Province, China
| | - Ai-Fang Wu
- Department of Obstetrics, 960 Hospital of PLA, Jinan 250031, Shandong Province, China
| | - Ying Qian
- Department of Endocrinology, 960 Hospital of PLA, Jinan 250031, Shandong Province, China
| | - Wei-Min Huang
- Department of Orthopedics, 960 Hospital of PLA, Jinan 250031, Shandong Province, China
| |
Collapse
|
9
|
Zou LC, Qian J, Bian ZY, Wang XP, Xie T. Pyogenic spondylitis caused by Escherichia coli: A case report and literature review. World J Clin Cases 2023; 11:3583-3591. [PMID: 37383891 PMCID: PMC10294177 DOI: 10.12998/wjcc.v11.i15.3583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/04/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Pyogenic spondylitis is often manifested as atypical low back pain and fever, which makes it easy to be confused with other diseases. Here we report a case of pyogenic spondylitis and describe the diagnosis and treatment based on the related literature.
CASE SUMMARY The reported case suffered from pyogenic spondylitis caused by Escherichia coli and complicated with bacteremia and psoas abscess. Acute pyelonephritis was initially diagnosed due to atypical symptoms. Symptoms were improved from antibiotic treatment while developing progressive lower limb dysfunction. One month post the admission, the patient underwent anterior lumbar debridement + autogenous iliac bone graft fusion + posterior percutaneous screw-rod internal fixation, and received 6 wk of antibiotic treatment after the operation. Reexamination 4 mo post the operation showed that the patient had no evident pain in the waist, and walked well with no evident dysfunction of lower limbs.
CONCLUSION Here we describe the application value of several imaging examinations, such as X-ray, computed tomography and magnetic resonance imaging, and certain tests like erythrocyte sedimentation rate and C-reactive protein in the clinical treatment of pyogenic spondylitis. This disease requires early diagnosis and treatment. Sensitive antibiotics should be used in early stages and surgical intervention should be taken if necessary, which may help for a speedy recovery and prevent the occurrence of severe complications.
Collapse
Affiliation(s)
- Lai-Cheng Zou
- Department of Orthopedic Surgery, The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Jin Qian
- Department of Orthopedic Surgery, The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Zhen-Yu Bian
- Department of Orthopedic Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Xue-Peng Wang
- Department of Orthopedic Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Tao Xie
- Department of Orthopedic Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| |
Collapse
|
10
|
Funayama T, Noguchi H, Shibao Y, Sato K, Kumagai H, Miura K, Takahashi H, Tatsumura M, Koda M, Yamazaki M. Unidirectional porous beta-tricalcium phosphate as a potential bone regeneration material for infectious bony cavity without debridement in pyogenic spondylitis. J Artif Organs 2023; 26:89-94. [PMID: 35503588 DOI: 10.1007/s10047-022-01335-2] [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: 01/20/2022] [Accepted: 04/10/2022] [Indexed: 11/24/2022]
Abstract
An 81-year-old man was initially diagnosed with T11 osteoporotic vertebral fracture. The fractured vertebral body was filled with unidirectional porous beta-tricalcium phosphate (β-TCP) granules, and posterior spinal fixation was conducted using percutaneous pedicle screws. However, the pain did not improve, the inflammatory response increased, and bone destructive changes extended to T10. The correct diagnosis was pyogenic spondylitis with concomitant T11 fragility vertebral fracture. Revision surgery was conducted 2 weeks after the initial surgery, the T10 and T11 pedicle screws were removed, and refixation was conducted. After the revision surgery, the pain improved and mobilization proceeded. The infection was suppressed by the administration of sensitive antibiotics. One month after surgery, a lateral bone bridge appeared at the T10/11 intervertebral level. This increased in size over time, and synostosis was achieved at 6 months. Resorption of the unidirectional porous β-TCP granules was observed over time and partial replacement with autologous bone was evident from 6 months after the revision surgery. Two years and 6 months after the revision surgery, although there were some residual β-TCP and bony defect in the center of the vertebral body, the bilateral walls have well regenerated. This suggested that given an environment of sensitive antibiotic administration and restricted local instability, unidirectional porous β-TCP implanted into an infected vertebral body may function as a resorbable bone regeneration scaffold without impeding infection control even without debridement of the infected bony cavity.
Collapse
Affiliation(s)
- Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan.
| | - Hiroshi Noguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan.
| | - Yosuke Shibao
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan
| | - Kosuke Sato
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan
| | - Hiroshi Kumagai
- Departament of Orthopaedic Surgery, Ichihara Hospital, 3681 Ozone, Tsukuba, Ibaraki, 3003253, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan
| | - Masaki Tatsumura
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center/ Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito, Ibaraki, 3100015, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan
| |
Collapse
|
11
|
Lee SH, Kim H, Han IB, Sheen SH, Hong JB, Sohn S. Association between ischemic stroke and pyogenic spondylitis in Korea: Nationwide longitudinal cohort study. J Cerebrovasc Endovasc Neurosurg 2023:jcen.2023.E2022.09.001. [PMID: 36647233 DOI: 10.7461/jcen.2023.e2022.09.001] [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: 09/06/2022] [Accepted: 12/31/2022] [Indexed: 01/18/2023] Open
Abstract
Objective The purpose of this nationwide age- and sex- matched longitudinal study was to determine the pyogenic spondylitis (PS) increases the incidence of ischemic stroke (IS) in Korea. Methods From the National Health Insurance Service (NHIS), we collected the patient data for the period from January 1, 2004 to December 31, 2015. PS was classified according to the International Classification of Disease codes M46.2-M46.8, M49.2, and M49.3. By using a 1:5 age- and sex- stratified matching, a total of 628 patients and 3140 control subjects were included in the study. The IS incidence rates in PS and control group was calculated by using the Kaplan-Meier method. The outcome of hazard ratio of IS was estimated by Cox proportional hazards regression analyses. This study did not exclude PS as a result of postoperative complications. Results According to the study, 51 patients (8.12%) in the PS group and 201 patients (6.4%) in the control group experienced IS. The adjusted hazard ratio of IS in the PS group was 3.419 (95% CI: 2.473-4.729) after adjusting individual medical condition and demographics. Following the results of subgroup analysis, the risk ratio of IS was greater in most of the subgroup categories (male, female, age <65, age >65, non-diabetic, hypertensive, non-hypertensive, dyslipidemic and non-dyslipidemic subgroup). However, the risk of IS did not differ significantly in diabetic subgroup (95% CI: 0.953-4.360). Conclusions The risk rate of IS increased in patient with pyogenic spondylitis.
Collapse
Affiliation(s)
- Soo Hyun Lee
- Department of Neurosurgery, CHA University, CHA Bundang Medical Center, Seongnam, Korea
| | - Hakyung Kim
- Genome & Health Big Data Branch, Department of Public Health, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - In-Bo Han
- Department of Neurosurgery, CHA University, CHA Bundang Medical Center, Seongnam, Korea
| | - Seung Hun Sheen
- Department of Neurosurgery, CHA University, CHA Bundang Medical Center, Seongnam, Korea
| | - Je Beom Hong
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seil Sohn
- Department of Neurosurgery, CHA University, CHA Bundang Medical Center, Seongnam, Korea
| |
Collapse
|
12
|
Hwang JH, Lee SY, Lee J, Hwang JH. Pyogenic spondylitis caused by Klebsiella pneumoniae: should the possibility of hypervirulent Klebsiella pneumoniae be considered? BMC Infect Dis 2022; 22:801. [PMID: 36303118 PMCID: PMC9615223 DOI: 10.1186/s12879-022-07785-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 05/31/2023] Open
Abstract
Background Klebsiella pneumoniae is rare but the second most common causative agent among gram-negative bacteria that cause pyogenic spondylitis. However, there are no available studies on the serotype, virulence factors, and clinical characteristics associated with K. pneumoniae-caused pyogenic spondylitis. Accordingly, we investigated the clinical characteristics of pyogenic spondylitis, K1 and K2 serotypes, and virulence factors of K. pneumoniae. Methods We reviewed the microbiological reports of specimens collected between January 2014 and December 2019 as well as the medical records of patients with pyogenic spondylitis caused by K. pneumoniae. We also evaluated K1 and K2 serotypes and the virulent genes rmpA, iutA, mrkD, ybtS, entB, and kfu. Strains that possessed rmpA and iutA were defined as hypervirulent K. pneumoniae. Results Six patients with pyogenic spondylitis caused by K. pneumoniae were enrolled in the study. The capsular serotypes K1 and K2 were present in 66.7% (4/6) of cases, and the hypervirulent strains were present in 88.3% (5/6) of cases. All patients had community-acquired infections, and all strains isolated were susceptible to antimicrobial agents. Intravenous antibiotic treatment continued for 2–7 weeks, and no patient underwent decompressive operation or surgical debridement. There was no recurrence. One patient died from pneumonia with a septic lung. Conclusion Hypervirulent K. pneumoniae is a rare but possible causative agent associated with pyogenic spondylitis.
Collapse
Affiliation(s)
- Joo-Hee Hwang
- Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, 20 Geonjiro, Deokjin-gu, 54907, Jeonju-si, Jeollabuk-do, South Korea.,Research Institute of Clinical Medicine, Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonjiro, Deokjin-gu, 54907, Jeonju-si, Jeollabuk-do, South Korea
| | - Seung Yeob Lee
- Research Institute of Clinical Medicine, Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonjiro, Deokjin-gu, 54907, Jeonju-si, Jeollabuk-do, South Korea.,Department of Laboratory Medicine, Jeonbuk National University Medical School and Hospital, 20 Geonjiro, Deokjin-gu, 54907, Jeonju-si, Jeollabuk-do, South Korea
| | - Jaehyeon Lee
- Research Institute of Clinical Medicine, Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonjiro, Deokjin-gu, 54907, Jeonju-si, Jeollabuk-do, South Korea. .,Department of Laboratory Medicine, Jeonbuk National University Medical School and Hospital, 20 Geonjiro, Deokjin-gu, 54907, Jeonju-si, Jeollabuk-do, South Korea.
| | - Jeong-Hwan Hwang
- Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, 20 Geonjiro, Deokjin-gu, 54907, Jeonju-si, Jeollabuk-do, South Korea. .,Research Institute of Clinical Medicine, Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonjiro, Deokjin-gu, 54907, Jeonju-si, Jeollabuk-do, South Korea.
| |
Collapse
|
13
|
Okusaki T, Araki Y, Narai S, Hamada T, Kusunoki R, Oda A, Nakamura H. Pyometra and Pyogenic Spondylitis with Suspected Involvement of Diverticulitis of the Sigmoid Colon: A Case Report. Intern Med 2022; 62:1231-1235. [PMID: 36104192 PMCID: PMC10183279 DOI: 10.2169/internalmedicine.0064-22] [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: 11/06/2022] Open
Abstract
Pyometra is a rare disease in which pus accumulates in the uterus and is typically caused by stenosis of the cervix. Only a few case reports have indicated that diverticular disease causes pyometra. We herein report an 83-year-old woman presented to our hospital with a fever, loss of appetite, general fatigue and back pain. After some inspections, she was diagnosed with pyometra and lumbar pyogenic spondylitis secondary to diverticulitis of the sigmoid colon. We performed transvaginal drainage and continued antibiotic administration for about three months. The pyometra and pyogenic spondylitis successfully resolved, and she did not experience any recurrence.
Collapse
Affiliation(s)
- Tai Okusaki
- Department of Respiratory Medicine, Kure Medical Center, Japan
| | - Yusuke Araki
- Department of Respiratory Medicine, Kure Medical Center, Japan
| | - Seika Narai
- Department of Respiratory Medicine, Kure Medical Center, Japan
| | - Takuro Hamada
- Department of Gastroenterology, Kure Medical Center, Japan
| | | | - Akihiro Oda
- Department of Orthopaedic surgery, Kure Medical Center, Japan
| | - Hiroko Nakamura
- Department of Obstetrics and Gynecology, Kure Medical Center, Japan
| |
Collapse
|
14
|
Fujii K, Imai T, Morita S, Saijyo S, Yamazaki T, Asada Y. Pyogenic spondylitis caused by Streptococcus dysgalactiae subspecies equisimilis in a patient with nasopharyngeal cancer. J Infect Chemother 2022:S1341-321X(22)00159-3. [PMID: 35637129 DOI: 10.1016/j.jiac.2022.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/26/2022] [Accepted: 05/19/2022] [Indexed: 11/20/2022]
Abstract
In the treatment of head and neck cancer, radiation therapy is an effective modality and is often used in routine clinical practice. Although rare, pyogenic spondylitis has been reported as a complication of radiation therapy. Here, we report a case of nasopharyngeal carcinoma resulting in pyogenic spondylitis from a catheter-related bloodstream infection after chemoradiotherapy. The initial symptoms were fever and posterior cervical pain. Streptococcus dysgalactiae subspecies equisimilis was detected in blood cultures. Magnetic resonance imaging showed abnormal enhancement of the C6 and C7 vertebrae and an anterior epidural abscess. The infection was successfully treated with antibacterial therapy.
Collapse
|
15
|
Murakami J, Itohara H, Orita T, Ishimura S, Kobayashi A, Nakamura A, Komatsu M. A case of pyogenic spondylitis caused by Paludibacteriumpurpuratum. J Infect Chemother 2021; 28:440-443. [PMID: 34857461 DOI: 10.1016/j.jiac.2021.11.009] [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: 07/11/2021] [Revised: 10/06/2021] [Accepted: 11/07/2021] [Indexed: 11/20/2022]
Abstract
Paludibacterium purpuratum was first reported as a Gram stain-negative, curved, rod-shaped bacterium isolated from a wetland soil in 2016. We report the first case in the world, to our knowledge, of pyogenic spondylitis caused by P. purpuratum. The patient, a 78-year-old man, came to our hospital complaining chiefly of fever and pain in the left knee. He did not complain of low back pain at the time of examination, although increased low back pain was observed for the first time after admission. Magnetic resonance imaging of the lumbar spine and percutaneous needle biopsy at the L2/L3 disc level were performed, and pyogenic spondylitis was diagnosed. A curved, Gram stain-negative rod was detected in the blood culture obtained at admission that was identified as P. purpuratum by 16S rDNA gene analysis.
Collapse
Affiliation(s)
- Jun Murakami
- Clinical Laboratory, Takarazuka City Hospital, Hyogo, Japan.
| | - Hitoshi Itohara
- Department of Orthopaedic Surgery, Takarazuka City Hospital, Hyogo, Japan
| | - Tamaki Orita
- Clinical Laboratory, Takarazuka City Hospital, Hyogo, Japan
| | - Saori Ishimura
- Clinical Laboratory, Takarazuka City Hospital, Hyogo, Japan
| | - Atsuko Kobayashi
- Infection Control Office, Takarazuka City Hospital, Hyogo, Japan
| | - Akihiro Nakamura
- Department of Clinical Laboratory Science, Tenri Health Care University, Nara, Japan
| | - Masaru Komatsu
- Department of Clinical Laboratory Science, Tenri Health Care University, Nara, Japan
| |
Collapse
|
16
|
Li SY, Miao Y, Cheng L, Wang YF, Li ZQ, Liu YB, Zou TM, Shen J. Surgical treatment of delayed cervical infection and incomplete quadriplegia with fish-bone ingestion: A case report. World J Clin Cases 2021; 9:7535-7541. [PMID: 34616823 PMCID: PMC8464462 DOI: 10.12998/wjcc.v9.i25.7535] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/20/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The most commonly ingested foreign body in Asians is fish bone. The vast majority of patients have obvious symptoms and can be timely diagnosed and treated. Cases of pyogenic cervical spondylitis and diskitis with retropharyngeal and epidural abscess resulting in incomplete quadriplegia due to foreign body ingestion have been rarely reported. The absence of pharyngeal or esophageal discomfort and negative computed tomography (CT) findings of fish bone have not been reported. We report the case of an elderly female patient with delayed cervical infection and incomplete quadriplegia who had a history of fish bone ingestion.
CASE SUMMARY A 73-year-old woman presented with right neck pain and weakness of four limbs for a week, and had a history of fish bone ingestion and negative findings on laryngoscopic examination one month previously. She did not complain of any pharyngeal or esophageal discomfort. Cervical magnetic resonance imaging showed C4/C5 spondylitis and diskitis along with retropharyngeal and ventral epidural abscesses. No sign of fish bone was detected on lateral cervical radiography and CT scans. The muscle strength of the patient’s right lower limb receded to grade 1 and other limbs to grade 2 suddenly on the 10th day of hospitalization. Emergency surgery was performed to drain the abscess and decompress the spinal cord by removing the anterior inflammatory necrotic tissue. Simultaneously, flexible esophagogastroduodenoscopy was carried out and a hole in the posterior pharyngeal wall was found. The motor weakness of the right lower limb improved to grade 3 and the other limbs to grade 4 within 2 d postoperatively.
CONCLUSION This rare case highlights the awareness of the posterior pharyngeal or esophageal wall perforation in patients with cervical pyogenic spondylitis along with a history of fish bone ingestion, even though local discomfort symptoms are absent and the radiological examinations are negative.
Collapse
Affiliation(s)
- Suo-Yuan Li
- Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Ye Miao
- Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Liang Cheng
- Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Ye-Feng Wang
- Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Zhi-Qiang Li
- Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Yu-Bo Liu
- Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Tian-Ming Zou
- Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Jun Shen
- Department of Orthopaedic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University; Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| |
Collapse
|
17
|
Zhang S, Wang S, Wang Q, Yang J, Xu S. Debridement and corpectomy via single posterior approach to treat pyogenic spondylitis after vertebral augmentation. BMC Musculoskelet Disord 2021; 22:591. [PMID: 34174863 PMCID: PMC8236162 DOI: 10.1186/s12891-021-04478-0] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/14/2021] [Indexed: 12/30/2022] Open
Abstract
Background Infection after vertebral augmentation (VA) often limits the daily activities of patients and even threatens their life. The operation may be one of the effective treatments if the patient suffers from intolerable severe pain, neurological deficits, and damage to spinal stability. This study aimed to investigate the clinical efficacy of the treatment of pyogenic spondylitis after vertebral augmentation (PSVA) with Single posterior debridement, vertebral body resection, and intervertebral bone graft fusion and internal fixation (sPVRIF). Methods The study was performed on 19 patients with PSVA who underwent VA at 4 hospitals in the region between January 2010 and July 2020. Nineteen patients were included. Among them, 16 patients underwent sPVRIF to treat the PSVA. Results A total of 2267 patients underwent VA at 4 hospitals in the region. Of the 19 patients with postoperative PSVA, suppurative spondylitis was misdiagnosed as an osteoporotic vertebral fracture(OVF) in 4 patients and they underwent VA. Besides osteoporosis, 18 patients had other comorbidities. The average interval between the first surgery and the diagnosis of PSVA was 96.4 days. Of the 19 patients, 16 received surgical treatment. The surgical time was 175.0±16.8 min, and the intraoperative blood loss was 465.6±166.0 mL. Pathogenic microorganisms were cultured in 12 patients. Conclusion PSVA is a severe complication that can even threaten the life of the patients. sPVRIF may be one of the effective treatments if the patient suffers from intolerable severe pain, neurological deficits, and damage to spinal stability.
Collapse
Affiliation(s)
- Shuai Zhang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Sichuan, 646000, Luzhou City, China
| | - Song Wang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Sichuan, 646000, Luzhou City, China.
| | - Qing Wang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Sichuan, 646000, Luzhou City, China
| | - Jin Yang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Sichuan, 646000, Luzhou City, China
| | - Shuang Xu
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Sichuan, 646000, Luzhou City, China
| |
Collapse
|
18
|
Sato T, Kudo D, Kushimoto S. Epidemiological features and outcomes of patients with psoas abscess: A retrospective cohort study. Ann Med Surg (Lond) 2021; 62:114-118. [PMID: 33520205 PMCID: PMC7819806 DOI: 10.1016/j.amsu.2021.01.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 12/14/2022] Open
Abstract
Background Psoas abscess (PA) is an uncommon disease. Although PA is associated with significant morbidity and mortality, its epidemiology and clinical characteristics remain unknown. This study aimed to evaluate the epidemiological and clinical features and outcomes of patients with PA in a prefectural-wide study. Materials and methods This was a multicenter retrospective cohort study conducted between 2010 and 2012 in the Miyagi prefecture with a population of 2,344,062 in 2011. Adult patients with PA were enrolled from 71 secondary and tertiary care hospitals. Results There were 57 patients with adult PA in the Miyagi prefecture. The median age of the patients was 72 years, and 67% patients were male. Fever and flank pain were the primary symptoms in 82% and 74% of patients, respectively. Ten patients (18%) had septic shock, and the hospital mortality rate was 12%. Secondary PA was present in 72% of cases, and the most common origin was pyogenic spondylitis. Of the patients with secondary PA, 44% had an epidural abscess. The most common pathogens were Staphylococcus aureus, and 11% (6 cases) of the cases were caused by methicillin-resistant S. aureus. Conclusion In the Miyagi prefecture of Japan, the estimated prevalence of PA was 1.21/100,000 population years and hospital mortality was 12%. Secondary PA accounted for more than 70% of the cases, and S. aureus was the most common causative pathogen. The hospital mortality rate of psoas abscess (PA) was 12% in Japan. Estimated prevalence of PA was 1.21/10,000 population years between 2010 and 2012. Secondary PA: >70% of cases with the most common origin as pyogenic spondylitis. Epidural abscess formed in 44% of patients. The most common pathogen was Staphylococcus aureus.
Collapse
Affiliation(s)
- Takeaki Sato
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Daisuke Kudo
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Shigeki Kushimoto
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| |
Collapse
|
19
|
Furukawa T, Masuda K, Shigematsu H, Tanaka M, Okuda A, Kawasaki S, Suga Y, Yamamoto Y, Tanaka Y. An infected aneurysm of the vertebral artery following cervical pyogenic spondylitis: a case report and literature review. BMC Musculoskelet Disord 2021; 22:22. [PMID: 33407352 PMCID: PMC7786991 DOI: 10.1186/s12891-020-03881-3] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/14/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND An important complication of pyogenic spondylitis is aneurysms in the adjacent arteries. There are reports of abdominal aortic or iliac aneurysms, but there are few reports describing infected aneurysms of the vertebral artery. Furthermore, there are no reports describing infected aneurysms of the vertebral arteries following cervical pyogenic spondylitis. We report a rare case of an infected aneurysm of the vertebral artery as a complication of cervical pyogenic spondylitis, which was successfully treated by endovascular treatment. CASE PRESENTATION Cervical magnetic resonance imaging (MRI) of a 59-year-old man who complained of severe neck pain showed pyogenic spondylitis. Although he was treated extensively by antibiotic therapy, his neck pain did not improve. Follow-up MRI showed the presence of a cyst, which was initially considered an abscess, and therefore, treatment initially included guided tapping and suction under ultrasonography. However, under ultrasonographic examination an aneurysm was detected. The contrast-enhanced computed tomography (CT) scan showed an aneurysm of the vertebral artery. Following endovascular treatment (parent artery occlusion: PAO), the patient's neck pain disappeared completely. CONCLUSION Although there are several reports of infected aneurysms of the vertebral arteries, this is the first report describing an infected aneurysm of the vertebral artery as a result of cervical pyogenic spondylitis. Whenever a paraspinal cyst exist at the site of infection, we recommend that clinicians use not only X-ray, conventional CT, and MRI to examine the cyst, but ultrasonography and contrast-enhanced CT as well because of the possibility of an aneurysms in neighboring blood vessels. It is necessary to evaluate the morphology of the aneurysm to determine the treatment required.
Collapse
Affiliation(s)
- Takahiro Furukawa
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, 6348522, Nara, Japan
| | - Keisuke Masuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, 6348522, Nara, Japan.
| | - Hideki Shigematsu
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, 6348522, Nara, Japan
| | - Masato Tanaka
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, 6348522, Nara, Japan
| | - Akinori Okuda
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, 6348522, Nara, Japan
| | - Sachiko Kawasaki
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, 6348522, Nara, Japan
| | - Yuma Suga
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, 6348522, Nara, Japan
| | - Yusuke Yamamoto
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, 6348522, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, 6348522, Nara, Japan
| |
Collapse
|
20
|
Ishikawa Y, Miyakoshi N, Hongo M, Kasukawa Y, Kudo D, Shimada Y. Pyogenic Atlantoaxial Rotational Dislocation Representing Adult Torticollis with Vertebral Artery Occlusion: A Case Report and Review. World Neurosurg 2020; 144:82-87. [PMID: 32889186 DOI: 10.1016/j.wneu.2020.08.153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/11/2020] [Revised: 08/20/2020] [Accepted: 08/22/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pyogenic atlantoaxial rotational dislocation is a rare but life-threatening condition. Disease progression damages the soft tissue and bony structure, resulting in spinal cord or brain stem compression. Rapid and correct diagnosis could enable successful treatment. However, few studies have been reported, and the characteristics of a successful treatment course are not well known. In addition, our case presented with vertebral artery (VA) occlusion. Here we present a report of successful treatment of pyogenic atlantoaxial rotational dislocation representing adult torticollis with VA occlusion. CASE DESCRIPTION A 67-year-old woman with neck pain and high fever was treated for suspected meningitis. Although her fever improved, pain persisted for several weeks. Examinations mostly showed characteristics of an infection with destructive atlantoaxial rotational dislocation; however, positive uptake with positron emission tomography, no anomalies with diffusion-weighted magnetic resonance imaging, and VA occlusion indicated the presence of a tumor lesion. After VA embolization and Halo reduction/stabilization, biopsy and blood culture revealed pyogenic infection. Antibiotics with rigid stabilization improved the inflammation and allowed definitive occipitocervical fixation, resulting in an uneventful postoperative course and painless bony fusion 2 years postoperatively. CONCLUSIONS VA involvement should be examined for safe treatment. Stabilization is warranted to improve chronic inflammation. Knowledge regarding the characteristic treatment course could enable successful treatment planning and may prove to be lifesaving.
Collapse
Affiliation(s)
- Yoshinori Ishikawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuji Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Daisuke Kudo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| |
Collapse
|
21
|
Kim YJ, Hong JB, Kim YS, Yi J, Choi JM, Sohn S. Change of Pyogenic and Tuberculous Spondylitis between 2007 and 2016 Year : A Nationwide Study. J Korean Neurosurg Soc 2020; 63:784-793. [PMID: 32623840 PMCID: PMC7671771 DOI: 10.3340/jkns.2020.0013] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/25/2020] [Indexed: 12/19/2022] Open
Abstract
Objective We attempted to compare the incidence of pyogenic spondylitis (PS) and tuberculous spondylitis (TS) between 2007 and 2016. Furthermore, we investigated the patients who underwent surgery in 2016 compared to that in 2007.
Methods We used a nationwide database managed by the Korean National Health Insurance Service (NHIS) in 2007 and 2016. Total 9655 patients with a newly diagnosis of PS or TS were enrolled in PS or TS group. Among them, 1721 patients underwent either fusion or decompression surgery. We analyzed demographic distribution of patients according to gender and age and year of diagnosis.
Results Comparing between 2007 and 2016, the incidence of PS has increased in 2016 than in 2007 (4874 vs. 2431, p<0.0001). Conversely, declination of incidence of TS was discovered in 2016 compared to 2007 (594 vs. 1756, p<0.0001). Females showed predominance over males regarding both PS and TS (5228 vs. 4427, p<0.0001). Among them, the number of PS patients who underwent surgery increased significantly in 2016 relative to that in 2007 (979 vs. 592, p<0.0001).
Conclusion This nationwide study suggests that PS may increase and TS may decrease in Korea. In addition, demand for surgery regarding PS may increase.
Collapse
Affiliation(s)
- Yeon Jee Kim
- Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Je Beom Hong
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeo Song Kim
- Department of Neurosurgery, Cheongju St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Cheongju, Korea
| | - Jeeeun Yi
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Jung Min Choi
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Seil Sohn
- Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, Korea
| |
Collapse
|
22
|
Luo W, Ou YS, Du X, Wang B. Anterior oblique retroperitoneal approach vs posterior transpedicular approach for the treatment of one- or two-level lumbar vertebral osteomyelitis: a retrospective cohort study. Int Orthop 2020; 44:2349-2356. [PMID: 32500308 DOI: 10.1007/s00264-020-04650-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the outcomes of debridement fusion surgery between two surgical approaches for one- or two-level lumbar vertebral osteomyelitis (LVO): oblique retroperitoneal approach (ORA) and posterior transpedicular approach (PTA). METHODS We performed a retrospective study for adult patients with one- or two-level lumbar vertebral pyogenic spondylitis. The primary clinical outcomes included the following: surgery-related information (intra-operative blood loss, operation time, and hospital length of stay), infection control (primary failure and recurrence), and bony fusion. The secondary objective was to determine the differences between groups in mean reduction of pain characters and physical functioning. RESULTS The data of 80 patients were collected retrospectively. The duration of follow-up was 27.8 ± 4.7 months (range, 24-42). Intra-operative blood loss, operation time, and hospital length of stay in ORA debridement were significantly lower. Primary failure (2.3% vs 2.7%) was similar between the groups, but recurrence (13.9% vs 5.4%) had difference. Bony fusion (94.6.3% vs 86.1.%) in ORA debridement was higher than those in PTA debridement at the final follow-up. Fusion occurred at six to 14 months (mean 9.8 months). Patients in ORA group had better results in functional and pain scores in the first three months, with similar results at the final follow-up. CONCLUSION In summary, ORA debridement provides a quicker recovery compared with PTA debridement for one- or two-level LVO. As for the infection control and fusion rate, both debridement approaches had similar results.
Collapse
Affiliation(s)
- Wei Luo
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 YouYi Road, Yuan Jia Gang, Yu Zhong District, Chongqing, 400016, People's Republic of China
| | - Yun-Sheng Ou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 YouYi Road, Yuan Jia Gang, Yu Zhong District, Chongqing, 400016, People's Republic of China.
| | - Xing Du
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 YouYi Road, Yuan Jia Gang, Yu Zhong District, Chongqing, 400016, People's Republic of China
| | - Ben Wang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 YouYi Road, Yuan Jia Gang, Yu Zhong District, Chongqing, 400016, People's Republic of China
| |
Collapse
|
23
|
Alas H, Fernando H, Baker JF, Brown AE, Bortz C, Naessig S, Pierce KE, Ahmad W, Diebo BG, Passias PG. Comparative outcomes of operative relative to medical management of spondylodiscitis accounting for frailty status at presentation. J Clin Neurosci 2020; 75:134-138. [PMID: 32171646 DOI: 10.1016/j.jocn.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/22/2019] [Accepted: 03/02/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Investigate outcomes in a spondylodiscitis (SD) patient cohort undergoing operative and medical treatment or medical treatment alone, accounting for frailty status at presentation. METHODS Patients >18 years old undergoing treatment for SD were retrospectively analyzed. The diagnosis of SD was made through a combination of clinical findings, MRI/CT findings, and blood/tissue cultures. Those who failed to respond to antibiotics, had deteriorating markers, or developed neurologic compromise were considered operative candidates. Patients were stratified based on operative (Op, operative plus medical management) or conservative (Cons, medical only) treatment. Univariate analyses identified differences in outcome measures across treatment groups. Conditional forward regression equations, controlling for patient age, identified predictors of increased mortality and inferior outcomes. RESULTS 116 patients with SD were included. 73 underwent Cons treatment and 43 were Op. Op patients were significantly younger (62.9vs70.7yrs; p < 0.001) and less frail (1.09vs1.85; p < 0.006) than Cons patients, with significantly higher WCC and ESR. Cons pts had higher rates of isolated SD, but Op pts had higher rates of SD with associated SEA, VOM, psoas abscess, and para-vertebral abscess (all p < 0.05). Op pts had significantly lower 30-day mortality than Cons pts (2.3%vs17.8%, p = 0.016), and trended lower 1Y mortality (11.6%vs20.5%, p = 0.310) with similar SD recurrence rates (11.6%vs16.4%, p = 0.592). Patients with an mFI > 3 had significantly higher 30-day mortality (30.4% vs 7.5%, p = 0.003) and trended higher 1-year mortality regardless of intervention. CONCLUSIONS Operative intervention was associated with lower 30-day mortality significantly and 1-year mortality compared to conservative treatment, while an increased mFI was associated with higher short-term mortality.
Collapse
Affiliation(s)
- Haddy Alas
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, United States
| | - Hasanga Fernando
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Joseph F Baker
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Avery E Brown
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, United States
| | - Cole Bortz
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, United States
| | - Sara Naessig
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, United States
| | - Katherine E Pierce
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, United States
| | - Waleed Ahmad
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, United States
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, State University of New York Downstate Medical Center, Brooklyn, NY, United States
| | - Peter G Passias
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, United States.
| |
Collapse
|
24
|
Kim YS, Kim JG, Yi J, Choi JM, Chung CK, Choi UY, Han IB, Sohn S. Changes in the medical burden of pyogenic and tuberculous spondylitis between 2007 and 2016: A nationwide cohort study. J Clin Neurosci 2020; 73:89-93. [PMID: 31952970 DOI: 10.1016/j.jocn.2020.01.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 10/09/2019] [Accepted: 01/06/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND This nationwide study aimed to compare the medical burdens of pyogenic spondylitis (PS) and tuberculous spondylitis (TS) between 2007 and 2016 in Korea. METHODS We used a national database managed by the National Health Insurance Service (NHIS) with data from the years 2007 and 2016. A total of 9655 newly diagnosed patients with PS or TS were correspondingly enrolled in the PS or TS group. Chi square test analyses were used to compare the PS and TS groups. RESULTS The overall incidence of infectious spondylitis during the study period was 9655 persons. The PS and TS groups consisted of 7305 and 2350 cases, respectively. Individual medical costs in the PS group (USD 10,049 ± 94 vs. USD 16,672 ± 17,729, P < 0.001) and the TS group (USD 4882 ± 6869 vs. USD 8531 ± 10,709, P < 0.001) both increased. The total medical cost for the PS group increased significantly between 2007 and 2016 in Korea (USD 24,428,560 vs. USD 81,044,196, P < 0.001). In contrast, the total medical cost for the TS group decreased between 2007 and 2016 in Korea (USD 8,573,038 vs. USD 4,879,520, P < 0.001). CONCLUSION This nationwide study shows that the total medical cost of PS has increased and that the total medical cost of TS has decreased between 2007 and 2016 in Korea.
Collapse
Affiliation(s)
- Yeo Song Kim
- Department of Neurosurgery, Cheong Ju St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Gyun Kim
- Department of Neurosurgery, Cheong Ju St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeeeun Yi
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Jung Min Choi
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Un Yong Choi
- Department of Neurosurgery, CHA University, CHA Bundang Medical Center, Seongnam, Gyeonggi-do, South Korea
| | - In-Bo Han
- Department of Neurosurgery, CHA University, CHA Bundang Medical Center, Seongnam, Gyeonggi-do, South Korea
| | - Seil Sohn
- Department of Neurosurgery, CHA University, CHA Bundang Medical Center, Seongnam, Gyeonggi-do, South Korea.
| |
Collapse
|
25
|
Liu X, Zheng M, Jiang Z, Wang G, Li T, Sun J, Cui X. Computed tomography imaging characteristics help to differentiate pyogenic spondylitis from brucellar spondylitis. Eur Spine J 2020; 29:1490-8. [PMID: 31754822 DOI: 10.1007/s00586-019-06214-8] [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] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/09/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Both pyogenic spondylitis (PS) and brucellar spondylitis (BS) can cause deformities and permanent neurologic deficits without prompt diagnosis and treatment. However, differential diagnosis is challenging. The aim of this study was to compare the computed tomography (CT) imaging features of PS with those of BS. METHODS Thirty-two patients with PS and 44 with BS were enrolled in the study. CT images were obtained in all cases. Data on bone destruction and formation, vertebral wall destruction, and osteosclerotic changes were collected and compared using the Chi-square test or t test. A P value < 0.01 was considered statistically significant. Positive predictive values (PPV) for detecting PS or BS were reported. RESULTS Involvement of the lumbar vertebrae and multiple spinal levels was more common in the BS group than in the PS group. Bone destruction was significantly greater in the PS group than in the BS group (30.8 vs 18.0%; t = 3.920, P = 0.000), with more extensive destruction of the vertebral body (35.8 vs 12.5%, χ2 = 12.672, P = 0.002, PPV = 63.16%). In the BS group, there was more osteosclerosis around erosions (70.5 vs 43.3%, χ2 = 11.59, P = 0.001, PPV = 67.74%) and fan-shaped osteosclerosis (27.3 vs 19.4%, χ2 = 18.556, P = 0.006, PPV = 64.86%), more bone formation around the vertebra (77.2 vs 34.3%, χ2 = 33.608, P = 0.000, PPV = 76.83%), more bone formation under the anterior longitudinal ligament (63.6 vs 19.4%, χ2 = 30.133, P = 0.000, PPV = 76.09%), more longer anterior bone formation (3.55 vs 0.78 mm, t = 3.997, P = 0.000), and more anterior and closed-bone formation with local erosion (42.0 vs 9.0%, χ2 = 74.243, P = 0.000, PPV = 74.36%). CONCLUSIONS CT images have unique advantages of revealing the morphology of erosions, osteosclerosis, and bone formation around the vertebra and help to differentiate PS from BS. These slides can be retrieved under Electronic Supplementary Material.
Collapse
|
26
|
Miyazaki M, Abe T, Ishihara T, Kanezaki S, Notani N, Kataoka M, Tsumura H. Cervical alignment after single-level anterior cervical corpectomy and fusion using autologous bone graft without spinal instrumentation for cervical pyogenic spondylitis. Eur J Orthop Surg Traumatol 2019; 30:479-484. [PMID: 31707454 DOI: 10.1007/s00590-019-02594-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Subsidence in anterior cervical corpectomy and fusion (ACCF) for cervical degenerative disease (CDD) are constantly observed during the postoperative course. Although kyphotic change of cervical alignment occurred frequently in cervical pyogenic spondylitis (CPS) postoperatively, studies on the postoperative change in segmental angle for CPS are limited. This study aimed to analyze cervical alignment after single-level ACCF using autologous bone graft without spinal instrumentation for CPS compared with that for CDD. METHODS Six patients underwent single-level ACCF using autologous bone graft without spinal instrumentation for CPS. The control group included 18 age-matched patients who underwent single-level ACCF using autologous bone graft for CDD without spinal instrumentation for the same duration. Cervical and lateral plain radiographs and computed tomography scans were taken. The Frankel classification was used to assess the neurological status preoperatively, postoperatively, and at 2-year follow-up for CPS. RESULTS At 2-year follow-up, the average segmental angle at the fusion level was - 12.2° ± 6.9° for CPS and - 5.2° ± 7.6° for CDD (p = 0.04). Changes in segmental angle at the fusion level were - 7.2 ± 9.0° for CPS and - 1.1° ± 7.1° for CDD (p = 0.02). At 2-year follow-up, the average anterior segmental fusion height was 23.4 ± 1.7 mm for CPS and 29.1 ± 5.1 mm for CDD (p < 0.001). At 2-year follow-up, bone fusion in the CPS group was classified as grade 5 (complete fusion) in 4 patients (66.7%) and grade 4 (probable fusion) in 2 (33.3%). In the CDD group, it was grade 5 in 13 patients (72.2%) and grade 4 in 5 patients (27.8%). Overall, both groups achieved 100% bone fusion rate. The Frankel classification in all CPS cases improved or leveled off. CONCLUSION Progression of segmental kyphosis angle and subsidence of graft bone were observed postoperatively on all CPS cases. However, the neurological recovery and bone union were satisfactory.
Collapse
Affiliation(s)
- Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan.
| | - Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Toshinobu Ishihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Naoki Notani
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Masashi Kataoka
- Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| |
Collapse
|
27
|
Iida K, Yoshikane K, Tono O, Tarukado K, Harimaya K. The effectiveness of a percutaneous endoscopic approach in a patient with psoas and epidural abscess accompanied by pyogenic spondylitis: a case report. J Med Case Rep 2019; 13:253. [PMID: 31412911 PMCID: PMC6694662 DOI: 10.1186/s13256-019-2193-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 07/08/2019] [Indexed: 11/25/2022] Open
Abstract
Background Psoas or epidural abscesses are often accompanied by pyogenic spondylitis and require drainage. Posterolateral percutaneous endoscopic techniques are usually used for hernia discectomy, but this approach is also useful in some cases of psoas or lumbar ventral epidural abscess. We here report a case of psoas and epidural abscesses accompanied by pyogenic spondylitis that was successfully treated by percutaneous endoscopic drainage. Case presentation Our patient was a 57-year-old Japanese woman who had been receiving chemotherapy for inflammatory breast cancer and who became unable to walk due to lower back and left leg pain. She was transported as an emergency to another hospital. Magnetic resonance imaging revealed psoas and epidural abscesses accompanied by pyogenic spondylitis, and methicillin-resistant Staphylococcus aureus was detected in a blood culture. Drainage of the psoas abscess was performed under echo guidance, but was not effective, and she was transferred to our institution. We performed percutaneous endoscopic drainage for the psoas and epidural abscesses. Immediate pain relief was achieved and the inflammatory reaction subsided after 8 weeks of antibiotic therapy with daptomycin. Conclusions Percutaneous endoscopy allowed us to approach the psoas and epidural abscesses directly, enabling the immediate drainage of the abscesses with less burden on the patient.
Collapse
Affiliation(s)
- Keiichiro Iida
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, 4546 Tsurumibaru, Beppu, Oita, 874-0838, Japan.
| | - Koichi Yoshikane
- Department of Orthopaedic Surgery, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Osamu Tono
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, 4546 Tsurumibaru, Beppu, Oita, 874-0838, Japan
| | - Kiyoshi Tarukado
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, 4546 Tsurumibaru, Beppu, Oita, 874-0838, Japan
| | - Katsumi Harimaya
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital, 4546 Tsurumibaru, Beppu, Oita, 874-0838, Japan
| |
Collapse
|
28
|
Nakamura D, Kondo R, Makiuchi A, Isobe K. Empyema and pyogenic spondylitis caused by direct Streptococcus gordonii infection after a compression fracture: a case report. Surg Case Rep 2019; 5:52. [PMID: 30945040 PMCID: PMC6447627 DOI: 10.1186/s40792-019-0613-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/26/2019] [Indexed: 12/18/2022] Open
Abstract
Background Empyema and pyogenic spondylitis are common diseases that are often caused by oral pathogens in direct or hematogenous infection. However, there exists no report describing empyema and pyogenic spondylitis caused by oral pathogens after a compression fracture of the vertebral body. Herein, we report a case of empyema and pyogenic spondylitis caused by direct Streptococcus gordonii infection after a compression fracture of the vertebral body. Case presentation A 74-year-old man had back pain while working. At 1 week after experiencing back pain, he underwent periodontal debridement. At 3 weeks after periodontal debridement, he visited our hospital owing to the absence of improvement in back pain. He was admitted on the same day with a diagnosis of compression fracture of the 12th thoracic vertebral body. Magnetic resonance imaging (MRI) revealed a compression fracture of the 12th thoracic vertebral body and a hematoma anterior to the vertebral body. Computed tomography (CT) showed no findings suggestive of infection. After admission, antibiotic therapy was initiated, as the patient developed fever and his blood cultures grew S. gordonii. CT performed after antibiotic therapy revealed a right-sided pleural effusion, and drainage was performed. As the inflammation did not improve after thoracic drainage for empyema, surgical debridement through video-assisted thoracic surgery was performed. Intraoperative pleural effusion cultures also grew S. gordonii. Postoperative MRI showed low T1-weighted signals and high T2-weighted signals in the 12th thoracic vertebral body, and the signals spread to the upper and lower intervertebral disk space; hence, a diagnosis of empyema and pyogenic spondylitis due to direct infection spread was established. Intravenous antibiotic therapy was continued for 6 weeks and then was switched to oral antibiotic treatment. His C-reactive protein level and erythrocyte sedimentation rate gradually decreased and remained within normal limits. Neither empyema nor pyogenic spondylitis had recurred at 12 months after surgery. Conclusions Compression fracture with dental procedures possibly results in the thoracic cavity and spinal infection caused by oral pathogens. We emphasize the importance of early imaging examinations, diagnosis, and appropriate treatment for patients with compression fractures who develop a fever.
Collapse
Affiliation(s)
- Daisuke Nakamura
- Department of Thoracic Surgery, National Hospital Organization Matsumoto Medical Center, 2-20-30 Murai-Machi-Minami, Matsumoto, 399-0021, Japan.
| | - Ryoichi Kondo
- Department of Thoracic Surgery, National Hospital Organization Matsumoto Medical Center, 2-20-30 Murai-Machi-Minami, Matsumoto, 399-0021, Japan
| | - Akiko Makiuchi
- Department of Thoracic Surgery, National Hospital Organization Matsumoto Medical Center, 2-20-30 Murai-Machi-Minami, Matsumoto, 399-0021, Japan
| | - Kenichi Isobe
- Department of Orthopedics, National Hospital Organization Matsumoto Medical Center, 2-20-30 Murai-Machi-Minami, Matsumoto, 399-0021, Japan
| |
Collapse
|
29
|
Nakamura T, Morimoto T, Katsube K, Yamamori Y, Mashino J, Kikuchi K. Clinical characteristics of pyogenic spondylitis and psoas abscess at a tertiary care hospital: a retrospective cohort study. J Orthop Surg Res 2018; 13:302. [PMID: 30486831 PMCID: PMC6264034 DOI: 10.1186/s13018-018-1005-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 11/15/2018] [Indexed: 12/04/2022] Open
Abstract
Background Psoas abscess and pyogenic spondylitis are intractable diseases that require long-term treatment, but the clinical characteristics and causative organisms have not been fully investigated. Herein, we describe the clinical characteristics of these diseases and evaluate the factors associated with in-hospital mortality and the presence of gram-negative rods as causative microorganisms. Methods All patients diagnosed with pyogenic spondylitis or psoas abscesses at a tertiary hospital were included. We retrieved the clinical data (age, sex, outcome, length of hospital stay, disease, bacteria, medication, comorbidities, and treatment status), vital signs (blood pressure, heart rate, and body temperature), and laboratory test results (blood cell count, liver function, renal function, electrolytes, blood sugar, and C-reactive protein) of all patients. The outcomes were in-hospital deaths and positive cultures of gram-negative rods. Results We analyzed 126 patients consisting of 69 (55%) men with a population mean age of 72 years. Seventy-two patients had pyogenic spondylitis and 54 had psoas abscesses. Eleven patients (8.3%) died during admission. The causative bacteria were gram-positive cocci in 63 patients (50%) and gram-negative bacteria in 19 patients (15%). The multivariate logistic model showed that blood urea nitrogen (BUN) (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02–1.06) and cardiovascular diseases (OR 7.02, 95% CI 1.55–31.8) were associated with in-hospital mortality. Platelets less than 150,000/μL (OR 3.14, 95% CI 1.02–9.65) and higher aspartic aminotransferase (OR 1.02, 95% CI 1.00–1.03) were associated with gram-negative rods. Conclusions Patients with suspected psoas abscesses or pyogenic spondylitis having a high BUN level and a history of cardiovascular diseases have a higher risk of mortality.
Collapse
Affiliation(s)
- Tsukasa Nakamura
- Department of Infectious Diseases, Shimane Prefectural Central Hospital, Izumo, Japan.,Clinical Education and Research Center, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Takeshi Morimoto
- Clinical Education and Research Center, Shimane Prefectural Central Hospital, Izumo, Japan. .,Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Kosuke Katsube
- Department of Orthopedics, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Yuji Yamamori
- Department of Emergency Medicine, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Junji Mashino
- Clinical Education and Research Center, Shimane Prefectural Central Hospital, Izumo, Japan.,Department of General Medicine, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Kiyoshi Kikuchi
- Department of Pediatrics, Shimane Prefectural Central Hospital, Izumo, Japan
| |
Collapse
|
30
|
Zhang SC, Li YX, Mo L, Liang D, Yang ZD, Guo DQ, Feng PB, Mo GY, Li DX, Li YW, Tang YC. [Analysis of clinical characteristics of 20 patients with pyogenic spondylitis]. Zhongguo Gu Shang 2016; 29:923-927. [PMID: 29285911 DOI: 10.3969/j.issn.1003-0034.2016.10.010] [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] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the diagnostic value of clinical manifestation, laboratory examination and imaging changes for pyogenic spondylitis and to summarize the clinical characteristics of patients with pyogenic spondylitis. METHODS The clinical data, of 20 patients with pyogenic spondylitis were diagnosed by histopathological examination from March 2012 to March 2015, were retrospectively analyzed. There were 9 males and 11 females, aged from 43 to 72 years old with an average of 58.9 years. Included 3 cases of cervical vertebrae, 7 cases of thoracic vertebrae, 10 cases of lumbar vertebrae. Patients of blood analysis, erythrocyte sedimentation rate(ESR), C reactive protein(CRP), X rays, CT and MRI were performed before treatment. Visual analogue scale (VAS) was used to evaluate the pain of patients suffering from vertebral pain. RESULTS All the patients had suffered from vertebral pain before treatment. VAS was 9 points in 4 cases, 8 points in 6 cases, 7 points in 1 case, 3 points in 6 cases, and 2 points in 3 cases. Among them, 7 patients complicated with neurological symptoms, 11 with aggravating night pain, 10 with fever. WBC and Neutrophil count (NEU) of 5 cases were increased and other 15 cases were normal;CRP of 19 cases were increased and 1 case was normal;ESR of all 20 cases were increased. X rays showed the intervertebral space narrowing in all 20 cases, 13 cases complicated with destruction of vertebral body; CT showed the lesions of vertebral body in the 20 cases and complicated with destruction, sclerosis of sclerotin; MRI showed that the lesions of the vertebral body in the T1 image had uneven medium low signal, in the T2 image of the 16 cases had uneven high signal and 2 cases had uniform and high signal, 2 cases had main high signal compliated with mixed signal. Thirteen patients underwent surgical treatment and 7 patients received conservative treatment, and the patients left hospital while VAS had significantly improved after treatment. CONCLUSIONS Pyogenic spondylitis is easy to be misdiagnosed or missed in clinic. It can be combined with the clinical manifestations, laboratory examination and imaging characteristics in order to make a definite diagnosis for purulent spondylitis in early.
Collapse
Affiliation(s)
| | | | | | - De Liang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510407, Guangdong, China;
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Hiyama Y, Takahashi S, Uehara T, Ichihara K, Hashimoto J, Masumori N. A case of infective endocarditis and pyogenic spondylitis after transrectal ultrasound guided prostate biopsy. J Infect Chemother 2016; 22:767-769. [PMID: 27374863 DOI: 10.1016/j.jiac.2016.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 12/29/2015] [Revised: 04/12/2016] [Accepted: 05/10/2016] [Indexed: 11/17/2022]
Abstract
We report a patient with infective endocarditis and pyrogenic spondylitis occurring simultaneously. The patient was a 59-year-old man. He was suspected of having prostate cancer due to a high prostate-specific antigen concentration noted in a checkup. He then underwent a transrectal ultrasound guided prostate biopsy with cefotiam as antimicrobial prophylaxis. He had a fever higher than 38 °C and lumbar pain for a few days after the biopsy. Enterococcus faecalis was isolated from 2 sets of blood culture. Magnetic resonance imaging revealed an abnormal image at C7/Th1 with a signal decrease in T1-weighted sequences and signal increase in T2-weighted sequences that were suspected to be due to bone destruction. Therefore, he was diagnosed as having pyogenic spondylitis by an orthopedist. At the same time, he complained of palpitation and a heart murmur was detected. Then transesophageal echocardiography was performed by a cardiologist and it revealed vegetation in his left ventricle and aortic regurgitation, and finally acute cardiac insufficiency was determined. He was treated with tazobactam/piperacillin and aortic valve displacement surgery. Based on the results of the prostate biopsy and image inspection, he was diagnosed as having localized prostate cancer. He was treated by androgen deprivation therapy and external beam radiation therapy. We have to keep in mind that E. faecalis can be a potential pathogen for severe infectious complications after prostate biopsy, especially if a cephalosporin is selected for antimicrobial prophylaxis.
Collapse
Affiliation(s)
- Yoshiki Hiyama
- Department of Urology, Sapporo Medical University School of Medicine, Japan.
| | - Satoshi Takahashi
- Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Japan
| | | | - Koji Ichihara
- Department of Urology, Sapporo Medical University School of Medicine, Japan
| | | | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Japan
| |
Collapse
|
32
|
Matsuo M, Rikimaru F, Higaki Y, Masuda M. A case of hypopharyngeal cancer with stenosis, perforation, and pyogenic spondylitis development after chemoradiotherapy. Int J Surg Case Rep 2016; 20:104-8. [PMID: 26829460 PMCID: PMC4818307 DOI: 10.1016/j.ijscr.2016.01.020] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/12/2016] [Accepted: 01/16/2016] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Chemoradiotherapy plays an important role in preserving function and morphology in head and neck cancer. However, in a few cases, chemoradiotherapy has been shown to result in late complications, such as hypopharyngeal perforation, which is very rare. PRESENTATION OF CASE A 65-year-old man, who had undergone chemoradiotherapy for hypopharyngeal cancer 30 months previously, presented with high fever and neck pain. He subsequently developed hypopharyngeal stenosis, hypopharyngeal perforation, and a retropharyngeal abscess followed by pyogenic spondylitis. He underwent surgical treatment (resection with reconstruction) and was administered an antibacterial agent and steroids for an extended period. This treatment regimen was successful, and the patient has survived disease-free without symptoms. DISCUSSION Chemoradiotherapy-induced hypopharyngeal perforation is an extremely rare condition. In the present case, the perforation was large (2cm), and the hypopharyngeal cavity was originally constricted. Pharyngeal reconstruction with a jejunal autograft was therefore necessary. Through the present case, we reconfirmed that although the primary purpose of chemoradiotherapy is organ preservation, it can also lead to organ destruction and fatal complications. It is important that physicians be aware of the possibility of hypopharyngeal perforation so as to avoid delayed diagnosis and treatment of similar rare cases. CONCLUSION Hypopharyngeal perforation can sometimes be fatal because it can lead to pyogenic spondylitis. Suitable surgical techniques and appropriate doses of antibacterial agents for long-term use were appropriate treatments for the patient in this case.
Collapse
Affiliation(s)
- Mioko Matsuo
- Department of Head and Neck Surgery, Japan Community Health Care Organization Kyushu Hospital, Kitakyushu City, Japan.
| | - Fumihide Rikimaru
- Department of Head and Neck Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka City, Japan.
| | - Yuichiro Higaki
- Department of Head and Neck Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka City, Japan.
| | - Muneyuki Masuda
- Department of Head and Neck Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka City, Japan.
| |
Collapse
|
33
|
Shinohara A, Ueno Y, Marumo K. Weekly teriparatide therapy rapidly accelerates bone healing in pyogenic spondylitis with severe osteoporosis. Asian Spine J 2014; 8:498-501. [PMID: 25187868 DOI: 10.4184/asj.2014.8.4.498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 08/23/2013] [Revised: 11/06/2013] [Accepted: 11/13/2013] [Indexed: 11/24/2022] Open
Abstract
Pyogenic spondylitis is a frequently observed disease in orthopedics, and the number of cases is increasing. Some patients with pyogenic spondylitis suffer from vertebral destruction due to infection. The disease is typically treated with antibiotics, bed rest, spinal support, and lesion curettage; however, vigorous drug therapy against vertebral body destruction by pyogenic spondylitis has not been attempted. In this report, a case of pyogenic spondylitis with spinal destruction caused by infection and treated with once-weekly teriparatide administration is presented. Vertebral body erosion in cortical and cancellous areas by the infection was rapidly repaired after 6 weeks of once-weekly teriparatide treatment. Treatment with once-weekly teriparatide appears to be a new strategy for patients with severe osteoporosis suffering from pyogenic spondylitis.
Collapse
|
34
|
Abstract
Pyogenic spondylitis and tuberculous spondylitis are common causes of spinal infection. It is difficult to differentiate tuberculous spondylitis and pyogenic spondylitis clinically and radiologically. Recently magnetic resonance imaging has been reported to be beneficial for early diagnosis and differential diagnosis of the spondylitis, and is being used extensively for diagnosis. However, the diagnosis must be considered in combination with corresponding changes in clinical manifestations, radiological findings, blood and tissue cultures and histopathological findings. Conservative treatments, including antimicrobial medications, are started initially. Surgical treatments, which include anterior or posterior approach, single-stage or two-stage surgery, with or without instrumentation, may be performed as indicated.
Collapse
|
35
|
Morii K, Kashihara A, Miura S, Okuhin H, Watanabe T, Sato S, Uesaka K, Yuasa S. Successful hepatectomy for intraperitoneal rupture of pyogenic liver abscess caused by Klebsiella pneumoniae. Clin J Gastroenterol 2012; 5:136-40. [PMID: 26182157 DOI: 10.1007/s12328-012-0293-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 02/29/2012] [Indexed: 12/07/2022]
Abstract
Klebsiella pneumoniae (KP) is the most common cause of pyogenic liver abscess in eastern Asia. KP liver abscess commonly presents as a single large abscess with a predominantly solid consistency. It is sometimes unsuitable for percutaneous catheter drainage because of the poorly liquefied contents. Antibiotic therapy alone may raise a probability of treatment failure and occurrence of complications such as abscess rupture. Hepatic or portal venous thrombosis, hematogenous spread, and spontaneous rupture also occur frequently. We report a case of KP liver abscess with a typical solid appearance, complicated by disseminated intravascular coagulation, spontaneous rupture, and pyogenic spondylitis.
Collapse
|
36
|
Heo W, Kang DH, Park KB, Hwang SH, Park IS, Han JW. Is titanium mesh cage safe in surgical management of pyogenic spondylitis? J Korean Neurosurg Soc 2011; 50:357-62. [PMID: 22200019 DOI: 10.3340/jkns.2011.50.4.357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 08/23/2011] [Accepted: 10/17/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To report our experience with pyogenic spondylitis treated with anterior radical debridement and insertion of a titanium mesh cage and to demonstrate the effectiveness and safety of the use of a titanium mesh cage in the surgical management of pyogenic spondylitis. METHODS We retrospectively analyzed the clinical characteristics of 19 patients who underwent surgical treatment in our department between January 2004 and December 2008. The average follow-up period was 11.16 months (range, 6-64 months). We evaluated risk factors, cultured organisms, lab data, clinical outcomes, and radiographic results. Surgical techniques for patients with pyogenic spondylitis were anterior radical debridement and reconstruction with titanium mesh cage insertion and screw fixation. All patients received intravenous antibiotics for at least 6 weeks postoperatively, and some patients received oral antibiotics. RESULTS The infections resolved in all of the patients as noted by normalization of their erythrocyte sedimentation rates and C-reactive protein levels. The mean pain score on a Visual Analog Scale was 7.8 (range, 4-10) before surgery and 2.4 (range, 1-5) after surgery. The Frankel grade was improved by one grade in seven patients. After surgery, the average difference of the angle was improved about 6.96° in all patients. At the last follow-up, the mean loss of correction was 4.86°. CONCLUSION Anterior radical debridement followed by the placement of instrumentation with a titanium mesh cage may be a safe and effective treatment for selected patients with pyogenic spondylitis. This surgical therapy does not lead to recurrent pyogenic spondylitis.
Collapse
Affiliation(s)
- Won Heo
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | | | | | | | | | | |
Collapse
|
37
|
Kim YM, Cha JH. Delayed diagnosis of tuberculous spondylitis masked by concomitant methicillin resistant Staphylococcus aureus infection. J Korean Neurosurg Soc 2010; 47:235-8. [PMID: 20379481 DOI: 10.3340/jkns.2010.47.3.235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 08/29/2009] [Accepted: 01/12/2010] [Indexed: 12/22/2022] Open
Abstract
We present a case of tuberculous spondylitis in which diagnosis was masked by a concomitant pyogenic infection. The patient had undergone percutaneous needle aspiration of an abscess in the cavity of the psoas muscle. Early results from the culture regimen showed isolation of methicillin-resistant Staphylococcus aureus. After eight weeks, mycobacterium tuberculosis was grown at regimen which was cultured at the same site. Initial isolation of pyogenic bacteria, considered to be highly virulent organisms, led to delayed diagnosis and treatment of the tuberculosis.
Collapse
Affiliation(s)
- Yong Min Kim
- Department of Neurosurgery, Maryknoll Medical Center, Busan, Korea
| | | |
Collapse
|
38
|
Abstract
Vertebroplasty is now extensively used worldwide for thoracic and lumbar osteoporotic compression fractures. Although percutaneous vertebroplasty is considered a minimally invasive procedure, it may result in several complications. In this report, we present two patients where pyogenic spondylitis developed after vertebroplasty surgery was required. The serious nature of these infections, surgical management and complication avoidance are discussed.
Collapse
|
39
|
Abstract
Study Design A retrospective study. Purpose This is a study of the diagnosis and treatment of tuberculous spondylitis and pyogenic spondylitis in atypical cases. Overview of Literature There have been several reports about clinical, hematological, pathological and radiological findings to differentiate pyogenic & tuberculous spondylitis. Methods We screened 55 patients diagnosed with tuberculous spondylitis and pyogenic spondylitis from January 1999 to June 2003. There were seven cases where it was difficult to make an accurate diagnosis. We reviewed the clinical manifestation, laboratory tests, radiological findings and confirmed the diagnoses by the use of biopsies and/or clinical response to treatment. Results Four cases, which were initially diagnosed as pyogenic spondylitis, had a clinical presentation of fever (37.4~38.5℃) on the day of hospitalization. These cases later turned out to be tuberculous spondylitis, as confirmed by an open biopsy and pathologic study. Three cases initially diagnosed as pyogenic spondylitis were treated with broad-spectrum antibiotics. Symptoms were aggravated in these cases, but improved after the use of an anti-tubercular drug. Bony union was observed in all cases in an averageof 4 months (range, 3~6 months). Conclusions In infectious spondylitis, it is important to establish an accurate diagnosis. An accurate diagnosis can be made by laboratory findings and by estimation of the response to treatment during follow-up. If there is no response or aggravation of symptoms despite treatment based on an initial diagnosis, the etiologic organism must be re-evaluated. A biopsy and observation of clinical response are needed to confirm the diagnosis.
Collapse
|
40
|
Abstract
STUDY DESIGN A retrospective study. PURPOSE We evaluated the results of the use of anterior debridement and interbody fusion followed by posterior spinal instrumentation. OVERVIEW OF LITERATURE An early diagnosis of pyogenic spondylitis is difficult to obtain. The disease can be treated with various surgical methods (such as anterior debridement and bone graft, anterior instrumentation, and posterior instrumentation). METHODS This study included 20 patients who received anterior debridement and interbody fusion with strut bone graft followed by posterior spinal fusion for pyogenic spondylitis between 1996 and 2005. We analyzed the culture studies, the correction of the kyphotic angle, blood chemistry, the bony union period, and the amount of symptom relief. RESULTS In terms of clinical symptoms relief, eight patients were grouped as "excellent", eleven patients as "good", and one patient as "fair". The vertebral body cultures were positive in 14 patients showing coagulase (-) streptococcus and S. aureus. The average times for normalization of the erythrocyte sedimentation rate and C-reactive protein level were 3.3 and 1.9 months, respectively. Four months was required for bony union. For complications, meralgia paresthetica was found in two cases. CONCLUSIONS Due to early ambulation and the correction of the kyphotic angle, anterior interbody fusion with strut bone graft and posterior instrumentation could be another favorable method for the treatment of pyogenic spondyulitis.
Collapse
|