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Dong S, Lin Q, Dai X, Lin Z. An immunocompetent host with blood-disseminated Aspergillus versicolor spondylitis: a case report and literature review. J Int Med Res 2024; 52:3000605241234574. [PMID: 38597095 PMCID: PMC11010765 DOI: 10.1177/03000605241234574] [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: 10/29/2023] [Accepted: 02/01/2024] [Indexed: 04/11/2024] Open
Abstract
Blood-disseminated Aspergillus spondylitis in immunocompetent individuals is rare. The clinical, imaging, and pathological manifestations of this condition are not specific. Therefore, this disease is prone to misdiagnosis and a missed diagnosis. Systemic antifungal therapy is the main treatment for Aspergillus spondylitis. We report a case of blood-disseminated Aspergillus versicolor spondylitis in a patient with normal immune function. The first antifungal treatment lasted for 4 months, but Aspergillus spondylitis recurred a few months later. A second antifungal treatment course was initiated for at least 1 year, and follow-up has been ongoing. Currently, there has been no recurrence.
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Affiliation(s)
- Shuangxia Dong
- Department of Respiratory, The Wenzhou Central Hospital and Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Qianding Lin
- Department of Respiratory, The Wenzhou Central Hospital and Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xinjian Dai
- Department of Respiratory, The Wenzhou Central Hospital and Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zhou Lin
- Department of Orthopaedic Surgery, The Wenzhou Central Hospital and Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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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.
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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.
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Wang J, Li Z, Chi X, Chen Y, Wang H, Wang X, Cui K, Wang Q, Lu T, Zheng J, Zhang Q, Hao Y. Development of a Diagnostic Model for Differentiating Tuberculous Spondylitis and Pyogenic Spondylitis With MRI: A Multicenter Retrospective Observational Study. Spine (Phila Pa 1976) 2024; 49:34-45. [PMID: 37796171 PMCID: PMC10702692 DOI: 10.1097/brs.0000000000004848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/02/2023] [Indexed: 10/06/2023]
Abstract
STUDY DESIGN Multicenter retrospective observational study. OBJECTIVE This study aimed to distinguish tuberculous spondylitis (TS) from pyogenic spondylitis (PS) using magnetic resonance imaging (MRI). Further, a novel diagnostic model for differential diagnosis was developed. SUMMARY OF BACKGROUND DATA TS and PS are the two most common spinal infections. Distinguishing between these types clinically is challenging. Delayed diagnosis can lead to deficits or kyphosis. Currently, there is a lack of radiology-based diagnostic models for TS and PS. METHODS We obtained radiologic images from MRI imaging of patients with TS and PS and applied the least absolute shrinkage and selection operator regression to select the optimal features for a predictive model. Predictive models were built using multiple logistic regression analysis. Clinical utility was determined using decision curve analysis, and internal validation was performed using bootstrap resampling. RESULTS A total of 201 patients with TS (n=105) or PS (n=96) were enrolled. We identified significant differences in MRI features between both groups. We found that noncontiguous multivertebral and single-vertebral body involvement were common in TS and PS, respectively. Vertebral bone lesions were more severe in the TS group than in the PS group (Z=-4.553, P <0.001). The patients in the TS group were also more prone to vertebral intraosseous, epidural, and paraspinal abscesses ( P <0.001). A total of 8 predictors were included in the diagnostic model. Analysis of the calibration curve and area under the receiver operating characteristic curve suggested that the model was well-calibrated with high prediction accuracy. CONCLUSIONS This is the largest study comparing MRI features in TS and PS and the first to develop an MRI-based nomogram, which may help clinicians distinguish between TS and PS.
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Affiliation(s)
- Jin Wang
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhaoxin Li
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiansu Chi
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yungang Chen
- Department of Spinal Orthopedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Huaxin Wang
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | | | - Kaiying Cui
- Department of Spinal Orthopedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Qing Wang
- Department of Orthopedics, Shandong Public Health Clinical Center Affiliated to Shandong University, Jinan, China
| | - Tongxin Lu
- Department of Orthopedics, Shandong Public Health Clinical Center Affiliated to Shandong University, Jinan, China
| | - Jianhu Zheng
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Qiang Zhang
- Department of Orthopedics, Shandong Public Health Clinical Center Affiliated to Shandong University, Jinan, China
| | - Yanke Hao
- Department of Spinal Orthopedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Li Y, Fei L, Shi J. Efficacy of posterior fixation and bone graft fusion for treatment of lumbar brucellosis spondylitis. Medicine (Baltimore) 2023; 102:e36577. [PMID: 38115351 PMCID: PMC10727668 DOI: 10.1097/md.0000000000036577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
The purpose of this study is to verify whether early stage patients with single-segment lumbar Brucella spondylitis can still be cured through simple posterior fixation and bone grafting, even without debridement. A retrospective study was conducted on 63 patients diagnosed with single-segment lumbar brucellosis spondylitis, who underwent posterior-only debridement (or not), bone grafting, and instrumentation from June 2016 to June 2019. Group A comprised 34 patients who did not undergo debridement, while group B comprised 29 patients who underwent debridement. The clinical data and imaging results of the patients were compared between the 2 groups to evaluate the clinical effects of debridement or not. Both groups of patients completed at least 1 year of follow-up. The group A had significantly lower values for operation time, blood loss, and hospital stay compared to the group B (P < .05). There were no significant differences between the 2 groups in terms of erythrocyte sedimentation rate, C-reactive protein, visual analogue scores, improvement of Japanese Orthopaedic Association Evaluation of treatment score, and Cobb angle. The bone fusion rate was 92% (31 patients) in group A and 96% (28 patients) in group B, with no significant difference between the 2 groups (P > .05). In summary, these findings suggest that posterior fixation and bone graft fusion are effective treatments for single-segment lumbar brucellosis spondylitis in early stages even without debridement. Importantly, these procedures offer several benefits, such as minimal trauma, short operation times, rapid postoperative recovery, and favorable bone graft fusion outcomes.
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Affiliation(s)
- Yu Li
- Ningxia Medical University, Yinchuan, Ningxia, China
| | - Le Fei
- Ningxia Medical University, Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jiandang Shi
- Ningxia Medical University, Department of Spine Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
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5
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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.
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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
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Kitajima H, Hatano E, Kawaguchi M, Sakamoto T, Ichiseki T, Kaneuji A, Kawahara N. Septic Arthritis of Cervical Spine Facet Joints: A Case Report and Review of Imaging. Am J Case Rep 2023; 24:e941578. [PMID: 37817401 PMCID: PMC10581355 DOI: 10.12659/ajcr.941578] [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: 06/26/2023] [Revised: 08/24/2023] [Accepted: 08/03/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Septic arthritis of the facet joint (SAFJ) has been considered a rare type of spinal infection. However, because of the aging of the population, the increase in compromised hosts, and the increase in MRI use in recent years, the number of reports has been increasing. We report the clinical progress of a rare case of septic arthritis of the cervical facet joint (SACFJ) with some imaging considerations, and we compare our findings with existing reports of SACFJ. CASE REPORT A 73-year-old Japanese woman presented with fever, paralytic symptoms, and paresthesia of the upper limbs. Here, we report a case of SACFJ in which MRI findings allowed early diagnosis, and a favorable course was obtained by conservative treatment with antibiotics. Although MRI performed 93 days after the initiation of treatment showed a slight residual signal change in the facet joints, no symptoms had recurred by the sixth month after hospital discharge. CONCLUSIONS If a patient develops neurological symptoms such as paralysis with fever and increased inflammatory response, the physician must consider the possibility of pyogenic spondylitis, including SACFJ, and order an MRI. Epidural abscess is almost inevitable in SACFJ, and surgical treatment, including abscess drainage, is required if spinal cord or paralytic symptoms progress. For patients with SACFJ, as well as pyogenic spondylitis, MRI may not be useful in determining treatment efficacy.
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Affiliation(s)
- Hironori Kitajima
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Eiju Hatano
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Masahito Kawaguchi
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Takuya Sakamoto
- Medical Research Institute, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Toru Ichiseki
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Ayumi Kaneuji
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Norio Kawahara
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
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Liu L, He L, Long G, He M. A rare case of aggressive pyogenic spondylitis with giant abscesses after vertebral augmentation. Jt Dis Relat Surg 2023; 34:731-736. [PMID: 37750280 PMCID: PMC10546850 DOI: 10.52312/jdrs.2023.1182] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/23/2023] [Indexed: 09/27/2023] Open
Abstract
Although Streptococcus constellatus (SC), an opportunistic pathogen, can cause abscesses and empyema. The SC infection after vertebral augmentation (VA) can interfere with patients' daily living activities and can be life-threatening in severe cases. A 67-year-old male complained of lumbar pain for two months. The patient underwent percutaneous vertebroplasty of the second and third lumbar vertebrae two months ago. On admission, laboratory and imaging evidence suggested infection of the second and third lumbar vertebrae with bilateral psoas major and left lumbodorsal abscesses. After three weeks of empirical anti-infective therapy, abscess removal and the second and third lumbar vertebrae fusion with iliac bone graft were performed under general anesthesia. Intraoperative pathology and next-generation sequencing (NGS) examination of the pus suggested SC infection, and oral linezolid was given for 12 weeks after surgery. The infection was eventually cured and the patient achieved satisfactory function. In conclusion, pyogenic spondylitis due to SC infection after VA is a life-threatening complication. In addition to infectious disease consultation and routine etiological screening, NGS is important to identify infection with unknown pathogens. Surgery combined with sensitive antibiotics is appropriate for patients with progressive neurological deficits.
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Affiliation(s)
| | | | | | - Min He
- Department of Orthopeadic Surgery, The Public Health Clinical Center of Chengdu No. 377, Jingming Road, Jinjiang District, Chengdu, 610061 China.
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Wang Y, Chen C, Peng L, Wang P. Fluoroscopy guided transpedicular abscess infusion and drainage in thoracic-lumbar spondylitis with prevertebral abscess. Int Orthop 2023; 47:2295-2300. [PMID: 37335315 DOI: 10.1007/s00264-023-05866-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE To evaluate the effectiveness of fluoroscopy guided transpedicular abscess infusion and drainage in thoracic-lumbar spondylitis with prevertebral abscess. METHODS We retrospectively reviewed 14 patients with infectious spondylitis with prevertebral abscesses from January 2019 to December 2022. All patients underwent fluoroscopy guided transpedicular abscess infusion and drainage. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analog scale (VAS), Macnab criteria, and magnetic resonance imaging (MRI) were compared before and after the operation to evaluate clinical outcomes. RESULTS Among the 14 patients with prevertebral abscesses, 64.29% (9/14) involved the lumbar spine and 35.71% (5/14) involved the thoracic spine. The ESR, CRP, and VAS scores decreased from 87.34 ± 9.21, 93.01 ± 11.17, and 8.38 ± 0.97 preoperatively to 12.35 ± 1.61, 8.52 ± 1.19, and 2.02 ± 0.64 at the final follow-up, respectively. MRI at the final follow-up showed the disappearance of the prevertebral abscess compared with that in the preoperative group (66.95 ± 12.63 mm in diameter). Ten patients achieved an "excellent" outcome, while the remaining four patients obtained a "good" outcome according to the Macnab criteria. CONCLUSION Fluoroscopy guided transpedicular abscess infusion and drainage is a safe and minimally invasive procedure for the management of thoracic-lumbar spondylitis with a prevertebral abscess.
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Affiliation(s)
- Yuanhao Wang
- Department of Spine Surgery, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, China
| | - Cong Chen
- Department of Spine Surgery, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, China
| | - Lei Peng
- Department of Spine Surgery, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, China
| | - Peng Wang
- Department of Spine Surgery, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, China.
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Lim KR, Son JS, Moon SY. The First Case of Infectious Spondylitis Caused by Gemella bergeri. Medicina (B Aires) 2023; 59:medicina59010145. [PMID: 36676769 PMCID: PMC9862655 DOI: 10.3390/medicina59010145] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
Gemella bergeri, a member of the genus Gemella, is a facultatively anaerobic, Gram-positive cocci. G. bergeri is a component of normal oral flora; however, it can become pathogenic and cause infections in patients with poor oral hygiene. A 78-year-old man was admitted to a hospital with a complaint of increasing posterior neck pain and lower back pain for 2 weeks. MRI was suggestive of infectious spondylitis at the C3-C4 level with prevertebral abscess formation, anterior epidural abscess formation. We identified Gemella bergeri in closed pus obtained during the surgery. Herein, we describe the first case of infective spondylitis caused by G. bergeri.
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Jung KY, Chung H. Infectious aortitis from pyogenic spondylitis and psoas abscess: Case report. ULUS TRAVMA ACIL CER 2022; 28:1016-1019. [PMID: 35775686 PMCID: PMC10493834 DOI: 10.14744/tjtes.2022.12925] [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: 03/24/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
Infectious aortitis has various causes, presents mainly with an aneurysm, and is fatal without surgical intervention. This case report describes an 89-year-old woman who developed fever and back pain which initially diagnosed infectious aortitis confirmed through contrast-enhanced computed tomography (CT). Pyogenic spondylitis and psoas abscess, which were not visible through CT at admis-sion, were identified as the cause of infectious aortitis confirmed through positron emission tomography (PET). After percutaneous drainage and intravenous antibiotics, the patient was discharged in good condition and without surgical intervention. This case report emphasizes the critical role of PET in identifying the cause of infectious aortitis and demonstrates the effectiveness of successive treat-ment with antibiotics and timely radiologic intervention.
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Affiliation(s)
- Kwang Yul Jung
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul-Republic of Korea
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul-Republic of Korea
| | - Hosub Chung
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul-Republic of Korea
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Li T, Yu Q, Wang XY, Wu C. A rare case of multi-level Brucella spondylitis combined with incomplete paralysis. Asian J Surg 2022; 45:2349-2350. [PMID: 35610149 DOI: 10.1016/j.asjsur.2022.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Tao Li
- Orthopaedics Center, Zigong Fourth People's Hospital, Sichuan Province, China
| | - Qin Yu
- Department of Pathology, The First People's Hospital of Zigong, Sichuan Province, China
| | - Xiang-Yu Wang
- Orthopaedics Center, Zigong Fourth People's Hospital, Sichuan Province, China
| | - Chao Wu
- Orthopaedics Center, Zigong Fourth People's Hospital, Sichuan Province, China.
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12
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Fujimoto K, Hosomi S, Nakata R, Sugita N, Nishida Y, Fukunaga S, Nadatani Y, Otani K, Tanaka F, Kamata N, Nagami Y, Taira K, Watanabe T, Fujiwara Y. Pyogenic Spondylitis Caused by Staphylococcus schleiferi in a Patient with Crohn's Disease. Intern Med 2022; 61:577-580. [PMID: 34393163 PMCID: PMC8907770 DOI: 10.2169/internalmedicine.7368-21] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Staphylococcus schleiferi has rarely been reported to cause pyogenic spondylitis. A 42-year-old man had been treated for Crohn's disease with immunosuppressive agents and home parenteral nutrition via a central vein (CV) port. The patient was admitted to our hospital, presenting with neck pain and a fever. A neurological examination showed slight weakness in his left-hand muscles, and he was diagnosed with pyogenic spondylitis of C6 and C7 vertebral bodies due to catheter-related blood stream infection caused by S. schleiferi. An early diagnosis by magnetic resonance imaging, CV port removal and antibiotic therapy targeting S. schleiferi improved his symptoms.
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Affiliation(s)
- Koji Fujimoto
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Shuhei Hosomi
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Rieko Nakata
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Naoko Sugita
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Yu Nishida
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Shusei Fukunaga
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Yuji Nadatani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Koji Otani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Fumio Tanaka
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Noriko Kamata
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Koichi Taira
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Toshio Watanabe
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
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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.
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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
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Karakida K, Uchibori M, Nakanishi Y, Tamura M, Takahashi M, Hoshimoto Y, Hamada Y, Aoki J. Pyogenic Spondylitis with Rapid Bone Destruction After Chemoradiotherapy for Tongue Cancer: A Case Report and Literature Review. Tokai J Exp Clin Med 2020; 45:182-188. [PMID: 33300588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/27/2020] [Indexed: 06/12/2023]
Abstract
Radiation therapy is a frequently used effective treatment for head and neck cancer. It has several adverse effects of which osteomyelitis is a late complication of radiotherapy. Although uncommon, when it occurs in the vertebral body, it results in pyogenic spondylitis, which can be fatal. We report a case of pyogenic spondylitis, observed 2 years and 5 months after chemoradiotherapy following surgery for the treatment of tongue cancer. The initial symptoms were fever and posterior cervical pain. Initial CT images showed no abnormality in the cervical spine. However, when CT and MRI were followed over time, bone destruction and abscess formation were observed at the C3 and C4 vertebral endplates. Hence, CT-guided puncture d rainage was performed from the anterior neck. The collected pus was d iagnosed as Class II pyogenic spondylitis by cytology and the culture test revealed the presence of Streptococcus agalactiae. The infection was successfully treated by drainage and antibacterial chemotherapy.
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Affiliation(s)
- Kazunari Karakida
- Department of Oral and Maxillofacial Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032 Japan.
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15
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Wang ZH, Wen J, Qian ZB, Yang Y, Wang H, Xue W, Wang ZP, Liu L. [Streptococcal suppurative spondylitis with submandibular gland abscess:a case report]. Zhongguo Gu Shang 2020; 33:859-861. [PMID: 32959575 DOI: 10.12200/j.issn.1003-0034.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Zhong-Hua Wang
- People's Hospital of Gansu Province, Lanzhou 730000, Gansu, China
| | - Jie Wen
- People's Hospital of Gansu Province, Lanzhou 730000, Gansu, China
| | - Zi-Bin Qian
- People's Hospital of Gansu Province, Lanzhou 730000, Gansu, China
| | - Yang Yang
- People's Hospital of Gansu Province, Lanzhou 730000, Gansu, China
| | - He Wang
- People's Hospital of Gansu Province, Lanzhou 730000, Gansu, China
| | - Wen Xue
- People's Hospital of Gansu Province, Lanzhou 730000, Gansu, China
| | - Zeng-Ping Wang
- People's Hospital of Gansu Province, Lanzhou 730000, Gansu, China
| | - Lin Liu
- People's Hospital of Gansu Province, Lanzhou 730000, Gansu, China
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Hadgaonkar S, Rathi P, Shyam A, Sancheti P, Kawedia M, Rajasekaran RB. Non-contiguous extensive multifocal spinal tuberculosis- treating uncommon scenarios. Indian J Tuberc 2020; 67:438-443. [PMID: 32825890 DOI: 10.1016/j.ijtb.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/10/2020] [Indexed: 06/11/2023]
Abstract
Noncontiguous multiple tuberculous spondylitis is not uncommon, and most of the reported cases have lesions only on 2 or 3 levels. To the best of our knowledge, multifocal extensive spinal TB involving the whole spine is rarely reported in the literature, which may be presented as asymptomatic and have a higher incidence of neurological complications. It is noticeable that the possibility of TB is considered for any skip lesions involving the spine cautiously. Diagnosis and treatment at early stages would resolve the neurological deficits without operation.
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Affiliation(s)
- Shailesh Hadgaonkar
- Department of Spine, Sancheti Institute of Orthopedics and Rehabilitation, Pune, Maharashtra, India
| | - Pradhyumn Rathi
- Department of Spine, Sancheti Institute of Orthopedics and Rehabilitation, Pune, Maharashtra, India.
| | - Ashok Shyam
- Department of Spine, Sancheti Institute of Orthopedics and Rehabilitation, Pune, Maharashtra, India
| | - Parag Sancheti
- Sancheti Institute of Orthopedics and Rehabilitation, Pune, Maharashtra, India
| | - Mahendra Kawedia
- Sancheti Institute of Orthopedics and Rehabilitation, Pune, Maharashtra, India
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17
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Wu P, Zhang YJ, Guo HB, Zhu YX, Cui SJ. [Values of Apparent Diffusion Coefficient and Fractional Anisotropy in the Diagnosis of Brucella Spondylitis]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2020; 42:154-163. [PMID: 32385020 DOI: 10.3881/j.issn.1000-503x.11300] [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: 06/11/2023]
Abstract
Objective To compare the differences in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) between brucella spondylitis (BS) groups at different stages before treatment and the normal control group and to evaluate the change trend of ADC value and FA value at different time points before and after treatment. Methods Totally 53 patients suspected of BS by conventional magnetic resonance imaging (MRI) and later confirmed as BS patients by serological tests were enrolled in this study. These patients underwent conventional MRI and diffusion tensor imaging scans,and the ADC value and FA value were measured. Independent sample t test was used to compare the ADC value and FA value between the BS group and the control group,the ADC value and FA value between the BS group at each stage. Repeated measurement ANOV was used to compare the ADC values and FA values at different time points before and after treatment. Results FA imaging showed that the color code of BS was different from that of the normal control group,and the color code of FA imaging showed increased singal. The ADC values of BS in the acute,subacute,and chronic stages [(1.45±0.02)×10 -3 mm 2/s,(1.35±0.03)×10 -3 mm 2/s,(1.26±0.05)×10 -3 mm 2/s,respectively] were significantly higher than those in the control group [(1.06±0.09) ×10 -3 mm 2/s](t=2.538,P=0.009;t=1.998,P=0.032;t=1.575,P=0.004),and the FA value (0.55±0.02,0.65±0.03,0.71±0.04,respectively) were significantly lower than those of the control group (0.78±0.02) (t=2.440,P=0.012; t=1.847,P=0.041;t=2.102,P=0.003). Repeated measurement analysis showed that there were statistically significant differences in ADC values and FA values at different time points before and after treatment in the acute,subacute,and chronic stages (ADC:F=12.100,P<0.001;F=8.439,P=0.005;F=9.704,P=0.004,respectively;FA:F=7.080,P=0.002;F=6.607;P=0.003;F=8.868,P=0.001,respectively). The ADC values at different time points after treatment were significantly lower than those before treatment or at a previous time point after treatment (F=332.14,P<0.001),and the FA values were significantly higher than those before treatment or at a previous time point after treatment (F=134.26,P<0.001). Conclusions FA color code can intuitively display differences in BS and normal vertebral bodies and show change of color code before and after treatment. Also,the ADC values and FA values can quantitatively reveal differences between BS and normal vertebral body in different time points and quantify BS vertebral lesion changes before and after treatment. In particular,in BS patients who are recovering from treatment,it can quantify microscopic edema. Therefore,diffusion tensor imaging may be useful objective indicator in evaluating the effectiveness of a specific treatment for BS.
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Affiliation(s)
- Peng Wu
- Department of Imaging,the First Hospital Affiliated to Hebei North University,Zhangjiakou,Hebei 075000,China
| | - Yu-Jiao Zhang
- Department of Imaging,the First Hospital Affiliated to Hebei North University,Zhangjiakou,Hebei 075000,China
| | - Hong-Bing Guo
- Department of Imaging,the First Hospital Affiliated to Hebei North University,Zhangjiakou,Hebei 075000,China
| | - Yue-Xiang Zhu
- Department of Imaging,the First Hospital Affiliated to Hebei North University,Zhangjiakou,Hebei 075000,China
| | - Shu-Jun Cui
- Department of Imaging,the First Hospital Affiliated to Hebei North University,Zhangjiakou,Hebei 075000,China
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Nagata K, Ando T, Nakamoto H, Kato S, Sasaki K, Oshima Y. Adaptation and limitation of anterior column reconstruction for pyogenic spondylitis in lower thoracic and lumbar spine. J Orthop Sci 2019; 24:219-223. [PMID: 30318425 DOI: 10.1016/j.jos.2018.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/12/2018] [Accepted: 09/10/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Surgical strategy for pyogenic spondylitis is controversial when vertebral body erosion is severe. Radical debridement and anterior column reconstruction is indicated for the purpose of early ambulatory to prevent secondary complication for long bed rest. However, such aggressive debridement and risk of perioperative complications are trade-off. The purpose of this study was to evaluate the risk factor of poor prognosis after anterior column debridement and reconstruction for pyogenic spondylitis in lower thoracic and lumbar spine. METHODS We performed a retrospective review of 40 patients diagnosed with pyogenic spondylitis in lower thoracic and lumbar spine who were introduced to our institution due to losing ambulatory ability and underwent anterior column debridement and reconstruction between January 2008 and May 2016. After the patient population was split into a regaining ambulatory group (Group A; n = 23) and a poor prognosis group (Group P; n = 17), we used Fisher exact tests and t-tests as appropriate for univariate analyses to compare patient characteristics and outcomes between the 2 groups. RESULTS Univariate analysis showed that the significant variables were massive bleeding (>2000 ml) (P < 0.01), Charlson Comorbidity Index ≥3 (P = 0.01), and two-stage surgery needed (P = 0.04). Logistic regression analysis showed that the factors associated with poor prognosis were massive bleeding (Odds Ratio 11.9; 95% confidence interval 1.8 to 119.7; P = 0.04). CONCLUSIONS Massive bleeding was associated with poor prognosis after debridement followed by anterior column reconstruction for pyogenic spondylitis in lower thoracic and lumbar spine.
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Affiliation(s)
- Kosei Nagata
- The University of Tokyo Hospital, Japan; Hitachi General Hospital, Japan.
| | | | | | - So Kato
- The University of Tokyo Hospital, Japan
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Jones C. Brucellosis in an adult female from Fate Bell Rock Shelter, Lower Pecos, Texas (4000-1300 BP). Int J Paleopathol 2019; 24:252-264. [PMID: 30710889 DOI: 10.1016/j.ijpp.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/20/2018] [Accepted: 01/22/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This project is a case study discussing the differential diagnosis of multiple osteolytic vertebral lesions typical of brucellosis from an adult female from Fate Bell Rock Shelter in the Lower Pecos, Texas (4000-1300 BP). MATERIALS One middle to late adult female with exceptional preservation of the vertebrae. METHODS All skeletal remains were observed with low power magnification and the vertebrae were examined in greater detail using computed tomography (CT). RESULTS Pathological conditions involving multiple osteolytic vertebral lesions such as tuberculosis, echinococcosis, and neoplastic conditions were reviewed but brucellosis is the most likely diagnosis based on the pattern and distribution of characteristic lesions. CONCLUSIONS Aside from this study, only one other case of brucellosis has been recognized in prehistoric North American hunter-gatherer skeletal remains. SIGNIFICANCE This individual represents the first case of brucellosis in a hunter-gatherer from prehistoric North America diagnosed using both macroscopic skeletal analysis and computed tomography (CT). LIMITATIONS Poor preservation of vertebrae make cross comparison of remains and differential diagnosis difficult. SUGGESTIONS FOR FURTHER RESEARCH Further review and paleopathological research is needed regarding Coxiella burnetti (Q-fever) infection as a possible contributing factor to osteolytic lesions.
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Affiliation(s)
- Christine Jones
- Texas A&M University-Central Texas, 1001 Leadership Place, Killeen, TX, 76549, United States.
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20
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Wang X, Zhou S, Bian Z, Li M, Jiang W, Hou C, Zhu L. Unilateral percutaneous endoscopic debridement and drainage for lumbar infectious spondylitis. J Orthop Surg Res 2018; 13:306. [PMID: 30509282 PMCID: PMC6276136 DOI: 10.1186/s13018-018-1009-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/19/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The treatment of lumbar infectious spondylitis is controversial. In this study, we attempted to demonstrate that unilateral percutaneous endoscopic debridement with physiologic saline and negative pressure drainage postoperatively may achieve a satisfactory result in lumbar infectious spondylitis. METHODS We retrospectively analyzed 17 patients with lumbar infectious spondylitis who underwent percutaneous endoscopic debridement and drainage (PEDD) through a posterolateral transforaminal approach. Each biopsy specimen was submitted without delay after surgery and examined for microorganisms and evaluated histopathologically. Patients were assessed by careful physical examination, MacNab criteria, Oswestry Disability Index (ODI), visual analog scale (VAS), regular serological tests, imaging studies for clinical function, and patient satisfaction. RESULTS Of the 17 patients, 14 (82.4%) had satisfactory relief of their back pain according to MacNab criteria at 1 week after PEDD. Three patients (17.6%) who had advanced infections with multilevel involvement and paraspinal abscesses underwent anterior debridement and autograft interbody fusion with instrumentation within 2 weeks. However, there were no other severe surgery-related complications. Causative bacteria were identified in most cases, and Staphylococcus aureus was the most prevalent strain. CONCLUSIONS Unilateral PEDD with physiological saline or empirical antibiotics did not disrupt lumbar stability and avoided the important intraspinal structures such as the dural sac and nerve roots. It not only had a high rate of identification of the causative pathogen, but also provided effective infection control and pain relief. PEDD may be a useful technique for treatment of lumbar infectious spondylodiscitis patients who have no severe deformities and are unable to undergo the conventional anterior surgery due to poor health or advanced age.
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Affiliation(s)
- Xuepeng Wang
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Shaobo Zhou
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Zhenyu Bian
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Maoqiang Li
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Wu Jiang
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Changju Hou
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Liulong Zhu
- Department of Orthopedics Surgery, Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310006 Zhejiang People’s Republic of China
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Vigeral M, Thomovsky SA, Lim CK, Bentley RT. What Is Your Neurologic Diagnosis? J Am Vet Med Assoc 2018; 253:1117-1120. [PMID: 30311530 DOI: 10.2460/javma.253.9.1117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kim K, Kim S, Lee YH, Lee SH, Lee HS, Kim S. Performance of the deep convolutional neural network based magnetic resonance image scoring algorithm for differentiating between tuberculous and pyogenic spondylitis. Sci Rep 2018; 8:13124. [PMID: 30177857 PMCID: PMC6120953 DOI: 10.1038/s41598-018-31486-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/20/2018] [Indexed: 12/16/2022] Open
Abstract
The purpose of this study was to evaluate the performance of the deep convolutional neural network (DCNN) in differentiating between tuberculous and pyogenic spondylitis on magnetic resonance (MR) imaging, compared to the performance of three skilled radiologists. This clinical retrospective study used spine MR images of 80 patients with tuberculous spondylitis and 81 patients with pyogenic spondylitis that was bacteriologically and/or histologically confirmed from January 2007 to December 2016. Supervised training and validation of the DCNN classifier was performed with four-fold cross validation on a patient-level independent split. The object detection and classification model was implemented as a DCNN and was designed to calculate the deep-learning scores of individual patients to reach a conclusion. Three musculoskeletal radiologists blindly interpreted the images. The diagnostic performances of the DCNN classifier and of the three radiologists were expressed as receiver operating characteristic (ROC) curves, and the areas under the ROC curves (AUCs) were compared using a bootstrap resampling procedure. When comparing the AUC value of the DCNN classifier (0.802) with the pooled AUC value of the three readers (0.729), there was no significant difference (P = 0.079). In differentiating between tuberculous and pyogenic spondylitis using MR images, the performance of the DCNN classifier was comparable to that of three skilled radiologists.
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Affiliation(s)
- Kiwook Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Seoul, South Korea
| | - Sungwon Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Seoul, South Korea
| | - Young Han Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Seoul, South Korea
| | - Seung Hyun Lee
- Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Research Center for Future Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Sungjun Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Seoul, South Korea.
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Duizer ML, Hermsen R, Te Boekhorst T, Janssen S. [Acute headache and neck pain caused by crowned dens syndrome]. Ned Tijdschr Geneeskd 2018; 162:D2699. [PMID: 30182630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Crowned dens syndrome (CDS) is a rare cause of acute headache and neck pain, which is accompanied by fever and a stiff neck. It is caused by calcium deposits (pseudogout) around the dens axis (C2). CASE DESCRIPTION A 61-year-old woman, with a history of migraine and of breast cancer 8 years previously, was referred to the accident and emergency department of our hospital with acute headache and neck pain. She was treated in the department with prednisone, on suspicion of giant-cell arteritis. However, an 18F-FDG-PET-CT showed inflammation and calcification around the dens, consistent with CDS. The patient's condition improved rapidly after treatment with prednisone. CONCLUSION CDS should be considered in the differential diagnosis of acute headache and neck pain. Familiarity with the disease course can prevent unnecessary diagnostic tests and treatment. The syndrome can be easily diagnosed with a CT scan, but an 18F-FDG-PET-CT can also be used to reveal inflammatory activity around the dens.
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Affiliation(s)
- Marleen L Duizer
- Canisius Wilhelmina Ziekenhuis, afd. Interne geneeskunde, Nijmegen
- Contact: M.L. Duizer
| | - Rick Hermsen
- Canisius Wilhelmina Ziekenhuis, afd. Nucleaire geneeskunde, Nijmegen
| | | | - Sven Janssen
- Canisius Wilhelmina Ziekenhuis, afd. Interne geneeskunde, Nijmegen
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Abstract
Retrospective Cross-Sectional Study.The purpose of this study was to investigate the accuracy of magnetic resonance imaging (MRI) for distinguishing between pyogenic spondylitis and brucellar spondylitis.Although pyogenic spondylodiscitis (PS) and brucellar spondylitis (BS) are common causes of spinal infections, the variety of their clinical manifestations complicates differential diagnosis. MRI may be helpful in differential diagnosis and treatment.MRI images of 64 patients who underwent MRI of the spine and with confirmed spondylitis were retrospectively reviewed. After referring to the related medical literature, we compared 32 patients with pyogenic spondylitis and 32 patients with brucellar spondylitis regarding MRI findings. Statistical analysis was performed with the chi-square test. Statistical significance was defined as P < .05.The significant differences between PS and BS on MRI findings are listed as follows (P < .05): diffuse, partial and fan-shaped hyperintense signals on middle sagittal fat-suppressed weighted images (PS: 51, 11, 3/65 vs BS:35, 18, 19/72); focal endplate destruction (PS: 9/43 vs BS:27/35); extensive end plate destruction (PS: 29/43 vs BS:8/35); ballooning change of the intravertebral space (PS: 7/32 vs BS:0/32); an inflammatory reaction line from the end plate (PS: 30/65 vs BS: 1/72); a disc invasion sign (PS: 1/28 vs BS:12/33); an inflammatory reaction line in the disc (PS: 5/28 vs BS:25/33); and 8) severe intravertebral space destruction (PS: 17/28 vs BS:12/33);MRI imaging provides useful information for the differentiation between pyogenic spondylitis and brucellar spondylitis.
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Affiliation(s)
- Tao Li
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Wei Li
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Yong Du
- Department of Orthopedics, Qingyun County People's Hospital, Jinan City, PR China
| | - Meng Gao
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Xiaoyang Liu
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Guodong Wang
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Haomin Cui
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Zhensong Jiang
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Xingang Cui
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Jianmin Sun
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
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Abstract
Tuberculous spondylitis of vertebral augmentation following percutaneous vertebroplasty or kyphoplasty is rare. We report an unusual case of tuberculous spondylitis diagnosed after percutaneous kyphoplasty (PKP). A 54-year-old woman presented to hospital complaining of back pain following a fall 20 days prior. Radiology showed an acute osteoporotic compression (L3 fracture). The patient denied a history of pulmonary tuberculosis and there were no signs of infection. The patient was discharged from hospital 2 days after undergoing L3 PKP with a dramatic improvement in her back pain. The patient was readmitted 10 months later with a history of recurrent back pain and low-grade fever for 3 months. Imaging examinations showed severe spondylitis at the L2-L3 level, with paravertebral abscess formation and bony destruction of L2 and L3. A positive result of the T-SPOT test preliminarily confirmed the diagnosis of tuberculous spondylitis. The tuberculosis test was positive, and serum C-reactive protein levels and erythrocyte sedimentation were relatively high. Treatment for tuberculous spondylitis was started. She underwent posterior fusion and instrumentation from T12-L5 after markers for infection returned to normal. After surgery, the patient continued antituberculous and anti-osteoporosis treatments. Her low back pain was relieved and low-grade fever and sweating disappeared.
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Affiliation(s)
| | | | | | | | - Zhu Xiao-Yu
- Zhu Xiao-Yu, Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, No. 188 Shizi Rd., Gusu District, Suzhou, Jiangsu 215006, China.
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Kumar Y, Gupta N, Chhabra A, Fukuda T, Soni N, Hayashi D. Magnetic resonance imaging of bacterial and tuberculous spondylodiscitis with associated complications and non-infectious spinal pathology mimicking infections: a pictorial review. BMC Musculoskelet Disord 2017; 18:244. [PMID: 28583099 PMCID: PMC5460517 DOI: 10.1186/s12891-017-1608-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/30/2017] [Indexed: 12/16/2022] Open
Abstract
Magnetic resonance (MR) imaging plays an important role in the evaluation of bacterial and tuberculous spondylodiscitis and associated complications. Owing to its high sensitivity and specificity, it is a powerful diagnostic tool in the early diagnosis of ongoing infections, and thus provides help in prompt initiation of appropriate, therapy which may be medical or surgical, by defining the extent of involvement and detection of complications such as epidural and paraspinal abscesses. More specifically, MR imaging helps in differentiating bacterial from tuberculous infections and enables follow up of progression or resolution after appropriate treatment. However, other non-infectious pathology can demonstrate similar MR imaging appearances and one should be aware of these potential mimickers when interpreting MR images. Radiologists and other clinicians need to be aware of these potential mimics, which include such pathologies as Modic type I degenerative changes, trauma, metastatic disease and amyloidosis. In this pictorial review, we will describe and illustrate imaging findings of bacterial and tuberculous spondylodiscitis, their complications and non-infectious pathologies that mimic these spinal infections.
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Affiliation(s)
- Yogesh Kumar
- Department of Radiology, Yale New Haven Health System at Bridgeport Hospital, 267 Grant Street, Bridgeport, 06610 CT USA
| | - Nishant Gupta
- Department of Radiology, St. Vincent’s Medical Center, 2800 Main Street, Bridgeport, 06606 CT USA
| | - Avneesh Chhabra
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, 75390 TX USA
| | - Takeshi Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Neetu Soni
- Department of Neuroradiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, U.P India
| | - Daichi Hayashi
- Department of Radiology, Yale New Haven Health System at Bridgeport Hospital, 267 Grant Street, Bridgeport, 06610 CT USA
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, 02118 MA USA
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Abstract
It was a retrospective analysis.The aim of the study was to explore the safety and reliability of emergency 1-stage radical debridement and reconstruction using titanium mesh filled with autologous bone for patients with cervical spine infection complicated by epidural abscess.At present, cervical spine infection complicated by epidural abscess is known as a severe spine disease. Recently, case report of this disease is showing quite an increasing tendency, particularly in economically undeveloped areas and countries. Regarding the treatment of this disease, 1-stage radical debridement and reconstruction has been widely adopted; however, emergency 1-stage anterior approach surgery without medication is considered as a relatively taboo, since it is generally acknowledged that such operation would possibly cause unexpected infection. Nevertheless, regular elective surgery may require longer time for preparation. In addition, long hour compression and stimulation of the abscess may leave the patients with irreversible spinal neural impairment. However, our department has finished 14 cases of cervical spine infection complicated with epidural abscess without 1 single case of postoperative infection.A retrospective study was conducted on 14 patients (9 males and 5 females; average age 57.4 years) who were diagnosed with cervical spine infection complicated by epidural abscess from January 2005 to December 2014. All the patients were admitted to hospital with varying degrees of neurological function losses, and then underwent 1-stage anterior focal debridement and reconstruction using titanium mesh within 24 hours after admission. They received postoperative standard antibiotic chemotherapy for 10 to 12 weeks. They were followed up for 18 to 36 months, an average of 27.4 months. X-ray, computed tomography (CT), and MRI (magnetic resonance imaging (MRI) were used to determine the fusion state and vertebral stability. American Spinal Injury Association (ASIA) international standards for neurological classification were adopted, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were evaluated to infection activity, and Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) criteria were used to judge clinical efficacy.All the 14 patients had no postoperative spread of infection. No recurrence of infection was found during the last follow-up. ASIA grade, VAS score, and JOA score were significantly improved (P < .05) after the operation. WBC, ESR, and CRP became normal after the operation (P < .05). Postoperative follow-up imaging results showed no significant loss of cervical curvature, collapse of the grafted bone or implant displacement but good spinal canal volume.Emergency 1-stage radical debridement and reconstruction using titanium mesh filled with autologous bone, combined with antibiotic chemotherapy, is a safe and effective surgical therapy for cervical infection complicated by epidural abscess.
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Džupová O, Cihlářová R. [Pyogenic Spinal Infections in Adults: A 5-Year Experience from a Tertiary Care Centre]. Acta Chir Orthop Traumatol Cech 2017; 84:40-45. [PMID: 28253945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE OF THE STUDY To describe epidemiological and clinical features of pyogenic spinal infections in patients treated at the Department of Infectious, Parasitic and Tropical Diseases of the Hospital Na Bulovce in 2010-2014, and to analyse a predictive significance of selected variables. MATERIAL AND METHODS A single-centre retrospective cohort study carried out from 1.1.2010 to 31.12.2014 enrolled adult patients with septic spondylitis, discitis and facet joint infections. Recorded parameters included: demographics, chronic comorbidities, time to diagnosis, radiological work-up, anatomical level of spinal infection, source of infection, etiological agent, complications, treatment and outcomes. RESULTS Fifty-four patients were enrolled, 35 men (65%) and 19 women (35%), age range 33-90, mean age 63 years. Forty patients (74.1%) had a chronic comorbidity, 20 patients (37%) were obese. Time to diagnosis ranged between 1-90 days, mean 16.3 days. The diagnosis was assessed with MRI in 41 (75.9%) and CT in 11 patients (20.4%). Lumbosacral spine was affected in 38 (70.4%), thoracic in 14 (25.5%), cervical in 8 patients (14.8%), and 6 patients (11.1%) had a multilevel disease. Epidural abscess developed in 28 (51.9%), paravertebral oedema or abscess in 41 patients (75.9%). Endocarditis was diagnosed in 8 patients (14.8%). Aetiology was identified in 45 patients (83.3%), with Staphylococcus aureus isolated in 29 patients (53.7%). Twenty-two patients (40.7%) were treated surgically in addition to antibiotics. The mean length of hospital stay, parenteral antibiotic treatment and total antibiotic treatment was 48.7, 38.2 and 71.5 days, respectively. Thirty-six patients (66.6%) recovered with no or mild sequelae, 7 (13%) with severe sequelae, and 11 patients (20.4%) died. None of the analysed variables proved to be a statistically significant predictive factor of clinical outcome. DISCUSSION In accordance with previous studies pyogenic spinal infections were diagnosed mainly in elderly with chronic internal comorbidities, mostly with magnetic resonance imaging, they were often localized in lumbar spine, with staphylococci being the leading agents. In spite of unavailable CT-navigated biopsy, the aetiology was discovered in majority of patients. In contrast, this study found a more frequent posterior segments involvement, a shorter time to treatment, no tuberculous cases, a relatively high case fatality ratio, but less sequelae and no relapse. CONCLUSIONS The study confirmed an increasing incidence of pyogenic spinal infections, known predisposing factors, importance of MRI in diagnostics, disease predilection in lumbar spine, staphylococcal predominance in causative pathogens, and a relatively high case fatality ratio. Although time to treatment was not proved to be a negative predictive factor of clinical outcome, it is an imperative to strive for an early diagnosis and treatment. Predictors of clinical outcome have to be evaluated in a more extensive cohort of patients. Key words: spinal infection, discitis, spondylitis, spondylodiscitis, epidural abscess, psoas muscle abscess.
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Affiliation(s)
- O Džupová
- Klinika infekčních nemocí, 3. lékařská fakulta Univerzity Karlovy a Nemocnice Na Bulovce, Praha
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Landi M, Maldonado-Ficco H, Perez-Alamino R, Maldonado-Cocco JA, Citera G, Arturi P, Sampaio-Barros PD, Flores Alvarado DE, Burgos-Vargas R, Santos E, Palleiro D, Gutiérrez MA, Vieyra-Sousa E, Pimentel-Santos F, Paira SO, Berman A, Barrezueta CV, Vazquez-Mellado J, Collantes-Estevez E. Gender differences among patients with primary ankylosing spondylitis and spondylitis associated with psoriasis and inflammatory bowel disease in an iberoamerican spondyloarthritis cohort. Medicine (Baltimore) 2016; 95:e5652. [PMID: 28002334 PMCID: PMC5181818 DOI: 10.1097/md.0000000000005652] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The aim of the study was to compare clinical manifestations, disease activity, functional capacity, spinal mobility, and radiological findings between men and women from a multicenter, multiethnic Ibero-American cohort of patients with Spondyloarthritis (SpA).This observational cross-section study included 1264 consecutive SpA patients who fulfilled the modified New York criteria for ankylosing spondylitis (AS). Demographic, clinical, and radiologic data were evaluated. Categorical data were compared by X or Fisher's exact tests and continuous variables by ANOVA with post-hoc tests.Primary AS was diagnosed in 1072 patients, psoriatic spondylitis in 147, and spondylitis associated to inflammatory bowel disease (IBD) in 45 patients. Overall, male patients were significantly younger, had longer diagnostic delay, lower disease activity, worse spinal mobility, better quality of life, and more severe radiologic damage. Dactylitis and enthesitis, as well as swollen joint count, were significantly more common among women. In primary AS, there was a marked male predominance (76.2%). Among patients with psoriatic spondylitis, male predominance was lower (57.8%), but was also associated with worse spinal mobility and more severe radiologic damage. In the total population, male patients with primary AS referred higher permanent work disability (13.2% vs 6.9%; P < 0.05), although no difference was observed in psoriatic or IBD spondylitis according to the gender.Among Ibero-American SpA patients, there are some differences in clinical and radiological manifestations, men showing more structural damage, whereas women more active disease. These data suggest that the phenotype of SpA differs between genders. This can influence the subsequent diagnostic approach and therapeutic decisions.
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Affiliation(s)
| | | | | | | | | | - Pablo Arturi
- Former Fellow in Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | | | | | - Rubén Burgos-Vargas
- Hospital General de Mexico, Facultad de Medicina, Universidad Nacional Autónoma de Mexico, Mexico DF, Mexico
| | - Elena Santos
- Portuguese Institute of Rheumatology, Lisbon, Portugal
| | - Daniel Palleiro
- Instituto Nacional de Reumatología del Uruguay, Montevideo, Uruguay
| | - Miguel A. Gutiérrez
- Department of Clinical Immunology and Rheumatology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Elsa Vieyra-Sousa
- Serviço de Reumatologia e de Doencas Ósseas Metabólicas, Centro Hospitalar Lisboa Norte
| | - Fernando Pimentel-Santos
- Facultade de Ciencias Médicas da Universidade Nova de Lisboa and CHLO, Hospital de Egas Moniz, Lisbon, Portugal
| | | | - Alberto Berman
- Centro Médico Privado de Reumatología, Tucumán, Argentina
| | - Claudia Vera Barrezueta
- Hospital Luis Vernaza, Guayaquil, Profesora de Inmunología Clínica, Universidad Católica de Guayaquil, Guayaquil, Ecuador
| | - Janitzia Vazquez-Mellado
- Rheumatology Service, Hospital General de Mexico y Facultad de Medicina, UNAM, Mexico DF, Mexico
| | - Eduardo Collantes-Estevez
- Rheumatology Department, “Reina Sofía” University Hospital / IMIBIC, University of Cordoba, Cordoba, Spain
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Mushkin AY, Malyarova EY, Evseev VA, Yablonskii PK. Surgical treatment of spondylitis and diaphragm relaxation in patient less than 1 year old. Neurol Neurochir Pol 2016; 50:374-8. [PMID: 27591064 DOI: 10.1016/j.pjnns.2016.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/14/2016] [Revised: 04/18/2016] [Accepted: 05/09/2016] [Indexed: 11/20/2022]
Abstract
DESIGN Case report. INTRODUCTION The combination of severe post-infectious kyphosis and diaphragm relaxation is extremely rare in patient early than 1 year old. Its no publications concerning their simultaneous surgical treatment. CASE DESCRIPTION 7-Month-old girl had simultaneous spinal reconstruction with anterior and posterior instrumentation and plastic of diaphragm because of sequelae of non-granulenatous spondylitis complicated by severe kyphosis (54°) and diaphragm relaxation. Between 1.5 and 3 months of live she had several infections incl. pneumonia, enterocolitis, ENT infection. Anterior fusion was done by titanium mesh with auto-rib, posterior - by compressive rods based on low-profile hooks. The deformity was reduced till 20°. 2.5 years after initial surgery and 1 year after removal of posterior instrumentation the adequate level of diaphragm and minimal (4°) loss of kyphosis correction were identified. CONCLUSIONS The combination of spondylitis and diaphragm relaxation in early aged patient could be explained but it could not be confirmed as a sequelae of late-onset neonatal sepsis with a multi-focal lesions. The simultaneous surgery provided on the combined approaches (trans-thoracic and posterior) looks as optimal options in such combination of pathologies. In remains controversial how will the spine develop after so early reconstructive surgery, including in situ stable anterior fusion carried out by titanium mesh with auto-rib.
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Affiliation(s)
- A Y Mushkin
- St-Petersburg Science-Research Institute of Phthisiopulmonology, St-Petesburg, Russian Federation; St-Petersburg North-West State Medical University named by I.I. Mechnikov, St-Petesburg, Russian Federation.
| | - E Y Malyarova
- St-Petersburg Science-Research Institute of Phthisiopulmonology, St-Petesburg, Russian Federation.
| | - V A Evseev
- St-Petersburg Science-Research Institute of Phthisiopulmonology, St-Petesburg, Russian Federation.
| | - P K Yablonskii
- St-Petersburg Science-Research Institute of Phthisiopulmonology, St-Petesburg, Russian Federation; St-Petersburg State University, St-Petesburg, Russian Federation.
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Lara-Oya A, Liébana-Martos MC, Rodríguez-Granger J, Sampedro-Martínez A, Aliaga-Martínez L, Gutierrez-Fernández J, Navarro-Marí JM. [Tuberculous prosthetic knee joint infection: a case report and literature review]. Rev Esp Quimioter 2016; 29:214-219. [PMID: 27341025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Prosthetic late infection occurs in the second month after surgery in the context of haematogenous spread from another source. Prosthetic mycobacterial infection is a rare complication whose clinical management is not standardized. CASE Patient of 77 years with no personal history except for diabetes and a prosthetic replacement of right knee with osteoarthritis three years ago. Patient goes to hospital emergency box for 6 months pain in the right knee with mechanical inflammatory signs but no fever associated. After their return within 5 days and clinical worsening is reporting growth of Mycobacterium tuberculosis in knee aspirate and antitubercular treatment is established for 9 months. Nuclear magnetic resonance imaging studies also confirmed the diagnosis of tuberculosis spondylitis in the clinical context of the patients. After surgery, M. tuberculosis was again isolated from intraoperative samples and therefore the patient received another batch of treatment for 9 months. After a year of monitoring, the development was acceptable but few months later, the patient died for cardiovascular causes. In the literature review, 15 publications with a total of 17 clinical cases of prosthetic infection by M. tuberculosis were found from 1980 to 2014. CONCLUSIONS Prosthetic tuberculous arthritis, although it is a rare presentation, it should be noted, especially in patients with predisposing conditions with a history of tuberculosis infection.
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Affiliation(s)
| | | | - J Rodríguez-Granger
- Javier Rodríguez-Granger, Servicio de Microbiología. Hospital Universitario Virgen de las Nieves. Avda. Fuerzas Armadas s/n. 180014. Granada, Spain.
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32
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Roed T, Frøkjær JB, Nielsen H. [Spinal tuberculosis with psoas abscess]. Ugeskr Laeger 2015; 177:V66164. [PMID: 25872673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Torsten Roed
- Infektionsmedicinsk Afdeling, Aalborg Universitetshospital.
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33
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Abstract
Magnetic resonance imaging is the imaging method of choice for diagnosing infection of the spine in unoperated cases. 2-[(18)F]-fluoro-2deoxy-d-glucose positron emission tomography/computed tomography study is recommended to distinguish between spinal infection and common Modic change in patients with metallic implants and prosthetic replacements and for differentiating tuberculous from pyogenic spondylitis in ambiguous cases, reflecting the activity of the infection. Also, it seems to have a strong clinical impact in more than half of patients with infectious spondylitis, while it is superior to other imaging techniques in revealing residual disease after treatment and early response to therapy. New tracers as well as new hybrid modalities are under investigation.
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Affiliation(s)
- Alexandros Georgakopoulos
- Nuclear Medicine Division, PET/CT section, Foundation for Biomedical Research of the Academy of Athens, Athens, Greece.
| | - Spiros G Pneumaticos
- 3rd Department of Orthopedic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos V Sipsas
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Chatziioannou
- Nuclear Medicine Division, PET/CT section, Foundation for Biomedical Research of the Academy of Athens, Athens, Greece; Second Department of Radiology, Medical School, National and Kapodistrian University of Athens, General University Hospital "ATTIKON", Athens, Greece
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34
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Affiliation(s)
- Brahim Eljebbouri
- Department of Neurosurgery, Mohamed V Military Teaching Hospital, Rabat, Morocco
| | - Abad Cherif El Asri
- Department of Neurosurgery, Mohamed V Military Teaching Hospital, Rabat, Morocco
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35
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Kumar MN, Joseph B, Manur R. Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting. Eur Spine J 2013; 22:624-32. [PMID: 23053761 PMCID: PMC3585624 DOI: 10.1007/s00586-012-2528-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 04/22/2012] [Revised: 09/16/2012] [Accepted: 09/23/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this prospective study is the analysis of the clinical and radiological outcomes of active thoraco-lumbar spinal tuberculosis treated with isolated posterior instrumentation without any posterior bone grafting or anterior inter-body bone grafting or anterior instrumentation. METHODS The study was a prospective follow-up of 25 patients with active thoraco-lumbar spinal tuberculosis who underwent posterior spinal instrumentation with pedicle screws and rods. These patients had posterior stabilization of the involved segment of the spine without anterior or posterior bone grafting. The mean duration of follow-up was 3.3 years and the minimum duration of follow-up was 2 years. RESULTS The mean kyphotic angle improved from 32.4° pre-operatively to 7.2° in the early follow-up period. Following a minor loss of correction during follow-up, the mean kyphotic angle settled at 11.5° at the time of final follow-up. Inter-body bony fusion was noticed at the final follow-up in all patients despite the absence of anterior bone grafting or cages. CONCLUSION Posterior instrumented stabilization followed by chemotherapy seems to be adequate for obtaining satisfactory healing of the lesions. Anterior inter-body bony arthrodesis occurs despite the absence of anterior bone grafts or cages. Careful patient selection is critical for successful outcome with this technique.
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36
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Affiliation(s)
- P Kyebambe
- Internal Medicine department, Kabale Regional Referral Hospital, Uganda.
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37
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Gäbler K, Flegel T, Köhler C, Niesterok C, Oechtering G, Ludewig E. [Radiological findings of inflammatory and neoplastic spinal column changes in the dog and cat]. Tierarztl Prax Ausg K Kleintiere Heimtiere 2011; 39:51-59. [PMID: 22143564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 11/22/2010] [Indexed: 05/31/2023]
Affiliation(s)
- K Gäbler
- Klinik für Kleintiere der Universität Leipzig.
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38
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Lubrano E, Marchesoni A, Olivieri I, D'Angelo S, Spadaro A, Parsons WJ, Cauli A, Salvarani C, Mathieu A, Zaccara E, Ferrara N, Helliwell PS. The radiological assessment of axial involvement in psoriatic arthritis: a validation study of the BASRI total and the modified SASSS scoring methods. Clin Exp Rheumatol 2009; 27:977-980. [PMID: 20149315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To assess the validity of the BASRI and m-SASSS scores for the radiological axial involvement in psoriatic arthritis (PsA). Secondary end-points were to report on clinical, functional and radiographic characteristics of axial involvement. METHODS Inclusion criteria were satisfaction of the CASPAR criteria and the presence of clinical, functional and/or radiological axial involvement. Three observers scored the radiographs by BASRI and m-SASSS. The construct validity was assessed by examining the correlation of instruments with patient reported outcomes and anthropometric measures. The reliability and the feasibility of the scores were also considered. RESULTS Seventy-seven patients were enrolled (58 M, 19 F, mean age 49.4 + or - 10.8 yrs, disease duration 13.9 + or - 7.9 yrs). Both instruments showed some modest but significant correlation with clinical measures. When compared, the BASRI showed a correlation with BASMI (rho=0.47, p<0.001), cervical rotation (rho=-0.49, p<0.001), tragus to wall (rho=0.34, p<0.01) and occiput to wall (rho=0.49, p<0.001), modified Schober test (rho=-0.24, p<0.05) and RLDQ (rho=-0.24, p<0.05). When compared, m-SASSS showed a correlation with BASMI (rho=0.39, p<0.001), cervical rotation (rho=-0.41, p<0.001), tragus to wall (rho=0.31, p<0.01) and occiput to wall (rho=0.42, p<0.001), modified Schober and Schober test (rho=-0.34, p<0.001; rho= -0.32, p<0.01), finger to floor (rho=0.37, p<0.01). No correlation was found with BASFI, BASDAI and HAQ. Test-retest showed a good reliability of the scores. Both were feasible but BASRI was the quickest. CONCLUSION Our results showed that BASRI and m-SASSS were valid instruments for use in spondylitis associated with psoriatic arthritis. Longitudinal data is required to provide sensitivity to change of the two scores.
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Affiliation(s)
- E Lubrano
- Rheumatology and Rehabilitation Research Unit, Fondazione Maugeri, IRCCS, Telese Terme, Italy.
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39
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Dhir V, Chaudhary GD, Singh YP, Lawrence A, Aggarwal AP, Misra R. Medical image. A case of lumbodynia. N Z Med J 2009; 122:115-117. [PMID: 19859098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Varun Dhir
- Clinical Immunology, SGPGIMS, Lucknow, Uttar Pradesh, India
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40
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Hess S, Vind SH, Høilund-Carlsen PF. [PET/CT for diagnosis of infections]. Ugeskr Laeger 2008; 170:3404-3407. [PMID: 18976595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Radiolabelled white blood cells are widely used for scintigraphic evaluation of infection. However, this technique is time-consuming and provides rather limited anatomical details. Positron emission tomography (PET) with 18F-fluordeoxyglucose is gaining ground in clinical settings and the added value of combined metabolic and anatomical imaging achieved by combining PET with computed tomography (CT) to PET/CT seems particularly promising. We present the current status for the use of PET/CT in selected infectious diseases based on the limited literature available.
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Affiliation(s)
- Søren Hess
- Nuklearmedicinsk Afdeling, Odense Universitetshospital, 5000 Odense C.
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41
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Wong SB, Peh WC, Lim SL. Clinics in diagnostic imaging (123). Singapore Med J 2008; 49:581-591. [PMID: 18695868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 60-year-old Indian man presented with lower thoracic pain and bilateral lower limb weakness. Radiographs showed compression fractures of T8 and T9 and destruction of the T7 and T10 endplates. Magnetic resonance imaging confirmed the vertebral changes and showed subligamentous spread, paravertebral masses, and epidural involvement leading to cord compression. Computed tomography-guided biopsy showed granulomatous caseous necrosis and acid-fast bacilli, confirming the diagnosis of tuberculosis spondylitis. The imaging features of infective spondylitis, with emphasis on tuberculous spondylitis, are discussed.
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Affiliation(s)
- S B Wong
- Department of Diagnostic Radiology, Alexandra Hospital, Singapore
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42
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Karabay O, Gurel K, Sirmatel O, Sirmatel F. Medical image. Brucellar spondylitis (Pedro Pons' sign). N Z Med J 2007; 120:U2782. [PMID: 17972989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Oguz Karabay
- Department of Infectious Diseases and Clinical Microbiology, Izzet Baysal Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey.
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Abstract
A 6-year-old German Shepherd dog was evaluated for hind limb lameness. When a diagnosis, could not be achieved using radiography and ultrasonography, bone scintigraphy was performed to look for occult lameness or the presence of multiostic disease. Bone scintigraphy was useful in identification of increased radiopharmaceutical uptake in the thoracic spine and right coxofemoral joint, which directed further testing leading to the diagnosis of discospondylitis, septic arthritis of the coxofemoral joint, and a urinary tract infection.
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Affiliation(s)
- Leah Stern
- Department of Surgery, Foster Hospital for Small Animals, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA
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Lin WC, Lui CC, Lee CH, Wang HC. Unusual femoral artery mycotic aneurysm complicated by infective spondylitis. Emerg Radiol 2007; 15:207-10. [PMID: 17619916 DOI: 10.1007/s10140-007-0650-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 06/15/2007] [Indexed: 10/23/2022]
Abstract
We present a patient who experienced an aortic aneurysm and a left femoral artery mycotic aneurysm, which resulted from L4-infective spondylitis via the iliopsoas compartment. This rare complication could be underdiagnosed in the absence of a more extended field of imaging view such as is provided by computed tomography.
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Affiliation(s)
- Wei-Che Lin
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung Hsiang, Kasohsiung Hsien, Taiwan, 833, Republic of China
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Abstract
STUDY DESIGN A retrospective assessment of 12 patients with pyogenic spondylitis accompanied by iliopsoas abscess treated by continuous irrigation with our new method between March 2003 and July 2005. OBJECTIVES To present our method of treatment and to evaluate outcomes of 12 patients undergoing it. SUMMARY OF BACKGROUND DATA Since patients with pyogenic spondylitis accompanied by iliopsoas abscess who require surgery are often immunocompromised hosts, open surgery may be excessively invasive. A less invasive operative procedure is therefore desirable for them. Percutaneous drainage is often used for secondary iliopsoas abscess due to pyogenic spondylitis. However, some authors have emphasized the importance of spondylitis as the primary source of infection for secondary iliopsoas abscess and have considered it essential to combine abscess drainage with curative treatment of the primary focus of infection. METHODS We describe our treatment, which involves continuous irrigation using a saline infusion tube inserted into the infectious spondylitic disc as the primary lesion and insertion of a drainage tube into the iliopsoas abscess communicating with the primary lesion. Clinical and radiographic assessment of all 12 patients who received this treatment was performed. RESULTS Ten (83%) of the 12 patients responded well to this treatment, with clinical results overall. Back pain, a major symptom, was relieved a mean of 9 days after the start of continuous irrigation. The mean duration to remission of C-reactive protein was 30.2 days. Follow-up MRI and CT with enhancement revealed disappearance or near-total resolution of the iliopsoas abscess cavity with healing of pyogenic spondylitis in all 10 patients who responded well to our treatment. CONCLUSION This treatment is minimally invasive and useful in carefully selected patients with pyogenic spondylitis complicated by iliopsoas abscess.
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Affiliation(s)
- Katsuhiro Tofuku
- Department of Orthopaedic Surgery, Kagoshima Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
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Hu JZ, Zhang J, Wang XY, He HB, Liu JY, Zhang HQ, Deng ZS, Long WR. [Infection of intervertebral space and the interventional therapy]. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2007; 32:512-4. [PMID: 17611336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To investigate the effect of interventional therapy in the treatment of intervertebral space infection. METHODS The needle was punctured into the infected intervertebral space from the post-lateral side of the spine monitored by X-rays. The pus was drained, the degenerative disc tissues and necrosis tissues were excised and taken out, and at the end a drainaging catheter was put into the space through the needle. The patient should lie in bed absolutely. The antibiotics was injected into the space through the silicon catheter every day. Three to four weeks later, the catheter was removed. RESULTS All the 8 patients got good results after the therapy. The low back pain was dramatically alleviated instantly at the day of operation. Erythrocyte sedimental rate gradually descended. After 3 approximately 4 weeks of treatment,the catheter was removed. CONCLUSION Interventional therapy of the intervertebral space infection has notable advantage over the open operation.
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Affiliation(s)
- Jian-zhong Hu
- Department of Orthopedics, Xiangya Hospital, Central South Univercity, Changsha 410008, China.
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Wong MA, Hopkins AL, Snyder PS, Goring RL. What is your diagnosis? Diskospondylitis. J Am Vet Med Assoc 2006; 229:1565-6. [PMID: 17107308 DOI: 10.2460/javma.229.10.1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Michael A Wong
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA
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Raczkiewicz-Papierska A, Bachta A, Nagańska E, Zagrodzka M, Skrobowska E, Tłustochowicz M, Dudek A, Tłustochowicz W. [Prevalence of cervical spine inflammatory changes in rheumatoid arthritis patients and the value of neurological examination in their diagnosis]. Pol Arch Med Wewn 2006; 116:938-946. [PMID: 18416295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The aim of the study was to evaluate prevalence of cervical spine inflammatory changes, especially atlantoaxial pathology, and their possible relation to subjective and objective neurological symptoms in rheumatoid arthritis patients. 100 patients (88 female and 12 male) aged 23 to 85 (61.4 +/- 12.9), with the mean disease duration of 12.5 +/- 9.5 years were included in the study. According to radiological examination (lateral and antero-posterior X-ray of the cervical spine) supplemented by MR of the cervical spine or CT of the atlanto-axial joint in suspected cases, 26% of patients had only inflammation, next 15% of patients presented with instability of the atlanto-axial joint and 9% developed basilar invagination of the dens of axis. 18% of patients presented subaxial cervical instability. Neurological examitation was performed by independent neurologist in 99 patients, only 14 presented abnormalities suggesting cervical myelopathy. Two of them showed no patology of the cervical spine. Remaining patients presented: C1/C2 inflammation in 4 cases, anterior atlanto-axial subluxation (AAS) in two cases, basilar invagination in 4 cases and instability with medullary compression on lower cervical levels only--in two cases. There were 4 cases of coexisting C1/C2 changes with medullary compression due to discopathy and (in 3 of them) instability on lower cervical levels. In 6 cases surgical stabilisation was proposed (5 patients with basilar invagination and 1 patient with AAS and myelopathy). There was statistically significant correlation between symptoms (like: paraesthesiae, intermittent problems with hearing and seeing), neurological examination and degree of radiological damage of atlanto-axial joint. The authors concluded that careful medical history and neurological examination can be useful in making decision of further radiological diagnostic procedures of the cervical spine in rheumatoid arthritis.
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Sucu HK, Ciçek C, Rezanko T, Bezircioğlu H, Erşahin Y, Tunakan M, Minoğlu M. Percutaneous computed-tomography-guided biopsy of the spine: 229 procedures. Joint Bone Spine 2006; 73:532-7. [PMID: 16677838 DOI: 10.1016/j.jbspin.2006.01.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Accepted: 01/18/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Percutaneous biopsy of the spine is an effective and well-evaluated procedure. Only very few series containing more than a hundred patients have been reported so far and there is no agreement about the factors affecting the diagnostic rate. We aimed to find out if there is any factor influencing the success rate of the spinal biopsy using our biopsy series. METHODS Two hundred and twenty-nine procedures were performed in 201 patients between November 2001 and August 2005. All procedures were performed under computed tomography guidance. The side was chosen according to the extension of the lesion. When the lesion was in the midline or extended to both sides, we preferred to obtain biopsy from the right side. The puncture point and the needle trajectory were planned on both lateral computed tomography scout scan and axial scans. RESULTS We found that the diagnostic rate was not affected by the variables such as age, gender, type and diameter of the biopsy needle, diagnosis as well as lesion localization and level. The success rate of the repeat biopsies was considerably lower than the first procedures. CONCLUSIONS The diagnostic rate is not affected by any of the variables but the approach, chosen can vary with the level, localization, and lesion characteristics.
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Affiliation(s)
- Hasan Kamil Sucu
- Department of Neurosurgery, Atatürk Training and Research Hospital, Izmir, Turkey.
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Axelsson P, Johnsson R, Strömqvist B. Radiostereometry in lumbar spine research. Acta Orthop Suppl 2006; 77:1-42. [PMID: 17299895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Paul Axelsson
- Department of Orthopedics, Lund University Hospital, SE-22185 Lund, Sweden.
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