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Hoogervorst LA, Punski-Hoogervorst JL, Baktash A, Brinkman DMC, de Witte PB. An Uncommon Cause of Nocturnal Crying and Discomfort: A Case of a 15-month-old Girl With Spondylodiscitis. J Pediatr Health Care 2024; 38:432-437. [PMID: 38180406 DOI: 10.1016/j.pedhc.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 01/06/2024]
Abstract
Nocturnal crying in toddlers has a broad spectrum of causes, including psychosocial and somatic causes, whereby the majority are self-limiting and do not need referral to specialist medical care. Although uncommon, atypical presentations of nocturnal crying-such as spondylodiscitis-require referral to specialist medical care, especially when combined with discomfort. In this case report, we present a case of a 15-month-old girl with an atypical presentation of nocturnal crying in combination with back pain.
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Hijazi MM, Siepmann T, El-Battrawy I, Schröttner P, Podlesek D, Schackert G, Juratli TA, Eyüpoglu IY, Filis A. The importance of the bacterial spectrum in the clinical diagnostics and management of patients with spontaneous pyogenic spondylodiscitis and isolated spinal epidural empyema: a 20-year cohort study at a single spine center. BMC Infect Dis 2024; 24:39. [PMID: 38166791 PMCID: PMC10762996 DOI: 10.1186/s12879-023-08946-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Personalized clinical management of spondylodiscitis (SD) and isolated spinal epidural empyema (ISEE) is challenging due to limited evidence of microbiologic findings and their clinical impact during the clinical course of the disease. We aimed to characterize clinico-microbiological and imaging phenotypes of SD and ISEE to provide useful insights that could improve outcomes and potentially modify guidelines. METHODS We performed chart review and collected data on the following parameters: bacterial antibiogram-resistogram, type of primary spinal infection, location of spinal infection, source of infection, method of detection, clinical complications (sepsis, septic embolism, and endocarditis), length of hospital and intensive care unit (ICU) stay, relapse rate, and disease-related mortality in patients with proven pyogenic SD and ISEE treated surgically in a university hospital in Germany between 2002 and 2022. RESULTS We included data from 187 patients (125 SD, 66.8% and 62 ISEE, 33.2%). Gram-positive bacteria (GPB) were overall more frequently detected than gram-negative bacteria (GNB) (GPB: 162, 86.6% vs. GNB: 25, 13.4%, p < 0.001). Infective endocarditis was caused only by GPB (GPB: 23, 16.5% vs. GNB: 0, 0.0%, p = 0.046). Methicillin-susceptible Staphylococcus aureus was the most frequently isolated strain (MSSA: n = 100, 53.5%), occurred more frequently in the cervical spine compared to other bacteria (OB) (MSSA: 41, 41.0% vs. OB: 18, 20.7%, p = 0.004) and was most frequently detected in patients with skin infection as the primary source of infection (MSSA: 26, 40.6% vs. OB: 11, 16.7%, p = 0.002). Streptococcus spp. and Enterococcus spp. (SE: n = 31, 16.6%) were more often regarded as the cause of endocarditis (SE: 8, 27.6% vs. OB: 15, 11.4%, p = 0.037) and were less frequently detected in intraoperative specimens (SE: 19, 61.3% vs. OB: 138, 88.5%, p < 0.001). Enterobacterales (E: n = 20, 10.7%) were identified more frequently in urinary tract infections (E: 9, 50.0% vs. OB: 4, 3.6%, p < 0.001). Coagulase-negative Staphylococci (CoNS: n = 20, 10.7%) were characterized by a lower prevalence of sepsis (CoNS: 4, 20.0% vs. OB: 90, 53.9%, p = 0.004) and were more frequently detected in intraoperative specimens (CoNS: 20, 100. 0% vs. OB: 137, 82.0%, p = 0.048). Moreover, CoNS-associated cases showed a shorter length of ICU stay (CoNS: 2 [1-18] days vs. OB: 6 [1-53] days, median [interquartile range], p = 0.037), and occurred more frequently due to foreign body-associated infections (CoNS: 8, 61.5% vs. OB: 15, 12.8%, p = 0.008). The presence of methicillin-resistant Staphylococcus aureus (MRSA) prolonged hospital stay by 56 [24-58] days and ICU stay by 16 [1-44] days, whereas patients with Pseudomonas aeruginosa spent only 20 [18-29] days in the hospital and no day in the ICU 0 [0-5] days. CONCLUSIONS Our retrospective cohort study identified distinct bacterial-specific manifestations in pyogenic SD and ISEE regarding clinical course, neuroanatomic targets, method of pathogen detection, and sources of infection. The clinico-microbiological patterns varied depending on the specific pathogens.
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Affiliation(s)
- Mido Max Hijazi
- Department of Neurosurgery, Division of Spine Surgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Timo Siepmann
- Department of Neurology, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology, Bergmannsheil University Hospital, Ruhr University Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany
| | - Percy Schröttner
- Institute for Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
- Institute for Microbiology and Virology, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Dino Podlesek
- Department of Neurosurgery, Division of Spine Surgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, Division of Spine Surgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Tareq A Juratli
- Department of Neurosurgery, Division of Spine Surgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Ilker Y Eyüpoglu
- Department of Neurosurgery, Division of Spine Surgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Andreas Filis
- Department of Neurosurgery, Division of Spine Surgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
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Washington ER, Carius BM, Dougherty C, Ashworth S. Abiotrophia defectiva triple threat: A rare case of infective spondylodiscitis, endocarditis, and brain abscess. Am J Emerg Med 2024; 75:199.e1-199.e4. [PMID: 37230847 DOI: 10.1016/j.ajem.2023.04.035] [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: 03/09/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Abiotrophia defectiva is a pathogen of the oral, gastrointestinal, and urinary tracts that can cause significant systemic disease with uniquely negative blood cultures depending on the growth medium. Prior cases note possible seeding from relatively common procedures such as routine dental work and prostate biopsies, however case literature describes prior infectious complications to include infective endocarditis, brain abscess formation, and spondylodiscitis. While prior cases describe some aspects of these presentations, we highlight a case of a 64-year-old male who presented to the emergency department (ED) f5or acute onset of low back pain with fever symptoms four days after an outpatient transrectal ultrasound-guided needle biopsy of the prostate, with a prior dental extraction described four weeks prior to arrival. Findings on initial ED presentation and subsequent hospitalization revealed infective spondylodiscitis, endocarditis, and brain abscess formation. This is the only cases noted in literature with all three infection locations with dual risk factors of dental and prostate procedures prior to symptom onset. This case highlights the multifocal illness that can complicate Abiotrophia defectiva infections, and the importance of thorough ED evaluation and multiservice approach for consultation and treatment.
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Affiliation(s)
- Eric R Washington
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, United States of America
| | - Brandon M Carius
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, United States of America.
| | - Christine Dougherty
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, United States of America
| | - Simeon Ashworth
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, United States of America
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Pilkington E, Goncalves R, Henze L, Grapes N, Volk H, De Decker S. Determining the prevalence and risk factors for positive bacterial culture in canine discospondylitis: 120 cases. Vet Rec 2023; 193:e3053. [PMID: 37211971 DOI: 10.1002/vetr.3053] [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: 08/01/2022] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Identification of the aetiologic agent in canine discospondylitis is infrequent; and risk factors for a positive bacterial culture have not previously been reported. METHODS Medical records at three institutions were searched to identify clinical features of dogs with discospondylitis diagnosed via radiography or cross-sectional imaging. Inclusion in this retrospective case-control study required culture of one or more samples. Multivariable binary logistic regression identified features associated with a positive culture. RESULTS Fifty (42%) of 120 dogs had one or more positive culture results obtained from either urine (28/115), blood (25/78), intervertebral disc aspiration (10/34) or cerebrospinal fluid (1/18). A positive culture was associated with higher bodyweight (p = 0.002, odds ratio [OR] = 1.054, 95% confidence interval [CI]: 1.019-1.089), more sample types cultured (p = 0.037, OR = 1.806, 95% CI: 1.037-3.147) and institution (p = 0.021). The presence of possibly associated preceding events (e.g., surgery), pyrexia, number of disc sites affected and serum C-reactive protein result, among other features, were not statistically significant. LIMITATIONS All isolates cultured were included since differentiation of true aetiologic agents from contaminants was not possible without histological confirmation and culture from surgical or postmortem biopsies. CONCLUSIONS Clinical features typically associated with infection were not identified as risk factors for positive culture in canine discospondylitis. The statistical significance of the institution suggests that standardisation of sampling protocols is necessary.
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Affiliation(s)
- Ed Pilkington
- Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - Rita Goncalves
- Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - Lea Henze
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hanover, Hanover, Germany
| | - Nick Grapes
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | - Holger Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hanover, Hanover, Germany
| | - Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
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Al-Afif S, Atallah O, Scheinichen D, Palmaers T, Cinibulak Z, Rollnik JD, Krauss JK. Surgical treatment of spondylodiscitis in critically ill septic patients. Acta Neurochir (Wien) 2023; 165:3601-3612. [PMID: 37587320 PMCID: PMC10739300 DOI: 10.1007/s00701-023-05748-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE Surgical procedures in critically ill patients with spondylodiscitis are challenging and there are several controversies. Here, we present our experience with offering surgical intervention early in critically ill septic patients with spondylodiscitis. METHOD After we introduced a new treatment paradigm offering early but limited surgery, eight patients with spondylodiscitis complicated by severe sepsis and multiple organ failure underwent urgent surgical treatment over a 10-year period. Outcome was assessed according to the Barthel index at 12-month follow-up and at the last available follow-up (mean 89 months). RESULTS There were 7 men and 1 woman, with a mean age of 62 years. The preoperative ASA score was 5 in 2 patients, and 4 in 6 patients. Six of them presented with high-grade paresis, and in all of them, spondylodiscitis with intraspinal and/or paravertebral abscesses was evident in MR imaging studies. All patients underwent early surgery (within 24 h after admission). The median time in intensive care was 21 days. Out of the eight patients, seven survived. One year after surgery, five patients had a good outcome (Barthel index: 100 (1); 80 (3); and 70 (1)). At the last follow-up (mean 89 months), 4 patients had a good functional outcome (Barthel index between 60 and 80). CONCLUSION Early surgical treatment in critically ill patients with spondylodiscitis and sepsis may result in rapid control of infection and can provide favorable long-term outcome. A general strategy of performing only limited surgery is a valid option in such patients who have a relatively high risk for surgery.
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Affiliation(s)
- Shadi Al-Afif
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
| | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Dirk Scheinichen
- Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Thomas Palmaers
- Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Zafer Cinibulak
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Jens D Rollnik
- Institute for Neurorehabilitation Research (InFo), BDH-Clinic Hessisch Oldendorf, Affiliated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
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Romay-Lema EM, Ventura-Valcárcel P, Iñiguez-Vázquez I, García-Pais MJ, Garcia-Garrote F, Rabuñal-Rey R, Alonso MP, Corredoira-Sánchez J. Streptococcus suis spondylodiscitis: 2 new cases and a literature review. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:66-70. [PMID: 34866038 DOI: 10.1016/j.eimce.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Streptococcus suis (S. suis) infection is poorly described zoonosis in our country, which is related with exposure to pigs or their meat. The most common clinical presentation is meningitis, while spine's involvement is rare. METHODS We report 2 cases of S. suis infection and perform a systematic review of the articles published on S. suis spondylodiscitis between January 1994 and May 2020 with the aim of defining the clinical characteristics, predisposing factors and evolution. RESULTS 17 cases are described, 76.5% males with a mean age of 57.6 years, generally without associated underlying disease. Enolism was a factor present in 17.6%. 70.6% had exposure to pigs or their meat and 20% hand injuries. The mean duration of symptoms was 10.2 days and the most affected segment was the lumbar level. 70.6% had meningitis. All were treated with beta-lactams with an average duration of 53.2 days. There was a recurrence and none died. CONCLUSION There are few cases of S. suis spondylodiscitis in the literature. When occurs, it is associated with another type of infection in most cases. They present a good response to medical treatment and a good prognosis.
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Affiliation(s)
- Eva-María Romay-Lema
- Unidad de Enfermedades Infecciosas, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | | | | | | | | | - Ramón Rabuñal-Rey
- Unidad de Enfermedades Infecciosas, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - María Pilar Alonso
- Servicio de Microbiología, Hospital Universitario Lucus Augusti, Lugo, Spain
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Fusini F, Colò G, Massè A, Girardo M. Uncommon cervical pain due by Bacillus pumilus spondylodiscitis in an immunocompetent patient: a case report. Acta Biomed 2021; 92:e2021136. [PMID: 34747374 PMCID: PMC10523035 DOI: 10.23750/abm.v92is1.10189] [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] [Received: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 11/23/2022]
Abstract
A fifty-three year-old military patient, presented with a 3 months neck pain and paraesthesia of upper right extremity after gastroscopy. Radiological examination demonstrated anuncertain degenerative/infective involvement of C6-C7 intervertebral disc. The patient underwent anterior debridement with C5-C6 disc excisional biopsy, with microbiological findings of Bacillus pumilus with high bacterial concentration. After biopsy, segment arthrodesis was achieved only with vertebral plate cruentation and 3 months of cervical collar. He completed a six-weeks course of intravenous antibiotics for the treatment of atypical spondylodiscitis. At one year of follow-up, he had no residual neck pain or neurological signs or symptoms.
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Affiliation(s)
- Federico Fusini
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Center, University of Turin, via Zuretti 29, 10121, Turin.
| | - Gabriele Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, via Venezia 16, 16121 Alessandria, Italy..
| | - Alessandro Massè
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, via Zuretti 29, 10121, Turin, Italy..
| | - Massimo Girardo
- Spine Surgery Unit, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, via Zuretti 29, 10121, Turin, Italy..
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Ohnishi T, Ogawa Y, Suda K, Komatsu M, Harmon SM, Asukai M, Takahata M, Iwasaki N, Minami A. Molecular Targeted Therapy for the Bone Loss Secondary to Pyogenic Spondylodiscitis Using Medications for Osteoporosis: A Literature Review. Int J Mol Sci 2021; 22:ijms22094453. [PMID: 33923233 PMCID: PMC8123121 DOI: 10.3390/ijms22094453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 12/11/2022] Open
Abstract
Pyogenic spondylodiscitis can cause severe osteolytic and destructive lesions in the spine. Elderly or immunocompromised individuals are particularly susceptible to infectious diseases; specifically, infections in the spine can impair the ability of the spine to support the trunk, causing patients to be bedridden, which can also severely affect the physical condition of patients. Although treatments for osteoporosis have been well studied, treatments for bone loss secondary to infection remain to be elucidated because they have pathological manifestations that are similar to but distinct from those of osteoporosis. Recently, we encountered a patient with severely osteolytic pyogenic spondylodiscitis who was treated with romosozumab and exhibited enhanced bone formation. Romosozumab stimulated canonical Wnt/β-catenin signaling, causing robust bone formation and the inhibition of bone resorption, which exceeded the bone loss secondary to infection. Bone loss due to infections involves the suppression of osteoblastogenesis by osteoblast apoptosis, which is induced by the nuclear factor-κB and mitogen-activated protein kinase pathways, and osteoclastogenesis with the receptor activator of the nuclear factor-κB ligand-receptor combination and subsequent activation of the nuclear factor of activated T cells cytoplasmic 1 and c-Fos. In this study, we review and discuss the molecular mechanisms of bone loss secondary to infection and analyze the efficacy of the medications for osteoporosis, focusing on romosozumab, teriparatide, denosumab, and bisphosphonates, in treating this pathological condition.
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Affiliation(s)
- Takashi Ohnishi
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai 072-0015, Japan; (Y.O.); (K.S.); (M.K.); (S.M.H.); (M.A.); (A.M.)
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (M.T.); (N.I.)
- Correspondence: ; Tel.: +11-81-126-63-2151
| | - Yuki Ogawa
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai 072-0015, Japan; (Y.O.); (K.S.); (M.K.); (S.M.H.); (M.A.); (A.M.)
| | - Kota Suda
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai 072-0015, Japan; (Y.O.); (K.S.); (M.K.); (S.M.H.); (M.A.); (A.M.)
| | - Miki Komatsu
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai 072-0015, Japan; (Y.O.); (K.S.); (M.K.); (S.M.H.); (M.A.); (A.M.)
| | - Satoko Matsumoto Harmon
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai 072-0015, Japan; (Y.O.); (K.S.); (M.K.); (S.M.H.); (M.A.); (A.M.)
| | - Mitsuru Asukai
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai 072-0015, Japan; (Y.O.); (K.S.); (M.K.); (S.M.H.); (M.A.); (A.M.)
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (M.T.); (N.I.)
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (M.T.); (N.I.)
| | - Akio Minami
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai 072-0015, Japan; (Y.O.); (K.S.); (M.K.); (S.M.H.); (M.A.); (A.M.)
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Pfahler S, Pflugmacher R, Karakostas P, Dabir D, Schäfer VS. [Coexistent septic arthritis and spondylodiscitis as important differential diagnosis in immunosuppressed patients]. Z Rheumatol 2020; 80:184-188. [PMID: 33336292 PMCID: PMC7929961 DOI: 10.1007/s00393-020-00943-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Abstract
Die septische Arthritis und Spondylodiszitis stellen bei immunsupprimierten Patienten eine wichtige Differenzialdiagnose des Gelenk- oder Wirbelsäulenschmerzes dar. Hierbei kommt es zu einem Erregerbefall eines Gelenks bzw. einer Bandscheibe und angrenzender Wirbelkörper. Es zeigen sich meist unspezifische Symptome wie lokaler Gelenk- oder Rückenschmerz, Fieber und verringerter Allgemeinzustand. Diagnostisch kann bei klinischem Verdacht die bakterielle Besiedelung durch eine Gelenkpunktion und Blutkulturen nachgewiesen werden. Zur Diagnosefindung einer Spondylodiszitis sollte eine bildmorphologische Darstellung mittels Magnetresonanztomographie erfolgen. Neben einer adäquaten Schmerztherapie und empirischer antibiotischer Therapie sollte bei einer septischen Arthritis die chirurgische Entfernung des infektiösen Materials aus dem Gelenk angestrebt werden. Eine chirurgische Versorgung der Spondylodiszitis sollte bei auftretenden Komplikationen erfolgen. Die folgende Kasuistik stellt den gleichzeitigen Befund einer septischen Polyarthritis und Spondylodiszitis bei einem immunsupprimierten Patienten mit HIV-Infektion vor und zeigt eindrücklich das Auftreten von Komplikationen bei Verzögerung einer adäquaten Therapie.
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Affiliation(s)
- S Pfahler
- Medizinische Klinik III, Onkologie, Hämatologie, Rheumatologie und klinische Immunologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - R Pflugmacher
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - P Karakostas
- Medizinische Klinik III, Onkologie, Hämatologie, Rheumatologie und klinische Immunologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - D Dabir
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - V S Schäfer
- Medizinische Klinik III, Onkologie, Hämatologie, Rheumatologie und klinische Immunologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland.
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Ibrahim FMF, El-Rady AERMA. Transverse process osteotomy for surgical drainage of primary iliopsoas abscess and secondary cases combined with spondylodiscitis. Int Orthop 2020; 45:165-171. [PMID: 32712788 DOI: 10.1007/s00264-020-04732-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
Iliopsoas abscess refers to collection of fluid in iliopsoas muscle compartment. It is well-known condition in medical history as a complication of tuberculous spine infection. Most of the cases now are due to pyogenic infection. Patient usually presents late due to delayed diagnosis. We aim to present a less invasive technique for surgical drainage of iliopsoas abscess. PATIENTS AND METHODS It is a prospective study done between 2015 and 2018. The study included 28 patients with confirmed diagnosis of iliopsoas abscess. Laboratory investigations included CBC, ESR, and C-reactive protein that were done for all patients. MRI with contrast enhancement was gold standard for diagnosis. Ten patients underwent surgical psoas abscess drainage by transverse process osteotomy via Wiltse approach without any other spine intervention. Eighteen patients had posterior spine fixation and interbody fusion together with transverse process osteotomy and abscess drainage as treatment for spondylodiscitis. The patients were followed up for clinical improvement, and functional assessment was done by Oswestry disability index. ESR and CRP were used for laboratory follow-up of infection subsidence. Follow-up of abscess size and resolution was done by pelvic-abdominal ultrasonography. RESULTS The mean maximum width of the abscesses in MRI axial views was 38.8 mm. Patients were divided into two groups. Group (1) included ten patients who underwent drainage only while group (2) included 18 patients who underwent spine fusion for treatment of spondylodiscitis. The amount of pus drained intra-operatively was of average 234 cc in group 1 and 191.6 in group 2. The drain was removed in average 58.6 hours post-operatively in group 1 with mean of 168.4 cc of drained fluid and in average of 74.3 hours for group 2 with mean of 350.5 cc of drained fluid. The ODI and inflammatory markers improved in all patients. The follow-up period was of average 26.7 months. The organism was isolated from 19 patients (5 patients were tuberculous and 14 patients were different pyogenic pathogens). No fluid recollection was observed in pelvic-abdominal ultrasound during follow-up in our series. CONCLUSION Transverse process osteotomy is a safe and effective approach for drainage of psoas abscess. It can be done alone or combined with posterior spine fusion for treatment of spondylodiscitis.
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Wakabayashi SI, Kimura T, Tanaka N, Pham J, Tanaka T, Higuchi S, Kobayashi J, Umemura T, Iijima A. Invasive liver abscess syndrome accompanied by spondylodiscitis: a case report and review of the literature. Clin J Gastroenterol 2020; 13:927-934. [PMID: 32638229 DOI: 10.1007/s12328-020-01161-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/14/2020] [Indexed: 11/26/2022]
Abstract
A 65-year-old man who had diabetes mellitus was referred to our hospital due to fever and back pain. Laboratory findings showed liver dysfunction and C-reactive protein (CRP) elevation. Enhanced computed tomography (CT) showed multiple liver abscesses, hepatic vein and inferior vena cava thrombosis, and spondylodiscitis in the fourth lumbar vertebrae. Based on several detections of Klebsiella pneumoniae (K. pneumoniae) in blood culture, he was diagnosed as having invasive liver abscess syndrome (ILAS), which is characterized by liver abscess and metastatic infection caused by K. pneumoniae. Despite the prompt improvement of liver abscess and thrombosis, after administering antibiotics and anticoagulant, spondylodiscitis worsened. Additionally, iliopsoas abscess emerged on repeated CT imaging. Lumbar laminectomy was needed as a radical treatment. We reviewed 12 cases of ILAS representing spondylodiscitis, and surgical treatments for spondylodiscitis were required in 7 of these cases (58%). When encountering patients with liver abscess and spondylodiscitis, we should consider the possibility of invasive disseminated K. pneumoniae infection, which is hard to treat with antibiotics alone and sometimes requires surgical treatments for spondylodiscitis.
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Affiliation(s)
- Shun-Ichi Wakabayashi
- Department of Internal Medicine, Nagano Prefectural Kiso Hospital, Kiso, Japan
- Division of Gastroenterology, Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takefumi Kimura
- Division of Gastroenterology, Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
- Molecular Signaling Section, Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bldg. 8, B1A07, Bethesda, MD, 20892, USA.
| | - Naoki Tanaka
- Department of Metabolic Regulation, Shinshu University School of Medicine, Matsumoto, Japan
- Research Center for Social Systems, Shinshu University, Matsumoto, Japan
| | - Jonathan Pham
- Molecular Signaling Section, Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bldg. 8, B1A07, Bethesda, MD, 20892, USA
| | - Tomoyuki Tanaka
- Department of Internal Medicine, Nagano Prefectural Kiso Hospital, Kiso, Japan
| | - Shohei Higuchi
- Department of Orthopedic Surgery, Nagano Prefectural Kiso Hospital, Kiso, Japan
| | - Junichi Kobayashi
- Department of Internal Medicine, Nagano Prefectural Kiso Hospital, Kiso, Japan
| | - Takeji Umemura
- Division of Gastroenterology, Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akihiro Iijima
- Department of Internal Medicine, Nagano Prefectural Kiso Hospital, Kiso, Japan
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Zhang CH, Zaidman N, Russo V. Hybrid Minimally Invasive Technique for Treatment of Thoracolumbar Spondylodiscitis and Vertebral Osteomyelitis. World Neurosurg 2020; 141:e752-e762. [PMID: 32526368 DOI: 10.1016/j.wneu.2020.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Spondylodiscitis and vertebral osteomyelitis cause significant morbidity and mortality, and typically occur in patients with multiple comorbidities. The use of minimally invasive spinal surgery in the previous decade has offered the advantages of reduced intraoperative blood loss and postoperative pain for patients. In the present report, we have described our experience with using a hybrid minimally invasive (HMI) technique (combining percutaneous fixation with a mini-open approach for decompression and debridement) for the treatment of thoracolumbar spondylodiscitis, reporting the patient demographics, intraoperative measures, and 12-month outcomes. METHODS The data from patients presenting to a tertiary referral neurosurgical center with thoracolumbar spondylodiscitis and osteomyelitis who had undergone HMI from 2016 to 2018 were retrospectively evaluated. Patient demographics, intraoperative factors, estimated blood loss, and immediate postoperative complications were recorded. The patient outcomes were evaluated using EuroQOL 5-dimension questionnaire and visual analog scale in the immediate postoperative period and at 12 months postoperatively. RESULTS A total of 13 patients were included in the present study, 12 with spontaneous infection and 1 with infection secondary to recent microdiscectomy at another institution. All the patients had systemic comorbidities with an American Society of Anesthesiologists class of ≥2. Of the 13 patients, 11 had pyogenic infections and 2 had spinal tuberculosis. The mean estimated blood loss was 546.2 mL. The mean time for patients to sit out of bed was 2.2 days, and the mean time to start mobilizing was 4.5 days. The EuroQOL 5-dimension questionnaire scores showed improvement in all modalities at 12 months postoperatively. CONCLUSIONS In our cohort, HMI was a safe and effective treatment of thoracolumbar spondylodiscitis, with the potential benefits of reduced blood loss, operative duration, and postoperative pain.
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Affiliation(s)
- Catherine Hao Zhang
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
| | - Nathalie Zaidman
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Vittorio Russo
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Andrén-Sandberg Å, Fridén T, Strömqvist B. [Spinal infection with spinal cord/cauda equina affection requires emergency handling]. Lakartidningen 2019; 116:FPZX. [PMID: 31742654] [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: 06/10/2023]
Abstract
Seventeen cases of infections in spinal structures were reported 2010-2017 to the Swedish Health and Social Care Inspectorate (IVO), a government agency responsible for supervising health care, for missed or delayed diagnosis. All patient records were scrutinized in order to find underlying causes and common factors. The delayed diagnoses were equally found among men and women and most frequent in in the age-group 65 to 79 years of age. The diagnostic delay most probably in many cases led to patient harm and avoidable sequelae, many with severe impairment for daily life. Several of the patients had a locus minoris resistentiae in the spine and in several cases the entry port of infections were cutaneous wounds, for example leg ulcers. The most important finding was that in the majority of cases the clinical investigation was inadequate and the clinical follow-up - while in hospital! - was inferior, without documentation of muscular weakness and sensory loss. In several cases a too passive management was found, when the losses eventually had become apparent, delaying surgical interventions.
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Affiliation(s)
- Åke Andrén-Sandberg
- Karolinska Universitetssjukhuset - Gastrocentrum kirurgi Stockholm, Sweden Karolinska Universitetssjukhuset - Gastrocentrum Stockholm, Sweden
| | - Thomas Fridén
- Inspektionen för vård och omsorg - Stockholm, Sweden Inspektionen för vård och omsorg - Stockholm, Sweden
| | - Björn Strömqvist
- Lund University - Orthopedics Lund/Malmö, Sweden Lund University - Orthopedics Lund/Malmö, Sweden
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Álvarez-Narváez AR, Elizalde-Martínez E, Moheno-Gallardo AJ, Lares-Cárdenas LA, López-Valencia J, Torres-González R, Morales-de Los Santos R. [Bacteriological-clinical association and characterization in Pyogenic Spondylodiscitis]. Acta Ortop Mex 2019; 33:141-145. [PMID: 32246603] [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 Determine the association between clinical characteristics and laboratory studies with the type of isolated microorganism in blood cultures of patients with Pyogenic Spondylodiscitis. MATERIAL AND METHODS It is a cross-analytical study, clinical records of patients with Pyogenic Spondylodiscitis were reviewed from January 2013 to January 2017. Univariate descriptive analysis was performed using frequencies and percentages for qualitative variables, central trend measures and dispersion for quantitative ones. Bivariate analysis by testing of 2 or Fishers exact test. Analysis of quantitative variables using T Student or Mann-Whitney U. Spearmans correlation coefficient was used. Considering statistical significance p 0.05. RESULTS A sample of 34 patients was obtained, 20 (58%) were women, median (Me) of age 60 years (52-66). Was isolated into blood cultures, Gram-positive bacteria 11 (32.4%) gram negatives 23 (67.6%). The microorganism most common isolate was Escherichia coli 12 (35.3%). Patients with Gram-negative spondylodiscitis had mild pain and globular sedimentation rate (VSG) Me 26 mm/hra P (18-36), patients with Gram-positive spondylodyscitis had severe pain and VSG Me 38 mm/h P (34-40) (p= 0.000 and 0.028, respectively). VSG and pain in the group of patients with gram-negative bacteria spondylodiscitis had a moderate Spearman correlation coefficient of 0.418, (p = 0.047); in the Gram positives group, a low correlation coefficient of Spearman 0.228, (p = 0.507). CONCLUSION There is a clinical and statistical association significant between types of isolated microorganism in blood culture, pain intensity valued on analog visual scale (EVA) and VSG levels.
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Affiliation(s)
- A R Álvarez-Narváez
- Departamento Clínico de Cirugía de Columna Ortopédica. Hospital de Traumatología y Ortopedia «Dr. Victorio de la Fuente Narváez». Unidad Médica de Alta Especialidad (UMAE), Instituto Mexicano del Seguro Social (IMSS). Colector 15 s/n (Av. Fortuna), Esq. Av. Politécnico Nacional, Col. Magdalena de las Salinas, Alcaldía. Gustavo A. Madero, CP 07760, Ciudad de México. México
| | - E Elizalde-Martínez
- Departamento Clínico de Cirugía de Columna Ortopédica. Hospital de Traumatología y Ortopedia «Dr. Victorio de la Fuente Narváez». Unidad Médica de Alta Especialidad (UMAE), Instituto Mexicano del Seguro Social (IMSS). Colector 15 s/n (Av. Fortuna), Esq. Av. Politécnico Nacional, Col. Magdalena de las Salinas, Alcaldía. Gustavo A. Madero, CP 07760, Ciudad de México. México
| | - A J Moheno-Gallardo
- Departamento Clínico de Cirugía de Columna Ortopédica. Hospital de Traumatología y Ortopedia «Dr. Victorio de la Fuente Narváez». Unidad Médica de Alta Especialidad (UMAE), Instituto Mexicano del Seguro Social (IMSS). Colector 15 s/n (Av. Fortuna), Esq. Av. Politécnico Nacional, Col. Magdalena de las Salinas, Alcaldía. Gustavo A. Madero, CP 07760, Ciudad de México. México
| | - L A Lares-Cárdenas
- Departamento Clínico de Cirugía de Columna Ortopédica. Hospital de Traumatología y Ortopedia «Dr. Victorio de la Fuente Narváez». Unidad Médica de Alta Especialidad (UMAE), Instituto Mexicano del Seguro Social (IMSS). Colector 15 s/n (Av. Fortuna), Esq. Av. Politécnico Nacional, Col. Magdalena de las Salinas, Alcaldía. Gustavo A. Madero, CP 07760, Ciudad de México. México
| | - J López-Valencia
- Departamento Clínico de Cirugía de Columna Ortopédica. Hospital de Traumatología y Ortopedia «Dr. Victorio de la Fuente Narváez». Unidad Médica de Alta Especialidad (UMAE), Instituto Mexicano del Seguro Social (IMSS). Colector 15 s/n (Av. Fortuna), Esq. Av. Politécnico Nacional, Col. Magdalena de las Salinas, Alcaldía. Gustavo A. Madero, CP 07760, Ciudad de México. México
| | - R Torres-González
- Departamento Clínico de Cirugía de Columna Ortopédica. Hospital de Traumatología y Ortopedia «Dr. Victorio de la Fuente Narváez». Unidad Médica de Alta Especialidad (UMAE), Instituto Mexicano del Seguro Social (IMSS). Colector 15 s/n (Av. Fortuna), Esq. Av. Politécnico Nacional, Col. Magdalena de las Salinas, Alcaldía. Gustavo A. Madero, CP 07760, Ciudad de México. México
| | - R Morales-de Los Santos
- Departamento Clínico de Cirugía de Columna Ortopédica. Hospital de Traumatología y Ortopedia «Dr. Victorio de la Fuente Narváez». Unidad Médica de Alta Especialidad (UMAE), Instituto Mexicano del Seguro Social (IMSS). Colector 15 s/n (Av. Fortuna), Esq. Av. Politécnico Nacional, Col. Magdalena de las Salinas, Alcaldía. Gustavo A. Madero, CP 07760, Ciudad de México. México
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Lin GX, Kim JS, Sharma S, Sun LW, Wu HH, Chang KS, Chen YC, Chen CM. Full Endoscopic Discectomy, Debridement, and Drainage for High-Risk Patients with Spondylodiscitis. World Neurosurg 2019; 127:e202-e211. [PMID: 30878748 DOI: 10.1016/j.wneu.2019.02.206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the efficacy and clinical results of full endoscopic debridement and drainage (FEDD) for high-risk patients with spondylodiscitis. METHODS Fourteen patients who underwent FEDD at our institution between November 2015 and September 2017 were retrospectively reviewed. All patients had single-level infectious spondylodiscitis and were high-risk candidates for surgery. Their general condition was evaluated according to the American Society of Anesthesiologists grading system. The Charlson Comorbidity Index was used for comprehensive assessment of comorbidity status. Outcomes were evaluated by numeric rating scale (NRS) pain score, Oswestry Disability Index, modified Macnab criteria, and radiographic images at follow-up. RESULTS All 14 patients experienced immediate relief of back pain after FEDD, with no procedure-related complications. The causative bacteria were identified in 10 of the 14 patients (71.5%). Half of the 14 patients had an American Society of Anesthesiologists score of ≥3. The average Charlson Comorbidity Index was 5.1 ± 1.6 points. Compared with the preoperative NRS score of 8.2 ± 0.9, the NRS scores at 1 week and 12 months after surgery were 3.4 ± 1.1 and 1.4 ± 1.2, respectively. A significant improvement in Oswestry Disability Index was observed after surgery (preoperative, 30.1 ± 3.9; 12 months postoperatively, 17.6 ± 6.2; P < 0.05). Satisfaction rate was 85.7% based on the Macnab criteria (excellent or good outcome). None of the patients developed any significant kyphotic deformity after FEDD. CONCLUSIONS FEDD may be an effective alternative to extensive open surgery in patients with infectious spondylodiscitis, especially those who are high-risk candidates for surgery (elderly patients with multiple comorbidities and patients in poor general condition).
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Affiliation(s)
- Guang-Xun Lin
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea; Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Sagar Sharma
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Li-Wei Sun
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsuan-Han Wu
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Kai-Sheng Chang
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Ying-Chieh Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; College of Nursing and Health Sciences, Dayeh University, Taiwan.
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Abstract
RATIONALE Gout occurs mainly in joints, but rarely in the spine. In the spine, urate crystals can cause intervertebral space instability but rarely lead to retrolisthesis. Here, we present an extremely rare disease with gout invaded the intervertebral disc with lumbar retrolisthesis. PATIENT CONCERNS A 61-years male patient with gout history has suffered from severe low back pain and intermittent claudication. Physical examination showed the level of muscle strength of his left first toe was 3/5. Images illustrated a destruction of the intervertebral space, and a retrolisthesis at L4/5 interspace and the dural sac obviously compressed. DIAGNOSES Combining with lab examinations, imaging examinations, and histopathological results, the patient was diagnosed with gouty arthritis associated with lumbar spinal stenosis, L4-5 spondylodiscitis and L4 vertebral body retrolisthesis. INTERVENTION The patient underwent posterior decompression, reduction, and interbody fusion, and then received an aggressive postoperative rehabilitation program. OUTCOMES The patient's low back pain was significantly alleviated after the operation. Postoperative X-ray shows the internal fixation was well placed and the sequence of spine was reconstructed. 12 weeks later, the lower limb symptoms of the patients were obviously improved, his muscle strength of the left first toe was 4/5, Japanese Orthopaedic Association (JOA) score was 19 and the improvement rate was 61.5%. LESSONS Gouty spondylodiscitis can cause intervertebral space instability. Sagittal imbalance and degeneration of disc with decreasing of segmental disc height are considered as the main factors of retrolisthesis. The appearance may lead to misdiagnose a patient with gout history with a destruction of the intervertebral space. Surgery is a compromise method for gouty spondylodiscitis patients with urgent neurological symptoms.
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von der Hoeh NH, Voelker A, Hofmann A, Zajonz D, Spiegl UA, Jarvers JS, Heyde CE. Pyogenic Spondylodiscitis of the Thoracic Spine: Outcome of 1-Stage Posterior Versus 2-Stage Posterior and Anterior Spinal Reconstruction in Adults. World Neurosurg 2018; 120:e297-e303. [PMID: 30144603 DOI: 10.1016/j.wneu.2018.08.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 05/20/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to compare the clinical, radiologic, and functional outcomes of a 1-stage posterior treatment versus a 2-stage posterior-anterior treatment in patients with pyogenic thoracic spondylodiscitis. METHODS A 1-stage posterior debridement, stabilization, and fusion with titanium-coated polyetheretherketone (PEEK) or mesh cage through a dorsolateral approach was performed in group A. A 2-stage procedure with initial posterior stabilization and debridement and second-stage fusion with a PEEK cage or mesh cage was performed with an anterior approach in group B. Clinical outcomes included Oswestry Low Back Pain Disability Questionnaire and visual analog scale score. Radiologic outcomes included fusion rate and kyphotic angle correction. Secondary variables included pathogens, complications, blood loss, and operative time. RESULTS One-level spondylodiscitis was treated surgically in the thoracic spine of 47 patients: 25 patients in group A and 22 patients in group B. The most frequent segment was T12-L1 (27%). There was a significantly longer operative time and greater blood loss (P > 0.001) in group B. At last follow-up, sagittal profile reconstruction was significantly better (P > 0.05) in group B. Both groups showed similar radiologic results with fusion in 92% of cases. Improved clinical outcomes, pain, and quality of life were achieved in both groups with no significant differences between the 2 groups. CONCLUSIONS Better reconstruction of the sagittal profile was achieved in the posterior-anterior-treated group, but this did not affect the clinical outcome. No significant differences were found in the clinical and functional outcomes between the 2 groups. Posterior-anterior combined treatment should be considered in cases of large anterior defects if a posterior reconstruction is inadequate.
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Affiliation(s)
| | - Anna Voelker
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Alex Hofmann
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Dirk Zajonz
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Ulrich Albert Spiegl
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Jan-Sven Jarvers
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
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Emam M, Lee D, Syrkin G, Lee SW. Evolution and Progression of Spondylodiskitis: A Case Presentation. PM R 2017; 10:97-100. [PMID: 28673734 DOI: 10.1016/j.pmrj.2017.06.017] [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] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 05/31/2017] [Accepted: 06/25/2017] [Indexed: 11/18/2022]
Abstract
Pyogenic infection of the spinal column is a relatively rare condition. Spondylodiskitis is characterized by infection of the intervertebral disk and the adjacent vertebrae. Diagnosis is often delayed because the symptoms are often nonspecific and also because of the high incidence of nonspecific low back pain in the general population. We report the case of a 42-year-old woman who developed low back pain secondary to spondylodiskitis. Her diagnosis was delayed because of a lack of supporting findings on initial magnetic resonance imaging. The case highlights the clinical scenario in which maintaining a high index of suspicion may lead to follow-up imaging and an accurate diagnosis. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Mohammed Emam
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E. 210 Street, Bronx, NY 10467
- Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Donald Lee
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E. 210 Street, Bronx, NY 10467
- Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Grigory Syrkin
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E. 210 Street, Bronx, NY 10467
- Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Se Won Lee
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E. 210 Street, Bronx, NY 10467
- Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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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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Dehghan Manshadi SA, Rezahosseini O, Abdi Liaei Z. Brucellosis With Multi-Organ Involvement in a Patient With History of Composite Aortic Graft and Hepatitis B. Acta Med Iran 2016; 54:750-753. [PMID: 28033700] [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] [Accepted: 11/14/2016] [Indexed: 06/06/2023] Open
Abstract
The brucellosis with multi-organ involvement in a patient with a history of the composite aortic graft (Bentall procedure) and Hepatitis B infection is rare. A 35-year-old man presented to us with fever and loss of consciousness. Four years ago, he was IDU and underwent cardiac surgery because of endocarditis. Recently lumbar spondylodiscitis was diagnosed. The Wright (1/320) and Coombs Wright tests (1/640) were positive. After CNS imaging, lumbar puncture was done. The CSF pleocytosis was lymphocyte dominant. In cardiac echocardiography, large vegetation on prosthetic aortic valve leaflets was seen. The brain MRI was reported abnormal. Treatment of brucellosis started with Ceftriaxone, Doxycycline, Rifampin and Gentamycin. After 4 days, he became oriented, and fever was disappeared then we continued the treatment for 16 days. The patient discharged and followed by daily phone calls. As symptoms of abdominal pain and jaundice were presented on the fifth day, he re-admitted. The patient expired because of hepatorenal and cardiac insufficiency. Drug side effects, activation of Hepatitis B and embolism of cardiac vegetation to other organs were suspected causes of death. We do not suggest medical therapy without cardiac surgery in such cases. When combination therapy is necessary for brucellosis in an HBsAg-positive patient, hepatitis virus activity should be assess by HBV-DNA PCR and the dose of drugs with known hepatotoxic effects such as rifampin and co-trimoxazole should be adjust. Combination therapy with quinolones instead of hepatoxic drugs is one of our suggustions.
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Affiliation(s)
- Seyed Ali Dehghan Manshadi
- Department of Infectious and Tropical Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Rezahosseini
- Department of Infectious and Tropical Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Abdi Liaei
- Department of Infectious and Tropical Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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García-País MJ, Rabuñal R, Armesto V, López-Reboiro M, García-Garrote F, Coira A, Pita J, Rodríguez-Macías AIB, López-Álvarez MJ, Alonso MP, Corredoira J. Streptococcus bovis septic arthritis and osteomyelitis: A report of 21 cases and a literature review. Semin Arthritis Rheum 2016; 45:738-46. [PMID: 26992635 DOI: 10.1016/j.semarthrit.2016.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/25/2016] [Accepted: 02/02/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Streptococcus bovis group (SBG) is a well-known cause of endocarditis, but its role in osteoarticular infections (OAIs) has not been well described. METHODS We analyzed all patients with OAIs by SBG diagnosed in our hospital (1988-2014). We selected those cases with septic arthritis and osteomyelitis, as defined according to clinical, microbiological, and imaging studies. Identification of the strains was performed by using the API 20 Strep and the GP card of the Vitek 2 system, and confirmed the identification by molecular methods. In addition, we reviewed the literature to select all cases of OAI by SBG during the period 1980-2015. RESULTS From the 83 cases of OAI included in the analysis (21 from our center and 62 from the literature review), 59 were osteomyelitis (57 of them spondylodiscitis) and 24 were arthritis (2 with associated spondylodiscitis). The mean age was 66.9 years, and 79.2% of the patients were men. Endocarditis (IE) was associated with 59% of the cases and this association was greater for osteomyelitis than for arthritis (78.9% vs. 13.6%; P = 0.001). OAI was a presenting symptom in 63% of the cases of IE. Colonoscopy was performed in 64 cases, which detected colorectal neoplasm (CRN) in 46 patients (71.8%), almost all asymptomatic. Some 69.5% of these neoplasm were carcinomas or advanced adenomas. The blood cultures were positive in 78.3% cases. In 45 cases, the S. bovis species was identified; in 82.2% of the cases the cause was Streptococcus gallolyticus subsp. gallolyticus. The mortality was 7.2%, which in no case was attributable to the OAI. CONCLUSIONS OAIs are frequently the initial manifestation of IE caused by SBG. S. gallolyticus causes most of these infections. Echocardiogram and colonoscopy are therefore mandatory, given the species' close association with IE and CRN.
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Affiliation(s)
| | - Ramón Rabuñal
- Infectious Disease Unit, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | - Victor Armesto
- Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | | | | | - Amparo Coira
- Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Julia Pita
- Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | | | | | - María Pilar Alonso
- Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Juan Corredoira
- Infectious Disease Unit, Hospital Universitario Lucus Augusti, Lugo, Spain
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Hurtado Caballero E, Mercader Cidoncha E, Ruiz de la Hermosa A, Amunategui Prats I, Maldonado Valdivieso P, Muñoz-Calero Peregrín A. [Not Available]. Acta Gastroenterol Latinoam 2015; 45:316-319. [PMID: 28590102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Tuberculosis is the commonest cause of spinal infection worldwide (9-46%). Tuberculosis spondylodiscitis causes multifocal thoracic and lumbar spinal disease, and big paraspinal and psoas abscesses. It is more frequent in people under 40 who had previous tuberculosis infection and from countries where the illness is endemic. Clinic is non-specific and sub-acute. We report the clinical case of a 29-year-old patient who suffered from pericardic tuberculosis in her childhood and who presents a bilateral retroperitoneal abscess due to tuberculosis spondylodiscitis. Her clinical debut began with left inguinal pain and an irreducible mass at this level that simulated an incarcerated inguinal hernia, which is why surgery was indicated. Due to discrepancies between intraoperative findings and the initial diagnosis, the diagnosis and treatment strategy were changed. The purpose of this case report is to emphasize the challenge that the diagnosis of this pathology represents, due to low incidence in our environment and poor clinical features, which results in late diagnosis and late management.
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23
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Suzuki K, Yamaguchi T, Iwashita Y, Yokoyama K, Fujioka M, Katayama N, Imai H. Case Series of Iliopsoas Abscesses Treated at a University Hospital in Japan: Epidemiology, Clinical Manifestations, Diagnosis and Treatment. Intern Med 2015; 54:2147-53. [PMID: 26328638 DOI: 10.2169/internalmedicine.54.4284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The incidence of iliopsoas abscesses has been increasing due to advances in diagnostic imaging techniques and the increased number of elderly individuals and immunodeficient patients with co-morbidities. Our aim was to investigate the management and treatment of iliopsoas abscesses, particularly the effectiveness of computed tomography (CT)-guided drainage in the era of interventional radiology. METHODS A retrospective analysis was performed at a university hospital between January 2009 and March 2014. Patients There were 15 patients (eight men, seven women) 50-85 years of age (average: 70 years) diagnosed with an iliopsoas abscess. RESULTS The etiology of the disease was investigated in 14 of the 15 patients, each of whom had a secondary iliopsoas abscess. The primary condition in nine of these patients (64.3%) was an orthopedic infection (spondylodiscitis); the most common symptom was fever (12 patients, 80%). Altogether, 10 patients (66.7%) had a multilocular abscess and five (33.3%) had bilateral abscesses. The most common pathogen was Staphylococcus aureus (seven patients, 50%). All 14 patients underwent drainage: 11 received CT-guided drainage, two underwent postdrainage surgery and one received ultrasonography-guided drainage. Poor drainage was overcome by inserting multiple drainage tubes (six patients) or performing transmembrane drainage with a guidewire. All but one patient survived. CONCLUSION Based on the high success rate of CT-guided drainage in this study, this technique is expected to continue to play a major role in cases requiring drainage, even in patients with bilateral or multilocular abscesses. However, this modality cannot be used in cases of gastrointestinal perforation.
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Affiliation(s)
- Kei Suzuki
- Emergency and Critical Care Center, Mie University Hospital, Japan
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25
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Abstract
A young mother presented her 19-month-old boy to the general practitioner (GP) with a 24 h history of reluctance to stand or walk and a slightly raised temperature. The GP arranged an assessment by the paediatrician, who organised an ultrasound of the hips which was normal. Approximately 1 week later the patient became constipated as well, was seen again by another GP but no cause was found. Another week later mother consulted the initial GP again as the boy had not shown any signs of improvement and had become more irritable. The GP arranged a review by the paediatrician and MRI scans of the hips and back were performed. These scans showed normal hips but lumbar spine changes suggestive of a spondylodiscitic event. The patient was treated with intravenous antibiotics, a corset and analgesia and made an excellent recovery.
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26
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Kwon SW, Cha JJ, Rhee JH. Prone position coronary angiography due to intractable back pain: another merit of transradial approach compared to transfemoral approach. J Invasive Cardiol 2012; 24:605-607. [PMID: 23117317] [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: 06/01/2023]
Abstract
We report a case of prone position coronary angiography due to intractable back pain via left transradial approach. When a patient cannot lie down in a supine position, prone position coronary angiography can be performed alternatively. This may be another merit of transradial approach compared to transfemoral approach on the evaluation of patients with suspected coronary artery disease.
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Affiliation(s)
- Sung Woo Kwon
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, 225 Geumhak-no, Cheoin-gu, Yongin-si, Gyeonggi-do, 449-930, Republic of Korea.
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27
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Borioni R, Fratticci L, Di Roma M, Mancinelli A, Zechini B, Versace I, Turani F, Garofalo M. Emergency treatment of a salmonella-infected abdominal aortic aneurysm associated with spondylodiscitis. Ann Ital Chir 2012; 83:343-346. [PMID: 22759472] [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: 06/01/2023]
Abstract
AIM To report surgical treatment of a ruptured abdominal aortic aneurysm (AAA) associated with spondylodiscitis due to Salmonella in emergency setting. CASE REPORT A 69-year-old male with an history of hypertension, presented with a ruptured AAA infected by nontyphoidal Salmonella (type H), associated with spondylodiscitis. Patient underwent an emergency operation consisting in surgical debridment of infected tissue and aortic replacement with a prosthetic Dacron graft impregnated with Gentamycine. The postoperative course was uneventful and the patient was discharged at day 20 after the index procedure in good clinical condition. antimicrobial therapy was continued for 8 weeks. A CT scan and nuclear medicine studies performed two months later demonstrated minimal sign of residual aortitis. A CT scan 21 months after the procedure showed complete anatomic resolution of the disease. CONCLUSIONS A rare but increasing number of aneurysms as a consequence of Salmonellosis can be observed with a high rate of morbidity and mortality, mainly in patients with a concurrent infection of the spine and paravertebral tissue. Combined antimicrobial therapy and one-stage surgical treatment can be associated with good outcome. KEYWORDS Abdominal aorta aneurysm, Mycotic aortic aneurysms, Salmonellosis, Spondylodiscitis.
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Hayati SN, Leong CL, Kumar CS, Lee C. Citrobacter koseri bacteraemia complicated by paraspinal abscess and spondylodiscitis--a case report. Med J Malaysia 2012; 67:337-339. [PMID: 23082432] [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: 06/01/2023]
Abstract
Paraspinal abscess and spondylodiscitis due to Citrobacter koseri is a very rare condition. We report a remarkable case of Citrobacter koseri bacteraemia complicated by paraspinal abscess and spondylodiscitis in a patient who has successfully been treated in our hospital. Our patient demonstrates one of the common challenges in the practice of infectious disease medicine, wherein an innocuous presentation may and often underlie a serious infection. This case report elucidates to us that the diagnosis of a paraspinal abscess and spondylodiscitis requires a high index of suspicion in at risk patient presenting with compatible signs and symptoms.
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Affiliation(s)
- Shaharuddin Nor Hayati
- Hospital Sungai Buloh, Medical Department, Jalan Hospital, Sungai Buloh, Selangor 47000, Malaysia.
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Abstract
BACKGROUND Spinal infections are an important clinical problem that often require aggressive medical therapy, and sometimes even surgery. Known risk factors are advanced age, diabetes mellitus, rheumatoid arthritis, immunosuppression, alcoholism, long-term steroid use, concomitant infections, poly-trauma, malignant tumor, and previous surgery or invasive procedures (discography, chemonucleolysis, and surgical procedures involving or adjacent to the intervertebral disc space). The most common level of involvement is at the lumbar spine, followed by the thoracic, cervical and sacral levels: lesions at the thoracic spine tend to lead more frequently to neurological symptoms. OBJECTIVE The aim of the current paper is to describe current evidence-based standards of therapy in the management of SD by emphasizing pharmacological therapy and principles and indications for bracing and surgery. METHODS A PubMed and Google Scholar search using various forms and combinations of the key words: spondylodiscitis, spine, infection, therapy, surgery, radiology, treatment. Reference citations from publications identified in the literature search were reviewed. Publications highlighted in this article were extracted based on relevancy to established, putative, and emerging diagnostic and therapeutic standards, either conservative (antibiotic therapy and bracing) or surgical. FINDINGS To date, conservative therapy, based on targeted antibiotic therapy plus bracing, represents the mainstay in the management of SD. Proper diagnosis and tailored therapy can improve clinical results and decrease the chance of failure. Surgery should be an option only for patients with complications of this disease, namely deformity, neural compression and neurological compromise. Current standards in the setting of SD are continuously evolving, as can be seen in the recent advances in the field of radiological diagnostics, and the use of growth factors and cell-therapy strategies to promote infection eradication and bone healing after surgery.
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Affiliation(s)
- Alberto Di Martino
- Center for Integrated Research, Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200 Rome 00128, Italy.
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Fisk M, Peck LF, Miyagi K, Steward MJ, Lee SF, Macrae MB, Morris-Jones S, Zumla AI, Marks DJB. Mycotic aneurysms: a case report, clinical review and novel imaging strategy. QJM 2012; 105:181-8. [PMID: 21217112 DOI: 10.1093/qjmed/hcq240] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- M Fisk
- Department of Cardiology, The Heart Hospital, London W1G 8PH, UK
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31
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Affiliation(s)
- Faycal El Guendouz
- Department of Medicine, Division of Endocrinology and Metabolism, Mohammed V Military Teaching Hospital, Morocco.
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Abstract
Bacteroides fragilis is a rare causative agent of spondylodiscitis. The pathophysiology of B. fragilis in spondylodiscitis remains largely unclear because of its rare occurrence. We herein report a case of spondylodiscitis complicated by an epidural abscess and meningitis; B. fragilis was detected in the blood of the patient. Moreover, the patient had a splenic abscess that was confirmed on magnetic resonance imaging. The patient completely recovered with antimicrobial therapy alone.
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Affiliation(s)
- Takeshi Kawakami
- Department of General Internal Medicine, Tsukuba Medical Center Hospital, Japan
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Riis P, Machraoui A, Börm W. A case of systemic brucellosis with spondylodiscitis mimicking postoperative spondylodiscitis after lumbar disc surgery. J Neurol Neurosurg Psychiatry 2011; 82:1295-6. [PMID: 20826876 DOI: 10.1136/jnnp.2010.209486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Morais RB, Gonçalves V, Pedro I, Costa MA, Durães F, Consciência G. [Infant cervical spondylodiscitis and abscess]. ACTA MEDICA PORT 2011; 24:641-644. [PMID: 22521025] [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] [Received: 02/24/2010] [Accepted: 10/16/2010] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Spondylodiscitis in childhood is rare and has non-specific clinical features, requiring a high index of suspicion. CLINICAL CASE The authors describe a nine month-old female infant, who presented at the emergency room (ER) with a torticollis for four days, without fever or trauma. Cervical X-rays were normal, and she received symptomatic treatment. Six days after, she returned to the ER with the same torticollis and also irritability, anorexia, and cervical hyper-extension. The CT scan showed cervical spondylodiscitis (C6-C7) with pre-vertebral abscess. The laboratory results only revealed a slightly elevated Sedimentation Rate. Treatment was systemic vancomycin, gentamicin and metronidazol for six weeks, followed by two weeks of oral flucloxacillin. The causative organism was not identified. The symptoms and the abscess resolved during the first week of treatment. Five days after finishing the antibiotics the magnetic resonance showed partial C6-C7 fusion, without neurologic compression or functional disability. COMMENTS Cervical spondylodiscitis with abscess is rare, especially in this age group. This case also emphasizes the importance of investigating an acquired persistent torticollis.
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Affiliation(s)
- Rita Belo Morais
- Serviço de Pediatria, Hospital de S. Francisco Xavier, Lisboa, Portugal
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35
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Whistance RN, Elfarouki GWE, Vohra HA, Livesey SA. A case of Tropheryma whipplei infective endocarditis of the aortic and mitral valves in association with psoriatic arthritis and lumbar discitis. J Heart Valve Dis 2011; 20:353-356. [PMID: 21714430] [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: 05/31/2023]
Abstract
Whipple's disease is a chronic condition that is characterized by diarrhea, weight loss and arthropathy, and caused by infection with the fastidious bacterium Tropheryma whipplei. Although once rare, Whipple's disease is being increasingly described owing mainly to advances in molecular genetics and an improved isolation of the organism. Whilst cardiac Whipple's disease occurs less commonly, especially in the absence of gastrointestinal symptoms, it has become apparent that some cases of culture-negative endocarditis may well be attributable to T. whipplei. The case is reported of a patient with Whipple's disease endocarditis in association with psoriatic arthritis and lumbar discitis.
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Affiliation(s)
- Robert N Whistance
- Department of Cardiothoracic Surgery, Southampton General Hospital, Southampton, UK
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36
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Dildy DW. A stomachache can be a pain to the rear. J Ark Med Soc 2011; 107:204-205. [PMID: 21739847] [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: 05/31/2023]
Affiliation(s)
- Dale W Dildy
- UAMS Department of Pediatrics and Arkansas Children's Hospital, USA
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Manchikanti L, Cash KA, McManus CD, Pampati V, Smith HS. One-year results of a randomized, double-blind, active controlled trial of fluoroscopic caudal epidural injections with or without steroids in managing chronic discogenic low back pain without disc herniation or radiculitis. Pain Physician 2011; 14:25-36. [PMID: 21267039] [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: 05/30/2023]
Abstract
BACKGROUND Lumbar radicular pain pathophysiology continues to be the subject of research and debate as discogenic pain is increasingly seen as a cause of non-specific low back pain. Among non-surgical methods used to manage chronic low back pain with or without disc herniation, epidural injections are one of the most common modalities. However, there is little evidence utilizing contemporary methodology for using epidural injections in patients with discogenic pain. STUDY DESIGN A randomized, double-blind, active-controlled trial. SETTING An interventional pain management practice, a specialty referral center, a private practice setting in the United States. OBJECTIVES To evaluate the effectiveness of caudal epidural injections with local anesthetic, with or without steroids, in managing chronic low back pain without disc herniation or radiculitis. METHODS A total of 120 patients were assigned to one of 2 groups. Group I patients received caudal epidural injections with local anesthetic (lidocaine 0.5% 10 mL); Group II patients received caudal epidural injections with 9 mL of 0.5% lidocaine mixed with 1 mL of steroid (either brand name or non-particulate betamethasone [6 mg] or methylprednisolone [40 mg]). Computer-generated randomization and random allocation sequence by simple randomization were the randomization techniques utilized. OUTCOMES ASSESSMENT Multiple outcome measures were utilized which included the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, functional status, and opioid intake at 3, 6, and 12 months post treatment. Significant pain relief and functional status improvement were described as a 50% or more reduction in scores from baseline. RESULTS Significant pain relief and functional status improvement were observed in 55% of the patients in Group I and 68% of the patients in Group II. In contrast, 84% of patients in Group I and 85% in Group II saw significant pain relief and functional status improvement in the successful group (62% in Group I and 68% in Group II). The average procedures per year were 3.8 ± 0.9 for Group I and 4.3 ± 0.9 for Group II. Average pain scores decreased from 8.0 ± 0.9 to 4.3 ± 1.79 for Group I and from 7.9 ± 1.0 to 3.8 ± 1.59 for Group II. There were no differences among the patients receiving one of the 3 steroids. LIMITATIONS The results of this study are limited by lack of a placebo group. CONCLUSION Caudal epidural injections with local anesthetic with or without steroids are effective in patients with chronic low back pain of discogenic origin without facet joint pain, disc herniation, and/or radiculitis.
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Omagari T, Fujita T. [Multiple suppurative arthritis, intervertebral discitis, musculus iliopsoas abscess, bacteremia caused by G group hemolytic streptococcus]. Kansenshogaku Zasshi 2010; 84:1-5. [PMID: 21648127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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German V, Papadopoulos N, Diakalis C, Goritsas C, Ferti A. Paravertebral abscess and neurological deficits in cervical brucellar spondylitis. East Mediterr Health J 2010; 16:448-450. [PMID: 20795433] [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: 05/29/2023]
Affiliation(s)
- V German
- Sotiria General Hospital of Athens, Department of lnternal Medicine, Athens, Greece
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40
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Nattier BA, Parker WT, Farress H, Griffin LH, Ramirez M. Vertebral osteomyelitis and discitis with epidural abscess: an unusual finding ten weeks post open abdominal aortic aneurysm repair. Am Surg 2010; 76:225-227. [PMID: 20336910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Barja JM, García-Silva J, Yebra-Pimentel T, Fonseca E. [Pathogenic significance of hyperkeratotic cutaneous tuberculosis]. Actas Dermosifiliogr 2010; 101:91-92. [PMID: 20109400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
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42
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Avcu S, Unal O, Turan A, Kiriş M, Yuca K. Retropharyngeal abscess presenting with acute respiratory distress in a case of cervical spondylodiscitis. B-ENT 2010; 6:63-65. [PMID: 20420084] [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: 05/29/2023] Open
Abstract
We treated a 41-year-old man who presented with dysphagia, fever and respiratory distress. Magnetic resonance imaging (MRI) showed a large retropharyngeal abscess (RPA) extending to the C5-6 level, C5-6 spondylodiscitis and a spinal epidural abscess. The RPA was drained surgically under emergency conditions. Because the tuberculin skin test was positive, the patient underwent a triple anti-tuberculous drugs regimen. After six months of drug therapy, the epidural abscess was completely resolved. One of the most important aetiologies of RPA is thought to be tuberculous spondylodiscitis, and cervical vertebrae should be scanned thoroughly with pre-operative MRI.
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Affiliation(s)
- S Avcu
- Department of Radiology, Yüzüncü Yil University Medical Faculty Van, Turkey.
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43
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Bok CW, Ng YS. Eggerthella lenta as a cause of anaerobic spondylodiscitis. Singapore Med J 2009; 50:e393-e396. [PMID: 20087537] [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
Anaerobic organisms are a rare cause of spondylodiscitis. Eggerthella lenta is an organism that is not commonly associated with spondylodiscitis. We describe a case of spondylodiscitis due to Eggerthella lenta in an 82-year-old Chinese woman presenting with back pain. The organism was isolated from tissue cultures obtained via radiology-guided biopsy.
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Affiliation(s)
- C W Bok
- Department of Rehabilitation Medicine, Singapore General Hospital, Outram Road, Singapore.
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Janssens E, Shahabpour M, Kichouh M, Goossens A, De Maeseneer M, De Mey J. Tuberculous arthritis of the finger: a forgotten disease. JBR-BTR 2009; 92:242-247. [PMID: 19999327] [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: 05/28/2023]
Abstract
We present a case of a 64-year-old man from Belgian origin with a chronic painful swelling of the third finger. A chronic arthritis from atypical germ was suspected at the third metacarpo-phalangeal joint on the plain radiography, ultrasonography and MR examination. A few months later, he developed thoracic back pain. Plain radiographs, a Technetium-99m bone scan and MR examination of the thoracic spine revealed a spondylodiscitis of the dorsal spine. A tuberculous origin was found on the biopsy of the affected dorsal vertebral bodies D9 and D10 as suspected on the first imaging examinations of the finger. Besides the patient was found to be HIV-positive. This case shows that it is important to think of musculoskeletal tuberculosis particularly in high-risk persons because if left untreated, it can be devastating.
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Affiliation(s)
- E Janssens
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Abstract
An elderly lady suffering from Paget's disease presented with severe back pain after sustaining a fall. The rise in inflammatory markers and poor response to analgesics led to the diagnosis of septic discitis [corrected] that was confirmed by MRI. A high index of suspicion for septic discitis [corrected] is necessary in elderly patients presenting with back pain and an associated rise in inflammatory markers.
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de Morais SS, Mafra MDO, Canterle EM, de Lima LL, Ribeiro SLE. [Histoplasmosis mimicking tuberculosis spondylodiscitis in a patient with rheumatoid arthritis]. Acta Reumatol Port 2008; 33:360-363. [PMID: 18846017] [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
Osteoarticular infection caused by lt i gt Histoplasma capsulatum lt i gt is rare in Rheumatoid Arthritis (RA) making its diagnosis difficult. In the immunocompetent individuals this infection is autolimited or localized, while in immunodepressed patients the infection may be disseminated, and represents the reactivation of latent focuses or exogenous acquisition. Fungemia occurs in 20% of the cases; bones and joints are involved in 15%, being the spine the most common site of infection. We describe a clinical case of a woman with RA and spondylodiscitis caused by Histoplasma capsulatum with an initial diagnosis of vertebral tuberculosis. The complications of the treatment with amphotericin B, such as, vomiting and severe hypokalemia, led to several interruptions in the medication causing the spread of the pathogen into the liver and lungs.
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Affiliation(s)
- Simora Souza de Morais
- Serviço de Reumatologia do Hospital Universitário Getúlio Vargas (HUGV), Universidade Federal do Amazonas (UFAM)
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Sumimoto K, Matsushita M, Okazaki T, Omiya M, Uchida K, Okazaki K. Crohn's disease accompanied by purulent discitis and psoas abscesses. Inflamm Bowel Dis 2008; 14:728-30. [PMID: 18213699 DOI: 10.1002/ibd.20355] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Avery KJ. Loss prevention case of the month. As usual, it's in the record. Tenn Med 2008; 101:33. [PMID: 18488681] [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: 05/26/2023]
Affiliation(s)
- Kelley J Avery
- State Volunteer Mutual Insurance Company, Brentwood, USA
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Vcelák J, Tóth L. [Surgical treatment of spondylodiscitis]. Acta Chir Orthop Traumatol Cech 2008; 75:110-116. [PMID: 18454915] [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
PURPOSE OF THE STUDY Surgical treatment of spondylodiscitis is associated with many complications and raises a number of issues for discussion. The aim of the study was to evaluate a group of patients who had undergone surgery for inflammation of the spine, and to discuss the optimal operative procedure. MATERIAL Between January 2000 and February 2005, a total of 81 patients were treated at our department for pyogenic or tuberculous spondylodiscitis. Of these, 31 (11 women and 20 men) underwent surgery. Patients treated by CT-guided abscess drainage puncture with antibiotic therapy were not included. Indications for surgery included neurological deficit in 20 patients, deformity or mechanic instability in six, and progressing septic condition in three patients. METHODS Simple decompression of nerve structures from the posterior approach, combined with drainage, was performed in seven patients, revision surgery from the posterior approach and fusion completed with suction drainage was done in five, anterior radical debridement and stabilization of the anterior column by replacement of the vertebral body was performed in 15 patients, and an anterior procedure completed with posterior instrumentation and fusion was carried out in four patients. The patients were followed up and evaluated at 3, 6 and 12 months post-operatively. RESULTS Improvement in neurological deficit by one or more Frankel grades was recorded in 30 % of the patients treated by posterior decompression and suction drainage, and in 83 % of the patients undergoing anterior debridement and stabilization. Further progression of deep infection requiring revision surgery and implant removal occurred in one patient. Clinical outcomes assessed as good or satisfactory were found in 68 % and poor results were in 32 % of the patients. DISCUSSION The selection of an optimal surgical procedure in spondylodiscitis depends on the primary localization of infectious lesions. In a typical anterior form of spondylodiscitis, anterior debridement and suction drainage are preferred. Reconstruction of the anterior spinal column in the presence of major destruction, and stabilization of an infected spine still remain challenging issues. CONCLUSIONS Radical debridement with deformity correction and segmental stabilization provide an efficient method of treatment for the most frequent anterior forms of pyogenic and tuberculous spondylodiscitis. The use of titan implants does not significantly increase the risk of persistent infection or its recurrence.
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Affiliation(s)
- J Vcelák
- Ortopedická klinika 1. LF UK a IPVZ FN Na Bulovce, Praha.
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Haveman LM, van Es HW, ten Berge-Kuipers M. [Complaints of back pain in childhood: find curable causes]. Ned Tijdschr Geneeskd 2008; 152:353-358. [PMID: 18380379] [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
Three children, a 13-year-old boy and a 3-year-old and 6-year-old girl, were presented to the hospital with back pain, caused by Scheuermann's disease, spondylodiscitis and sickle cell disease, respectively. The boy with Scheuermann's disease received exercise therapy, the spondylodiscitis was treated with antibiotic therapy and the girl with sickle cell disease was given hyperhydration and folic acid. Although back pain is a common problem in children and teenagers, it is infrequently reported in the clinic. In contrast to back pain in adults, the same complaint in childhood is more often caused by a serious disorder which should be treated. Various causes of back pain in children can be distinguished: mechanical problems, infections of the lumbar spine, neoplasia, inflammation, and other causes, such as sickle cell disease. A child or adolescent presenting to the clinic with complaints of back pain deserves a careful detailed evaluation of the history, appropriate physical examination and additional investigation. Alarm symptoms are an increase in back pain, age below 4 years, pain during the night, restriction in function, systemic complaints or neurological deficits.
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Affiliation(s)
- L M Haveman
- St. Antonius Ziekenhuis, afd. Kindergeneeskunde, Nieuwegein.
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