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Motov S, Stemmer B, Krauss P, Bonk MN, Wolfert C, Steininger K, Shiban E, Sommer B. Clinical and surgical outcome in patients with cervical spondylodiscitis-a single-center retrospective case series of 24 patients. Front Surg 2024; 11:1292977. [PMID: 38887314 PMCID: PMC11180735 DOI: 10.3389/fsurg.2024.1292977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 05/16/2024] [Indexed: 06/20/2024] Open
Abstract
Objective Cervical spondylodiscitis is a rare pathology, with an incidence of 0.5-2.5 per 100,000 population, posing significant potential risks. This type of infection can lead to neurological impairment in up to 29% of patients. Radical surgical debridement of the infected segment, fusion, and an intravenous antibiotic regimen remains the gold standard in most spine centers. This study aimed to analyze the surgical outcome in a tertiary spine center based on disease severity. Methods In this study, we retrospectively included all patients diagnosed with cervical spondylodiscitis and treated at the University Hospital Augsburg between January 2017 and May 2022. We collected and analyzed baseline parameters on clinical presentation with symptoms, laboratory parameters, radiological appearance, and surgical parameters such as type of approach and implant, as well as neurological and radiological outcomes. Descriptive statistics were performed using SPSS, and relevant correlations were examined using the t-test for independent samples and the chi-square test. Results Twenty-four patients (9%) with cervical spondylodiscitis were identified. Twenty-two (92%) surgically treated patients were subdivided into the complicated discitis group (n = 14, 64%) and the uncomplicated discitis group (n = 8, 36%). Seventeen patients (71%) presented with sepsis on admission, 17 patients (71%) were diagnosed with epidural abscess on primary imaging, and 5 patients (21%) had more than one discitis lesion at a distant spinal segment. The presence of epidural abscess was significantly associated with systemic sepsis (OR = 6.2; p = 0.03) and myelopathy symptoms (OR = 14.4; p = 0.00). The most frequently detected specimen was a multisensitive Staphylococcus aureus (10 patients, 42%). Six patients (25%) died after a median of 20 days despite antibiogram-accurate therapy, five of whom were diagnosed with a complicated type of discitis. The follow-up data of 15 patients (63%) revealed permanent neurological damage in 9 patients (38%). Notably, the surgical approach was a significant factor for revision surgery (p = 0.008), as three out of five (60%) ventrodorsal cases with complicated discitis were revised. Conclusion Cervical spondylodiscitis represents a severe infectious disease that is often associated with permanent neurological damage or a fatal outcome, despite adequate surgical and antibiotic treatments. Complicated types of discitis may require a more challenging surgical and clinical course.
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Affiliation(s)
- S. Motov
- Klinik für Neurochirurgie, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - B. Stemmer
- Klinik für Neurochirurgie, Universitaetsklinik Augsburg, Augsburg, Germany
| | - P. Krauss
- Klinik für Neurochirurgie, Universitaetsklinik Augsburg, Augsburg, Germany
| | - M. N. Bonk
- Klinik für Neurochirurgie, Universitaetsklinik Augsburg, Augsburg, Germany
| | - C. Wolfert
- Klinik für Neurochirurgie, Universitaetsklinik Augsburg, Augsburg, Germany
| | - K. Steininger
- Klinik für Neurochirurgie, Universitaetsklinik Augsburg, Augsburg, Germany
| | - E. Shiban
- Klinik für Neurochirurgie, Universitaetsklinik Augsburg, Augsburg, Germany
| | - B. Sommer
- Klinik für Neurochirurgie, Universitaetsklinik Augsburg, Augsburg, Germany
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Encarnación-Santos D, Valerievich KA, Scalia G, Shestov E, Pachev M, Wellington J, Bozkurt I, Rubenovich-Chikara D, Kirilin I, Chmutin G, Tapia A, Ekhsan N, Chaurasia B. Spondylodiscitis: Understanding pathophysiology, surgical strategies, and postoperative management - A single-center study. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:185-189. [PMID: 38957766 PMCID: PMC11216645 DOI: 10.4103/jcvjs.jcvjs_164_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/23/2024] [Indexed: 07/04/2024] Open
Abstract
Background Spondylodiscitis (SD) is an inflammatory condition affecting the intervertebral discs and adjacent structures, often leading to serious complications, including epidural abscesses. This study aimed to differentiate postoperative SD from spontaneous cases caused by osteoporotic defects and associated pathologies, evaluating the frequency of SD in spinal diseases at a single center. Materials and Methods A retrospective observational study involving 25 patients was conducted, analyzing variations between postoperative revisions in SD patients and spontaneous SD due to concurrent pathology and osteoporotic defects. The effects of postoperative wound healing following transforaminal lumbar interbody fusion and decompressive hemilaminectomy with pedicle screws were also investigated. Ethical guidelines were strictly followed during the study, conducted from January 2023 to September 2023 at Moscow City Clinical Hospital No. 68, Demikhova V.P. Results Among the 25 patients with spontaneous SD, 15 females and 10 males were included, with only two undergoing surgical revision. Predominant purulent inflammatory foci were observed at specific spinal levels, and demographics revealed prevalent comorbidities such as arterial hypertension (80%) and type 2 diabetes mellitus (60%). Postoperative complications included paravertebral abscesses and wound-related issues. Structural observations indicated vertebral destruction, joint gaps, and localized spinal canal narrowing, revealing complexities in SD cases. Conclusion Surgical intervention remains crucial for addressing SD-related vertebral complications, while antimicrobial therapy tailored to specific pathogens is pivotal. Concurrent conditions necessitate comprehensive management, often involving cardiological interventions. Postoperatively, a combined approach of conservative therapy and calcium phosphate adjuncts is recommended, especially considering the observed low bone density, aiming to optimize patient recovery and spinal stability.
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Affiliation(s)
| | - Kim-A Valerievich
- Deparment of Neurosurgery, City Clinical Hospital № 68 Gbuz Gkb Im. V.P. Demikhova, Moscow, Russia
| | - Gianluca Scalia
- Department of Head and Neck Surgery, Neurosurgery Unit, Garibaldi, Hospital, Catania, Italy
| | - Eugeny Shestov
- Deparment of Neurosurgery, City Clinical Hospital № 68 Gbuz Gkb Im. V.P. Demikhova, Moscow, Russia
| | - Murat Pachev
- Deparment of Neurosurgery, City Clinical Hospital № 68 Gbuz Gkb Im. V.P. Demikhova, Moscow, Russia
| | - Jack Wellington
- London School of Hygiene and Tropical Medicine, Branford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ismail Bozkurt
- Department of Neurosurgery, Medical Park Ankara Hospital, Ankara, Turkey
- Department of Neurosurgery, School of Medicine, Yuksek Ihtisas University, Ankara, Turkey
| | | | - Igor Kirilin
- Deparment of Neurosurgery, City Clinical Hospital № 68 Gbuz Gkb Im. V.P. Demikhova, Moscow, Russia
| | - Gennady Chmutin
- Department of Neurosurgery, People of Friendship University RUDN, Moscow, Russia
| | - Ariel Tapia
- Deparment of Orthopedic, Hospital Dr. Dario Contreras Santo Domingo, Santo Domingo Este, Dominican Republic
| | - Naim Ekhsan
- Deparment of Neurosurgery, City Clinical Hospital № 68 Gbuz Gkb Im. V.P. Demikhova, Moscow, Russia
| | - Bipin Chaurasia
- Department of Neurosurgery, Bhawani Hospital and Research Center, Birgunj, Nepal
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Wu CY, Tseng CS, Lee YJ. Infected calcium oxalate stone leading to pyogenic spondylodiscitis and bilateral lower limb weakness: a case report. Ann Med Surg (Lond) 2023; 85:5183-5186. [PMID: 37811066 PMCID: PMC10553182 DOI: 10.1097/ms9.0000000000001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/08/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction and importance It is rare for calcium oxalate renal stone, presented mainly in sterile urine, to result in urinary tract infection. The stone-related infection could develop spondylodiscitis, causing neurological deficits. To date, there are no reports about calcium oxalate partial staghorn stone and spondylodiscitis. Case presentation A 62-year-old male suffered from haematuria, fever, and flank pain. He came to the urology outpatient department, where acute pyelonephritis was diagnosed, and a left partial staghorn stone was seen on computed tomography. Oral antibiotics were prescribed with improvement. Two weeks after antibiotics treatment, he developed bilateral lower limb weakness and numbness under the nipple level. He was brought to the emergency department, where the spine MRI revealed T2-T3 spondylodiscitis with epidural abscess and spinal cord compression. He underwent T2-T3 spine operation with improvement in muscle power and hypesthesia. The culture of the surgical lesion yielded Citrobacter koseri, the same as the urine culture obtained at his first visit. Left-side percutaneous nephrolithotomy was performed 1 month after with successful stone removal and resolution of pyuria. Stone analyses reported calcium oxalate. Follow-up MRI showed marked improvement with resolution of spondylodiscitis. Clinical discussion Urinary tract infection resulting from partial staghorn stone, with additional hematogenous spread causing spondylodiscitis, is scarcely discussed. The authors illustrated a case with calcium oxalate stone, belonging to sterile Jensen's classification type 1. However, a urinary tract infection could be seen in urine stasis or obstruction. Conclusion With accurate diagnosis and essential interventions, the patient had immediate neurological improvement and reached disease-free status.
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Affiliation(s)
- Cheng-Yang Wu
- Department of Medical Education, National Taiwan University Hospital
| | - Chi-Shin Tseng
- Department of Urology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Yuan-Ju Lee
- Department of Urology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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Oka M, Suzuki A, Terai H, Kato M, Toyoda H, Takahashi S, Tamai K, Nakamura H. Factors Predicting the Final Diagnosis in Image-Guided Percutaneous Needle Biopsy for Suspected Spinal Tumors. J Clin Med 2023; 12:4292. [PMID: 37445327 DOI: 10.3390/jcm12134292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
In cases of suspected spinal tumors on imaging studies, a biopsy is often necessary for establishing the diagnosis. Predictive factors for tumors or malignancies may help in scheduling biopsies or avoiding unnecessary ones. However, there have been few studies on determining these factors. We aimed to determine the factors associated with the final diagnosis in cases requiring spinal biopsy. This study included 117 patients who underwent image-guided (fluoroscopy- or computed tomography [CT]-guided) needle biopsy of the spine. Data on patient demographic, pathological diagnoses, and final diagnoses were retrospectively collected from the medical records. The imaging features and location of lesions were also evaluated on CT and magnetic resonance imaging. Furthermore, factors related to tumors or malignancies were analyzed. The diagnostic accuracy of biopsy was 94.0%, and there was no difference in the diagnostic accuracy between the fluoroscopic and CT-guided biopsies. Sixty-six and fifty-six patients were diagnosed with spinal tumors and malignant tumors, respectively. Multivariate analysis revealed that a history of malignant tumors and the presence of pedicle lesions and/or extravertebral lesions were related factors for both tumors or malignancy in the final diagnosis. These findings can help determine the necessity for or timing of biopsy in patients with suspected spinal tumors.
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Affiliation(s)
- Makoto Oka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka 545-8585, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka 545-8585, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka 545-8585, Japan
| | - Minori Kato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka 545-8585, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka 545-8585, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka 545-8585, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka 545-8585, Japan
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Bernard E, Enelis B, Nurmukhametov R, Ramirez MDJE, Dosanov M, Shirshov I, Efe IE, Ramirez Pena IJ, Barrientos Castillo RE. Surgical Management of Lumbar Hardware Failure Due to Recurrent Postoperative Spondylodiscitis: Case Report. Cureus 2022; 14:e27457. [PMID: 36060329 PMCID: PMC9420540 DOI: 10.7759/cureus.27457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 11/24/2022] Open
Abstract
Spondylodiscitis is a rare bacterial infection of the vertebrae and intervertebral discs that causes inflammation and follows a destructive course. When conservative management fails, surgical management requires immediate debridement of the infective focus, with decompression and stabilization through a ventral approach. The most frequently involved locations are the lumbar spine (58%), thoracic (30%), and cervical (11%) regions. Gram-positive organisms such as Staphylococcus aureus and Streptococcus species are the most commonly isolated organisms (67% and 24%, respectively). Pathophysiologically, infectious spondylodiscitis begins in the anterior portion of the vertebral body, due to its rich vascular supply, and then spreads to the rest of the vertebral body and along the medullary spaces. In this study, we report the management of recurrent lumbar postoperative spondylodiscitis with transforaminal lumbar interbody fusion (TLIF) hardware failure in a 62-year-old female.
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Ahlhelm F, Rotzinger R, Heesen M, Gebhard H, Omidi R. [Spinal ozone therapy]. Radiologe 2021; 61:736-741. [PMID: 34244811 PMCID: PMC8328893 DOI: 10.1007/s00117-021-00878-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/16/2022]
Abstract
Klinisches/methodisches Problem Technische Fortschritte auf dem Gebiet der spinalen interventionellen Neuroradiologie ermöglichen es, eine breite Palette an gezielten, minimal-invasiven Behandlungsoptionen einschließlich der spinalen Ozontherapie beim Rückenschmerz anzuwenden. Dieser Beitrag gibt eine Übersicht der biochemischen, molekularen, immunologischen und pharmazeutischen Mechanismen sowie Applikationstechniken der gezielten Ozontherapie. Radiologische Standardverfahren Zum Einsatz kommen die Computertomographie (CT) sowie konventionelle Röntgenaufnahmen (Durchleuchtung). Leistungsfähigkeit Die CT-gesteuerten Interventionen (epidural, periradikuläre, Facettengelenk und intradiskal) haben den höchsten Stellenwert und haben sich historisch durchgesetzt. Durchleuchtungsgesteuerte Verfahren können ebenfalls eingesetzt werden. Schlussfolgerung Die Ozontherapie liefert vielversprechende Ergebnisse. Der Beitrag soll dazu dienen, Informationen über die Grundlagen dieser Technik(en) zu vermitteln.
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Affiliation(s)
- F Ahlhelm
- Abteilung Neuroradiologie, Zentrum für Bildgebung, Kantonsspital Baden AG, Baden, Schweiz
| | - R Rotzinger
- Abteilung Neuroradiologie, Zentrum für Bildgebung, Kantonsspital Baden AG, Baden, Schweiz
| | - M Heesen
- Abteilung Anästhesie und Intensivmedizin, Kantonsspital Baden AG, Baden, Schweiz
| | - H Gebhard
- Klinik für Traumatologie, Universitätsspital Zürich ZH, Zürich, Schweiz.,Abteilung Wirbelsäulenchirurgie, Kantonsspital Baselland BL, Baselland, Schweiz
| | - R Omidi
- Abteilung Neuroradiologie, Zentrum für Bildgebung, Kantonsspital Baden AG, Baden, Schweiz.
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