Tuberculous spondylitis after percutaneous vertebroplasty: A case series of 9 cases

Analysis of Prognostic Factors in Osteoporotic Patients Who Were Treated with Percutaneous Vertebroplasty for Refracture After Vertebral Augmentation

OBJECTIVE

To retrospectively analyze prognostic factors in osteoporotic patients who treated with percutaneous vertebroplasty for refracture after vertebral augmentation.

METHODS

A retrospective analysis was performed of 61 patients with refractures after vertebral augmentation who received percutaneous vertebroplasty treatment again from January 2019 to December 2021. Based on the presence of back pain at the last follow-up, 17 patients were placed in the pain group, and 44 patients were placed in the pain-free group. The following covariates were reviewed: age; bone mineral density; bone cement dosage; bone cement leakage; body mass index; and rate of anterior vertebral height (AVH) loss in the target before surgery, 1 week after surgery, and at last follow-up. Patients were assessed using visual analogue scale score and Oswestry Disability Index.

RESULTS

Binary logistic regression analysis revealed that the rate of AVH loss after surgery was associated with postoperative back pain. According to the receiver operating characteristic curve analysis, the area under the curve of AVH loss rate at 1 week after surgery was 0.6845, and the cutoff value was 0.18; the area under the curve of AVH loss rate at the last follow-up was 0.7306, and the cutoff value was 0.2815. Kaplan-Meier survival analysis showed that patients with lower AVH loss rates had lower incidence of postoperative back pain and better prognosis.

CONCLUSIONS

Occurrence of postoperative back pain was strongly associated with AVH loss after surgery. Patients with a lower rate of AVH loss had a lower incidence of postoperative back pain and a better prognosis.

Risk factors for tuberculous or nontuberculous spondylitis after percutaneous vertebroplasty or kyphoplasty in patients with osteoporotic vertebral compression fracture: A case-control study

Objectives

The contributing factors for spondylitis after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) remain unclear. Here, we sought to investigate the factors affecting spondylitis occurrence after PVP/PKP. We also compared the clinical characteristics between patients with tuberculous spondylitis (TS) and nontuberculous spondylitis (NTS) following vertebral augmentation.

Methods

Literature searches (from January 1, 1982 to October 16, 2020) using MEDLINE, EMBASE, Google Scholar and Web of science databases were conducted to identify eligible studies according to predefined criteria. The local database was also retrospectively reviewed to include additional TS and NTS patients at our center.

Results

Thirty studies from the literature and 11 patients from our local institute were identified, yielding a total of 23 TS patients and 50 NTS patients for analysis. Compared with NTS group, patients in the TS group were more likely to have a history of trauma before PVP/PKP treatment. Univariate analyses of risk factors revealed pulmonary tuberculosis and diabetes were significant factors for TS after PVP/PKP. Analyzing NTS, we found obesity, a history of preoperative trauma, urinary tract infection, diabetes and multiple surgical segments (≥2) were significantly associated with its occurrence following PVP/PKP treatment. Multivariate logistic analyses showed a history of pulmonary tuberculosis and diabetes were independent risk factors for TS after PVP/PKP, while diabetes and the number of surgically treated segments independently influenced NTS development.

Conclusions

A history of pulmonary tuberculosis and diabetes were independent risk factors for TS. For NTS, diabetes and the number of surgically treated segments significantly influenced the occurrence of postoperative spinal infection. These data may be helpful for guiding risk stratification and preoperative prevention for patients, thereby reducing the incidence of vertebral osteomyelitis after PVP/PKP.

Simultaneous-onset infectious spondylitis with vertebral fracture mimicking an acute osteoporotic vertebral fracture erroneously treated with balloon kyphoplasty: illustrative case

BACKGROUND

Early balloon kyphoplasty (BKP) intervention for acute osteoporotic vertebral fracture (OVF) has been reported to be more effective than the conservative treatment. However, complications of early BKP intervention are still unknown.

OBSERVATIONS

A 71-year-old patient with OVF of L2 underwent BKP 2 weeks after symptom onset. Preoperative magnetic resonance imaging (MRI) and radiograph were compatible with new L2 OVF. Although computed tomography (CT) images revealed the atypical destruction of lower endplate of L2 as OVF, L2 BKP was planned. After BKP, his back pain improved dramatically. Two weeks after BKP, his lower back pain recurred. MRI and CT confirmed the diagnosis of infectious spondylitis with paravertebral abscess formation. With adequate antibiotic treatment and rehabilitation, he was symptom-free and completely ambulatory without signs of infection.

LESSONS

Signal changes on the fractured vertebral bodies during initial MRI and fractured vertebral instability on radiograph can mislead the surgeon to interpret the infection as a benign compression fracture. If the patients exhibit unusual destruction of the endplate on CT imaging, “simultaneous-onset” spondylitis with vertebral fracture should be included in the differential diagnosis. To determine the strategy for OVF, preoperative biopsy is recommended if simultaneous-onset spondylitis with vertebral fracture is suspected.

Comparison of Anterior and Posterior Decompressions in Treatment of Traumatic Thoracolumbar Spinal Fractures Complicated with Spinal Cord Injury

Background

For patients with thoracolumbar spinal fractures complicated with spinal cord injury, timely surgery is the first choice. We compared the effects of anterior and posterior decompressions in treatment of these patients.

Material/Methods

A total of 80 male patients with traumatic thoracolumbar spinal fractures and spinal cord injury were prospectively selected and divided into 2 groups. The control group underwent posterior decompression and internal fixation and the observation group underwent real-time anterior decompression.

Results

The observation group had longer operative time and length of postoperative hospital stay, larger intraoperative blood loss, remarkably greater immediate postoperative anterior height and middle column height of the fractured vertebrae, and a notably smaller Cobb’s angle than in the control group. The total ASIA score was significantly higher in the observation group than in the control group immediately after surgery and at 6 months and 1 year after surgery. The maximal urine flow, maximal detrusor pressure, and bladder compliance were also evidently higher in the observation group than in the control group during 1 year of follow-up. Compared with the control group, the International Index of Erectile Function-5 (IIEF-5) score in the observation group was significantly higher at 3 months, 6 months, and 1 year after surgery.

Conclusions

Compared with the posterior approach, anterior decompression in patients with thoracolumbar spinal fractures complicated with spinal cord injury can effectually enhance the surgical efficiency, and restore the physiological anatomy of the fractured vertebrae, thereby improving patient quality of life.

The many (sur)faces of B cells

This issue of the Biomedical Journal is dedicated to the latest findings concerning the complex development and functions of B lymphocytes, including their origins during embryogenesis, their meticulous control by the CD22 receptor and different types of T cells, as well as the immunosuppressive abilities of certain B cell subsets. Furthermore, we learn about the complicated genetic background of a rare cardiac disease, the surgical outcomes of pure conus medullaris syndrome and occurrences of tuberculous spondylitis after percutaneous vertebroplasty. Finally, we discover that brain waves could very well be used for biometric authentication and that diffusion imaging displays good reproducibility through a spectrum of spatial resolutions.