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Treffy RW, Laing B, Eraky AM, Shabani S. Cervical spine spondylodiscitis: Review of literature on current treatment strategies. Heliyon 2023; 9:e17875. [PMID: 37483708 PMCID: PMC10359881 DOI: 10.1016/j.heliyon.2023.e17875] [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: 01/16/2023] [Revised: 05/15/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023] Open
Abstract
Infections of the spine are an ever-increasing health concern requiring an often complex and prolonged treatment that can lead to significant morbidity. Of particular interest is the cervical spine where there is an increase rate of post-infectious deformity, secondary neurological deficits and substantially higher rates of associated morbidity and mortality than the thoracic or lumbar spine. In this review, we explore the diagnosis and treatment of spondylodiscitis with particular focus on the cervical spine.
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Affiliation(s)
- Randall W. Treffy
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Brandon Laing
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Akram M. Eraky
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Saman Shabani
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
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Jeon S, Yu D, Bae SW, Kim SW, Jeon I. Analysis of Clinical Factors Associated with Medical Burden and Functional Status in Pyogenic Spine Infection. J Clin Med 2023; 12:jcm12072551. [PMID: 37048635 PMCID: PMC10095451 DOI: 10.3390/jcm12072551] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/16/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Background and purpose: Pyogenic spinal infection (PSI) has recently been on the rise due to aging and increasing degenerative spinal disease related procedures. PSI requires long-term antibiotic treatment and is followed by sustained functional disability even after successful treatment. This study aimed to analyze the clinical factors associated with medical burden and functional status of PSI. Methods: This retrospective study involved patients with non-postoperative PSI of thoraco-lumbo-sacral area in a single tertiary hospital. The length/cost of hospitalization with an antibiotic therapy and severity of back pain using the short form 36 (SF-36) were defined as the medical burden and functional status, respectively. We analyzed the clinical factors associated with medical burden and functional status. Results: We enrolled 142 patients (91 males and 51 females). The length and cost of hospitalization were 55.56 ± 27.09 (7–172) days and $14,070.17 ± 9289.39 (1611.87–48,722.35), respectively. A recurrence rate of 7.7% (11/142) and significant improvement of SF-36 at six months after completion of antibiotic treatment were noted (p < 0.05). Procedure-related (OR 2.702), C-reactive protein (CRP; OR 1.062), bacteremia (OR 4.966), additional surgical treatment (OR 6.524), recurrence (OR 12.453), and paraspinal abscess (OR 5.965) for above-average length of hospitalization were observed; female (OR 4.438), CRP (OR 1.071), bacteremia (OR 4.647), additional surgical treatment (OR 6.737), recurrence (OR 22.543), and extent of lesion (OR 1.431) for above-average cost of hospitalization; leg weakness (OR 15.966), white blood cell (WBC; OR 1.116), Charlson’s comorbidity index (CCI, OR 1.485), and identification of causative bacteria (OR 2.913) for below-average initial SF-36 were observed; leg weakness (OR 7.975) and WBC (OR 1.094) for below-average 6-month SF-36 were the statistically significant clinical factors in the multivariable logistic regression analysis (p < 0.05). Conclusion: Recurrence and leg weakness were identified as the most important clinical factors for medical burden and functional status in PSI, respectively. We think that it is necessary to actively suppress recurrence and manage neurological deficits for decreasing medical burden and achieving favorable functional outcome in the treatment of PSI.
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Affiliation(s)
- Seongmin Jeon
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea; (S.J.); (D.Y.); (S.W.K.)
| | - Dongwoo Yu
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea; (S.J.); (D.Y.); (S.W.K.)
| | - Sang Woon Bae
- Department of Infectious Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea;
| | - Sang Woo Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea; (S.J.); (D.Y.); (S.W.K.)
| | - Ikchan Jeon
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea; (S.J.); (D.Y.); (S.W.K.)
- Correspondence: or
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Giordan E, Radaelli R, Gallinaro P, Pastorello G, Zanata R, Canova G, Marton E, Del Verme J. Bibliographic Study and Meta-Analysis of Clinical Outcomes of Full-Endoscopic Spine Surgery for Painful Lumbar Spine Conditions. World Neurosurg 2023; 171:e64-e82. [PMID: 36442782 DOI: 10.1016/j.wneu.2022.11.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Full-endoscopic spine surgery (FESS) indications already cover degenerative, infectious, and neoplastic diseases. This study aimed to use a bibliometric search and meta-analysis of the highest-quality studies in the last 20 years to determine the quantity and quality of FESS research, geographic distribution, and the outcomes for lumbar conditions. METHODS Articles on FESS published from 2000 to 2022 were screened and assessed through Web of Science, PubMed, and Scopus. Also, databases were searched for longitudinal studies to pool in a meta-analysis of patients undergoing FESS for lumbar conditions. After stratifying the risk of bias and having collected the studies of the highest quality, we included the proportion of patients with a satisfactory outcome and intraoperative and postoperative adverse events after the analysis of lumbar spine conditions. RESULTS A total of 728 articles were identified by the bibliographic search. Between 2000 and 2021, the published articles increased 21-fold. Most were from China (70.15%), followed by South Korea (19.5%). Most were retrospective (68.3%) and regarding treatment of lumbar disease (86.4%). Fifty studies, including 34,828 patients, were pooled in the meta-analysis. More than 85% of patients experienced satisfactory improvement in each of different lumbar conditions. Major adverse events were <2%; recurrence and postoperative dysesthesia rates were within those reported for open or mini-invasive procedures. CONCLUSIONS This study may fill research gaps on FESS and lead to adequately designed studies. Our meta-analysis showed that FESS for lumbar diseases is a procedure with satisfactory outcomes and low rates of adverse events.
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Affiliation(s)
- Enrico Giordan
- Neurosurgical Department, Aulss2 Marca Trevigiana, Treviso, Italy.
| | | | - Paolo Gallinaro
- Neurosurgical Department, Aulss2 Marca Trevigiana, Treviso, Italy
| | | | - Roberto Zanata
- Neurosurgical Department, Aulss2 Marca Trevigiana, Treviso, Italy
| | - Giuseppe Canova
- Neurosurgical Department, Aulss2 Marca Trevigiana, Treviso, Italy
| | - Elisabetta Marton
- Neurosurgical Department, Aulss2 Marca Trevigiana, Treviso, Italy; Department of Neuroscience, University of Padova, Padova, Italy
| | - Jacopo Del Verme
- Neurosurgical Department, Aulss2 Marca Trevigiana, Treviso, Italy
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Mirbagheri A, Etminan N, Schölch S, Maier C, Perrin J, Enders F. Lumbar Spondylodiscitis Mimicking Cholecystitis: A Case Report and Review of Literature. J Neurol Surg A Cent Eur Neurosurg 2023; 84:95-102. [PMID: 35354214 DOI: 10.1055/a-1811-7393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Lower back pain is a frequent cause of emergency department visits and one of the leading causes of the disease burden worldwide. The purpose of this case report and literature review was to discuss atypical abdominal entities mimicking spinal diseases typically presenting with lower back pain. METHODS A 79-year-old man presented with lower back pain and urinary incontinence after receiving a non-image-guided lumbar infiltration treatment 4 weeks prior to admission. The magnetic resonance imaging (MRI) highlighted multisegmental hyperintensities in the intervertebral disk spaces of the lumbar spine indicative for spondylodiscitis. Antibiotic treatment over a week did not lead to significant clinical improvement. Blood cultures, cardiologic, otorhinolaryngologic, and dental examinations turned out negative for a focus of infection. A computed tomography (CT) guided biopsy was indicated after discontinuation of antibiotic treatment for less than 24 hours. Rapid clinical deterioration with concomitant onset of abdominal pain resulted in the diagnosis of cholecystitis, which required cholecystectomy. We performed a systematic literature review using the Pubmed database for the keywords "spondylodiscitis," "spine," "abdominal," and "cholecystitis," to identify abdominal diseases that mimic spine pathologies and spinal diseases that mimic abdominal pathologies. RESULTS No other report in English literature of cholecystitis associated with initial onset of lower back pain was identified. Eighteen reports referred to abdominal conditions that mimic spinal diseases, among them a patient with cyclic lumbar back pain who received a lumbar spinal fusion who, after persisting symptoms led to further diagnostic procedures, was ultimately diagnosed with endometriosis. Spinal symptoms included paraplegia and urinary incontinence as results of acute aortic pathologies. Eleven reports presented spinal pain mimicking abdominal conditions including abdominal pain and diarrhea as well as have had surgical procedures such as an appendectomy before the spinal condition was discovered. CONCLUSION Clinical symptoms of the spine such as lower back pain can be unspecific and lead to false conclusions in the presence of concomitant pathologies in MRI. Only clinical deterioration in our case patient prompted correction of the diagnosis on day 7. Initial workup for alternative common infectious foci such as lung and urinary tract was performed, but further abdominal workup despite the absence of abdominal symptoms may have led to an earlier diagnosis. Our literature review found several cases of misdiagnosed spinal and abdominal conditions. Some had undergone unnecessary surgical procedures before the right diagnosis was made. Because of the high incidence of symptoms such as lumbar back pain and abdominal pain, considering optimal patient care as well as economic aspects, it would be essential to conduct an interdisciplinary clinical management to avoid errors in the early stage of diagnostics.
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Affiliation(s)
- Andia Mirbagheri
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nima Etminan
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sebastian Schölch
- Junior Clinical Cooperation Unit Translational Surgical Oncology (A430), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Surgery, University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christopher Maier
- Junior Clinical Cooperation Unit Translational Surgical Oncology (A430), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Surgery, University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jason Perrin
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frederik Enders
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Baryeh K, Anazor F, Iyer S, Rajagopal T. Spondylodiscitis in adults: diagnosis and management. Br J Hosp Med (Lond) 2022; 83:1-9. [DOI: 10.12968/hmed.2021.0448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Spondylodiscitis is often diagnosed late in its course because its symptoms are vague. The incidence in adults increases with age, being seen most commonly in men in their 50s and 60s, so the presence of other medical conditions or infections can make it more difficult to identify spondylodiscitis. Diagnosis is made based on clinical suspicion, raised levels of inflammatory markers, a positive blood or tissue biopsy culture and radiological findings. Once a diagnosis is confirmed, treatment must be started promptly. The mainstay of treatment is medical management, with antibiotics tailored to the relevant organism, as well as immobilisation. Where surgery is indicated, the aims are debridement of infected tissue, tissue sampling, neural decompression and stabilisation. Spondylodiscitis is associated with high rates of mortality and morbidity and should be treated promptly to ensure the best outcome.
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Affiliation(s)
- Kwaku Baryeh
- Department of Trauma and Orthopaedics, Royal Berkshire Hospital, Reading, UK
- Department of Medical Education, West Middlesex University Hospital, Middlesex, UK
| | - Fitzgerald Anazor
- Department of Trauma and Orthopaedics, Royal Berkshire Hospital, Reading, UK
| | - Shabnam Iyer
- Department of Microbiology, Royal Berkshire Hospital, Reading, UK
| | - Trichy Rajagopal
- Department of Trauma and Orthopaedics, Royal Berkshire Hospital, Reading, UK
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Bendtsen MAF, Hanberg P, Slater J, Hansen J, Öbrink-Hansen K, Stilling M, Bue M. Steady-state concentrations of flucloxacillin in porcine vertebral cancellous bone and intervertebral disc following oral and intravenous administration assessed by microdialysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1508-1514. [PMID: 35488132 DOI: 10.1007/s00586-022-07208-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/03/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Abstract
AIMS Flucloxacillin is a frequently used antibiotic in the treatment of spondylodiscitis. We assessed steady-state concentrations and time above minimal inhibitory concentration (fT > MIC) of flucloxacillin in the intervertebral disc, vertebral cancellous bone, subcutaneous tissue and plasma, after intravenous and oral administration. METHODS Sixteen pigs were randomized into two groups; Group Peroral (Group PO) and Group Intravenous (Group IV) received 1 g flucloxacillin every 6 h for 24 h orally or intravenously. Microdialysis was used for sampling in the compartments of interest. A flucloxacillin target of 50% fT > MIC was applied for three MIC targets: 0.125, 0.5 and 2.0 μg/mL. RESULTS Intravenous administration resulted in significantly longer fT > MIC for all targets. Target attainment was only reached for the low target of 0.125 μg/mL in Group IV in vertebral cancellous bone, subcutaneous tissue, and plasma (intervertebral disc 47%). In Group IV, mean fT > MIC values in the investigated compartments were in the range of 47-67% of the dosing interval for 0.125 μg/mL, 20-35% for 0.5 μg/mL, and 0-15% for 2.0 μg/mL. In Group PO, mean fT > MIC values for 0.125 μg/mL were in the range of 1-33%. No pigs reached a concentration of 0.5 μg/mL in any of the investigated compartments in Group PO. CONCLUSION Administration of 1 g flucloxacillin every 6 h resulted in surprisingly low steady-state fT > MIC after intravenous and oral administration. However, intravenous administration resulted in significantly higher concentrations across compartments compared to oral administration. Sufficient target tissue concentrations for treatment of spondylodiscitis may require a dose increase or alternative dosing regimens.
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Affiliation(s)
- Mathias A F Bendtsen
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
- Aarhus Microdialysis Research Group, Aarhus University Hospital, Aarhus, Denmark.
- Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark.
| | - Pelle Hanberg
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Aarhus Microdialysis Research Group, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopedic Surgery, Horsens Regional Hospital, Horsens, Denmark
| | - Josefine Slater
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Aarhus Microdialysis Research Group, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark
| | - Jakob Hansen
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Institute of Forensic Medicine, Aarhus University, Aarhus, Denmark
| | - Kristina Öbrink-Hansen
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Aarhus Microdialysis Research Group, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark
| | - Mats Bue
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Aarhus Microdialysis Research Group, Aarhus University Hospital, Aarhus, Denmark
- Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark
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Hosameldin A, Hussein M, Abdelhalim E, Shehab M, Osman A. Surgical management of spontaneous thoracic and lumbar spondylodiscitis by fixation and debridement. Surg Neurol Int 2022; 13:44. [PMID: 35242410 PMCID: PMC8888297 DOI: 10.25259/sni_1236_2021] [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] [Received: 12/13/2021] [Accepted: 01/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Spondylodiscitis could be considered one of the most disturbing challenges that face neurosurgeons due to variety of management strategies. The lumbar region was highly affected then dorsal region with higher percentage for lesion in L4/5 (25%) followed by T11/12 and L5/S1 (15%). In our study, we discuss the efficacy of debridement and fixation in cases of spontaneous thoracic and lumbar spondylodiscitis. Methods: This retrospective study included 40 patients with spontaneous thoracic or lumbar spondylodiscitis indicated for surgical intervention in the period from March 2019 to February 2021. All patients were subjected to thorough history taking, neurological examination, and investigations. The patients were operated on through posterior approach by debridement and posterior transpedicular screws fixation and fusion. Results: Clinical assessment early postoperative revealed 75% of cases showed full motor power and 20% showed improvement in motor power, for sensory assessment, 85% showed improvement, the mean visual analog scale (VAS) score was of 3.65 ± 0.87. After 3 months postoperatively, 95% of cases were full motor power with sensory and autonomic (sphincteric) improvement. The mean VAS score was 2.5 ± 0.68. After 6 months postoperative, the clinical assessment revealed that 95% of cases were full motor power with sensory manifestation improvement, and 95% of them were continent. The mean VAS score was 1±0.85. Culture results showed that 65% of samples were negative culture, 15% had methicillin-resistant Staphylococcus aureus, and 10% had Escherichia coli with a single case of Pseudomonas and another one of fungal (Candida albicans). Postoperative 90% of cases showed improvement in erythrocyte sedimentation rate results and 95% of cases showed improvement in C-reactive protein results. Conclusion: Management of spontaneous thoracic and lumbar spondylodiscitis by surgical debridement and posterolateral open transpedicular fixation seems to be effective and safe method despite the presence of infection. We found that the clinical condition of our patients showed significant improvement with this addressed approach.
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Affiliation(s)
- Ahmed Hosameldin
- Department of Neurosurgery, Fayoum University Hospitals, Fayoum University, Fayoum, Egypt
| | - Mohammed Hussein
- Department of Neurosurgery, Fayoum University Hospitals, Fayoum University, Fayoum, Egypt
| | - Ehab Abdelhalim
- Department of Neurosurgery, Cairo University, Cairo, Cairo, Egypt
| | - Mohammed Shehab
- Department of Neurosurgery, Cairo University, Cairo, Cairo, Egypt
| | - Ashraf Osman
- Department of Neurosurgery, Fayoum University Hospitals, Fayoum University, Fayoum, Egypt
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Weihe R, Taghlabi K, Lowrance M, Reeves A, Jackson SR, Burton DC, El Atrouni W. Culture Yield in the Diagnosis of Native Vertebral Osteomyelitis: A Single Tertiary Center Retrospective Case Series with Literature Review. Open Forum Infect Dis 2022; 9:ofac026. [PMID: 35198644 PMCID: PMC8860156 DOI: 10.1093/ofid/ofac026] [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] [Received: 11/02/2021] [Accepted: 01/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background Vertebral osteomyelitis is a serious condition that requires prompt diagnosis to avoid delays in proper management. There is no well-defined gold standard for diagnosis. We describe the current diagnostic approach at our institution, with a focus on the yield of image-guided vertebral biopsy. Methods We performed a single-centre 10-year retrospective case series, including adults with imaging suggestive of vertebral osteomyelitis/discitis, with either positive blood cultures, and/or a vertebral biopsy. We defined positive histopathology as our gold standard for test characteristic evaluation of biopsy cultures. Results Out of 694 patients identified, 221 met our inclusion criteria, and 173/221 (78.2%) patients underwent a spinal biopsy. Of those patients with biopsies, 113 (65%) had received antibiotics within 2 weeks preceding their evaluation. Six of 43 (13.9%) bone specimens were positive by culture, while 66/152 (43.4%) of disc specimens were culture positive. Forty-seven of 84 (55.9%) histopathology (bone or disc) specimens were diagnostic for osteomyelitis/discitis. The sensitivity of bone and disk culture were 30.0% and 56.0%, respectively, with specificities of 92.8% and 75.0%, respectively. Twenty-three (13.4%) patients had repeat biopsies, including 10 bone specimens and 14 disc specimens, and 11 (47.8%) specimens had histopathology performed which diagnosed an additional 3/23 patients (13% additional diagnostic yield). Conclusions Culture of percutaneous biopsy of disc resulted in the highest diagnostic yield. Histopathology added to the diagnostic yield in culture-negative specimens. Histopathologic evaluation of bone had better yield than bone culture. A repeat biopsy can add to the diagnostic yield.
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Affiliation(s)
- Rachel Weihe
- Assistant Professor of Internal Medicine, Division of Infectious Diseases, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1028, Kansas City, KS 66160, USA
| | - Khaled Taghlabi
- Department of Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1011, Kansas City, KS 66160 USA
| | - Maren Lowrance
- Assistant Director for Medical Informatics and Enterprise Analytics, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3065, Kansas City, KS 66160 USA
| | - Alan Reeves
- Associate Professor and Director of Interventional Neuroradiology, Department of Radiology University of Kansas Medical Center, 3901 Rainbow Blvd, MS 4032, Kansas City, KS 66160 USA
| | - Sean R Jackson
- Associate Professor of Orthopedic Surgery, Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3017, Kansas City, KS 66160 USA
| | - Douglas C Burton
- Professor of Orthopedic Surgery, Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 3017, Kansas City, KS 66160 USA
| | - Wissam El Atrouni
- Assistant Professor of Internal Medicine, Division of Infectious Diseases, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1028, Kansas City, KS 66160, USA
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Clinical characteristics of pyogenic vertebral osteomyelitis, and factors associated with inadequate treatment response. Int J Infect Dis 2021; 108:487-493. [PMID: 34091001 DOI: 10.1016/j.ijid.2021.05.078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Pyogenic vertebral osteomyelitis (PVO) is associated with a high burden of disease. Our study aimed to describe characteristics at presentation of PVO, the risk of inadequate treatment response (ITR), relapse, and death, and to determine risk factors for ITR. METHODS Patients with an ICD-10 discharge code for PVO and admission to a major Danish university hospital between November 2016 and April 2019 were included. ITR was defined as clinical, microbiological, and/or radiological progression during treatment. Data were collected through review of medical records, and logistic regression was used to determine adjusted odds ratios (aOR). RESULTS Of 106 patients included, 87% presented with pain in the spine, 97% elevated CRP, 14% severe sepsis, and 13% with a history of previous spinal surgery. 39% were infected with Staphylococcus aureus and 9% with Escherichia coli. 31% responded inadequately to treatment, and risk factors for ITR were previous spinal surgery (aOR 19.29; 95% confidence interval (CI) 2.20-169.08), severe sepsis (aOR 4.59; 95% CI 1.28-15.41), and infection with Escherichia coli (aOR 8.10; 95% CI 1.71-38.45). 13% experienced relapse within the first 2 years, while the 1-year crude mortality was 12%. CONCLUSION Staphylococcus aureus is still the main pathogen in PVO patients, and the risks of relapse and mortality remain high. Factors found to be associated with ITR were previous spinal surgery, severe sepsis, and infection with Escherichia coli.
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Hasan GA, Raheem HQ, Qutub A, Wais YB, Katran MH, Shetty GM. Management of Pyogenic Spondylodiscitis Following Nonspinal Surgeries: A Tertiary Care Center Experience. Int J Spine Surg 2021; 15:591-599. [PMID: 33985997 DOI: 10.14444/8080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The literature is lacking on the incidence and management of pyogenic spondylodiscitis (PS) following routine elective surgical procedures. This study aimed to analyze the presentation and treatment outcome in patients with PS following nonspinal surgeries at a tertiary care center with a minimum follow-up of 12 months. METHODS The demographic, clinical-radiologic features, and treatment outcomes in 40 patients with a diagnosis of PS following nonspinal surgical procedures were retrospectively reviewed and analyzed. RESULTS The mean age at presentation was 36.4 ± 11.8 years, with 80% of patients being female. The common surgical procedures associated with PS were cesarean delivery (30%), gastric sleeve surgery (12.5%), and dilatation and curettage (12.5%). The tissue biopsy culture was positive in 82.5% of patients. A total of 26 patients (65%) were treated with conservative management and 14 patients (35%) were treated surgically. The mean pretreatment Core Outcome Measure Index score significantly decreased at 12 months (P < .0001) after treatment. The mean pretreatment erythrocyte sedimentation rate (P < .0001) and C-reactive protein (P < .0001) levels significantly decreased at 12 months after treatment. CONCLUSIONS With most patients with PS following nonspinal surgeries treated with conservative management, excellent clinical outcomes were achieved in all patients at 12 months after treatment. The diagnosis of PS should be considered in patients presenting with low back pain (LBP) with a recent history of undergoing a nonspinal surgical procedure. Patients who undergo surgical procedures are an important "at-risk" patient population, and early diagnosis and treatment can help achieve excellent clinical outcomes. Further studies are required to determine risk factors and possible perioperative precautions that can be taken to prevent PS in patients who undergo nonspine surgeries. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE Pyogenic spondylodiscitis should be suspected in patients presenting with LBP after a recent non-spinal surgical procedure. Early diagnosis and treatment can help achieve excellent clinical outcomes in these patients.
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Affiliation(s)
- Ghazwan A Hasan
- Department of Orthopaedic Surgery, Al-Kindi Teaching Hospital, Baghdad, Iraq
| | | | | | | | | | - Gautam M Shetty
- Orthopaedic & Knee Clinic, Mumbai, India.,AIMD Research, Mumbai, India
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Carbone A, Lieu A, Mouhat B, Santelli F, Philip M, Bohbot Y, Tessonnier L, Peugnet F, D'Andrea A, Cammilleri S, Delpierre Q, Gouriet F, Camoin-Jau L, Gun M, Casalta JP, Riberi A, Collart F, Martel H, Arregle F, Guedj E, Raoult D, Drancourt M, Tribouilloy C, Habib G. Spondylodiscitis complicating infective endocarditis. Heart 2020; 106:1914-1918. [PMID: 32467102 DOI: 10.1136/heartjnl-2019-316492] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The primary objective was to assess the characteristics and prognosis of pyogenic spondylodiscitis (PS) in patients with infective endocarditis (IE). The secondary objectives were to assess the factors associated with occurrence of PS. METHODS Prospective case-control bi-centre study of 1755 patients with definite IE with (n=150) or without (n=1605) PS. Clinical, microbiological and prognostic variables were recorded. RESULTS Patients with PS were older (mean age 69.7±18 vs 66.2±14; p=0.004) and had more arterial hypertension (48% vs 34.5%; p<0.001) and autoimmune disease (5% vs 2%; p=0.03) than patients without PS. The lumbar vertebrae were the most frequently involved (84 patients, 66%), especially L4-L5. Neurological symptoms were observed in 59% of patients. Enterococci and Streptococcus gallolyticus were more frequent (24% vs 12% and 24% vs 11%; p<0001, respectively) in the PS group. The diagnosis of PS was based on contrast-enhanced MRI in 92 patients, bone CT in 88 patients and 18F-FDG PET/CT in 56 patients. In-hospital (16% vs 13.5%, p=0.38) and 1-year (21% vs 22%, p=0.82) mortalities did not differ between patients with or without PS. CONCLUSIONS PS is a frequent complication of IE (8.5% of IE), is observed in older hypertensive patients with enterococcal or S. gallolyticus IE, and has a similar prognosis than other forms of IE. Since PS is associated with specific management, multimodality imaging including MRI, CT and PET/CT should be used for early diagnosis of this complication of endocarditis.
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Affiliation(s)
- Andreina Carbone
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Audrey Lieu
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France.,Research Unity 2 EA 7517, MP3CV, Jules Verne University of Picardie, Amiens, France
| | - Basile Mouhat
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | | | - Mary Philip
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Yohann Bohbot
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France.,Research Unity 2 EA 7517, MP3CV, Jules Verne University of Picardie, Amiens, France
| | | | - Fanny Peugnet
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France.,Research Unity 2 EA 7517, MP3CV, Jules Verne University of Picardie, Amiens, France
| | - Antonello D'Andrea
- Luigi Vanvitelli University-Naples, Monaldi Hospital, Naples, Italy.,Dipartimento di Scienze Cardio-Toraciche e Respiratorie, Università degli Studi della Campania "Luigi Vanvitelli, Naples, Italy
| | - Serge Cammilleri
- Department of Nuclear Medicine, La Timone Hospital, Marseille, France
| | - Quentin Delpierre
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France.,Research Unity 2 EA 7517, MP3CV, Jules Verne University of Picardie, Amiens, France
| | - Frédérique Gouriet
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095-IHU, Marseille, France.,Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Laurence Camoin-Jau
- Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France.,Department of Hematology, La Timone Hospital, Marseille, France
| | - Mesut Gun
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France.,Research Unity 2 EA 7517, MP3CV, Jules Verne University of Picardie, Amiens, France
| | - Jean-Paul Casalta
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095-IHU, Marseille, France.,Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Alberto Riberi
- Department of Cardiac surgery, La timone Hospital, Marseille, France
| | - Frederic Collart
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Hélène Martel
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Florent Arregle
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Eric Guedj
- Department of Nuclear Medicine, La Timone Hospital, Marseille, France
| | - Didier Raoult
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095-IHU, Marseille, France.,Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Michel Drancourt
- URMITE, Aix Marseille Université, UM63, CNRS 7278, IRD 198, INSERM 1095-IHU, Marseille, France.,Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Christophe Tribouilloy
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France.,Research Unity 2 EA 7517, MP3CV, Jules Verne University of Picardie, Amiens, France
| | - Gilbert Habib
- Cardiology Department, APHM, La Timone Hospital, Marseille, France .,Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
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