1
|
Zhong Y, Tang B, Zhang Z, Sheng Y, Li C, Guo J, Luo S, Yao H, Wan Z. Clinical efficacy and imaging analysis for the surgical treatment of thoracolumbar infections in elderly patients: a retrospective study. Sci Rep 2023; 13:10341. [PMID: 37365248 DOI: 10.1038/s41598-023-36985-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Few reports have been conducted to comparing surgical results and safety evaluations between the different types of infections in geriatric patients with thoracolumbar infections. The aim of this study is to investigate the safety and efficacy of surgical treatment for thoracolumbar infections in elderly patients. 21 patients with pyogenic spondylodiscitis (PS) and 26 patients with tuberculous spondylodiscitis (TS) were enrolled in the study. All patients were treated using one-stage posterior debridement, decompression, and pedicle screw fixation. Comparison of operative safety parameters between the two groups. Clinical efficacy was evaluated using visual analogue scale (VAS) score, the American Spinal Injury Association (ASIA) grade, the short form (SF)-36 survey and Oswestry disability index (ODI) to determine patient quality of life pre- and post-operatively. Hospitalisation and intensive care unit duration in the PS group were significantly shorter than in the TS group (P < 0.05). The total incidence of post-operative complications for both groups was 44.7%. More complications occurred in the TS group, but the difference was not significant. The scores of VAS, ODI and SF-36 of all 47 patients were significantly improved compared with those before operation.The VAS and SF-36 scores (physical component) were significantly better in the PS group 6 months post-operatively, and the SF-36 (mental component) scores were significantly better in the PS group at the 1-year follow-up. Neurological status in both groups improved post-operatively, and 83% of patients reported satisfactory results based on the modified MacNab standard. Imaging results showed that bone graft fusion improved in both groups at 6 months, 1 year and at the final follow-up. One-stage posterior debridement, decompression, interbody fusion, and internal fixation can be considered a safe and effective method of treating spinal infections in the elderly. This method can improve nerve function, reconstruct spinal stability, and enhance the quality of life of elderly patients. Both PS and TS who underwent surgery achieve similar clinical and radiological results.
Collapse
Affiliation(s)
- Yanlong Zhong
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Benyu Tang
- Department of Orthopedics, The People's Hospital of Yi Chun City, Yichun, 336000, Jiangxi, People's Republic of China
| | - Zizhen Zhang
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Yonghong Sheng
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Chao Li
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Jia Guo
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Shiwei Luo
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Haoqun Yao
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Zongmiao Wan
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China.
| |
Collapse
|
2
|
Mireles-Cano N, Álvarez-Canales JA, Huitrón-García MJ, Quezada M, Macías AE, Mosqueda-Gómez JL. Fluoroscopy-Guided Percutaneous Transpedicular Biopsy Versus Posterolateral Endoscopy for Infective Spondylodiskitis Diagnosis: A Comparative Study. World Neurosurg 2023; 170:e827-e833. [PMID: 36481445 DOI: 10.1016/j.wneu.2022.11.137] [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: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We sought to determine the concordance in frequency of microbiologic isolation and species identification in specimens obtained by 2 methods. METHODS Intervertebral disk specimens were taken simultaneously from each patient using percutaneous needle and posterolateral endoscopic biopsies. The isolates were reported in frequencies and concordance using the chi square and Cohen kappa tests. RESULTS Thirty patients were recruited. The average age was 58.1 years, and 15 patients were women. The clinical evolution time was 7 ± 4 months. The causative organism was identified in 12 (40%) specimens obtained by fluoroscopy-guided percutaneous transpedicular biopsy and in 14 (46.6%) obtained by posterolateral endoscopy. The most common organism isolated was Staphylococcus aureus in 3 patients with the percutaneous technique and in 5 with the endoscopic one; Escherichia coli was isolated in 3 patients with each method. The kappa test showed a high degree of agreement between both methods (kappa = 0.86); the agreement in bacterial species identification was 100%. CONCLUSIONS Fluoroscopy-guided percutaneous biopsy and endoscopic sampling have a good degree of concordance for both, frequency of organism isolation and identification in patients with infectious spondylodiskitis.
Collapse
Affiliation(s)
- Nicolás Mireles-Cano
- High Specialty Regional Hospital Bajio, Health Secretariat, León, Guanajuato, Mexico; Department of Medicine and Nutrition, Laboratory of Microbiology, University of Guanajuato, León, Guanajuato, Mexico
| | - José A Álvarez-Canales
- High Specialty Regional Hospital Bajio, Health Secretariat, León, Guanajuato, Mexico; Department of Medicine and Nutrition, Laboratory of Microbiology, University of Guanajuato, León, Guanajuato, Mexico.
| | - Mary Jose Huitrón-García
- Department of Medicine and Nutrition, Laboratory of Microbiology, University of Guanajuato, León, Guanajuato, Mexico
| | - Marianne Quezada
- Department of Medicine and Nutrition, Laboratory of Microbiology, University of Guanajuato, León, Guanajuato, Mexico
| | - Alejandro E Macías
- Department of Medicine and Nutrition, Laboratory of Microbiology, University of Guanajuato, León, Guanajuato, Mexico
| | - Juan L Mosqueda-Gómez
- High Specialty Regional Hospital Bajio, Health Secretariat, León, Guanajuato, Mexico; Department of Medicine and Nutrition, Laboratory of Microbiology, University of Guanajuato, León, Guanajuato, Mexico
| |
Collapse
|
3
|
[Translated article] Analysis of results of open and percutaneous disc biopsy in the diagnosis of spondylodiscitis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
4
|
Navarro-Navarro R, Suárez-Cabañas A, Fernández-Varela T, Lorenzo-Rivero J, Montesdeoca-Ara A. Análisis de los resultados de la biopsia discal abierta y percutánea en el diagnóstico de la espondilodiscitis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:189-199. [DOI: 10.1016/j.recot.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/20/2021] [Accepted: 09/24/2021] [Indexed: 12/01/2022] Open
|
5
|
Ryu S, Kim YJ, Lee S, Ryu J, Park S, Hong JU. Pathophysiology and MRI Findings of Infectious Spondylitis and the Differential Diagnosis. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:1413-1440. [PMID: 36238882 PMCID: PMC9431966 DOI: 10.3348/jksr.2021.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/25/2021] [Accepted: 11/21/2021] [Indexed: 11/25/2022]
Abstract
MRI에서 추간판의 이상 신호와 위, 아래 척추체 종판의 파괴, 종판 주변의 골수부종 등은 감염성 척추염의 전형적인 소견으로 여겨지나 퇴행성 척추질환, acute Schmorl's node, 척추관절병증, synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO)/chronic recurrent multifocal osteomyelitis, 척추신경관절병증, calcium pyrophosphate dehydrate 결절침착질환 등 다양한 비감염성 척추질환에서도 나타날 수 있다. MRI에서 이러한 비감염성 척추질환과 감별되는 감염성 척추염의 영상 소견은 추간판의 고신호와 농양, 척추 연부조직의 농양, 그리고 T1 강조영상에서 저신호로 보이는 종판의 경계가 불명확해지는 점 등이다. 그러나 이러한 감별점이 항상 적용되는 것은 아니며 감염성, 비감염성 질환의 영상 소견에 유사점이 많기 때문에 정확한 진단을 위해서는 감염성 척추염뿐만 아니라 감염과 감별해야 하는 다양한 질환의 병태생리와 연관된 영상학적 특징을 아는 것이 중요하다.
Collapse
Affiliation(s)
- Sunjin Ryu
- Department of Radiology, Hanyang University School of Medicine, Seoul Hospital, Seoul, Korea
| | - Yeo Ju Kim
- Department of Radiology, Hanyang University School of Medicine, Seoul Hospital, Seoul, Korea
| | - Seunghun Lee
- Department of Radiology, Hanyang University School of Medicine, Seoul Hospital, Seoul, Korea
| | - Jeongah Ryu
- Department of Radiology, Hanyang University School of Medicine, Guri Hospital, Guri, Korea
| | - Sunghoon Park
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jung Ui Hong
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| |
Collapse
|
6
|
Duan K, Qin Y, Ye J, Zhang W, Hu X, Zhou J, Gao L, Tang Y. Percutaneous endoscopic debridement with percutaneous pedicle screw fixation for lumbar pyogenic spondylodiscitis: a preliminary study. INTERNATIONAL ORTHOPAEDICS 2020; 44:495-502. [PMID: 31879810 PMCID: PMC7026210 DOI: 10.1007/s00264-019-04456-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/21/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To access the feasibility and efficacy of percutaneous endoscopic debridement (PED) combined with percutaneous pedicle screw fixation (PPSF) in the treatment of lumbar pyogenic spondylodiscitis. METHODS Forty-five patients diagnosed as pyogenic spondylodiscitis underwent PPSF followed by PED. A drainage catheter was left in place for negative pressure drainage. Adequate systematic antibiotics were administered empirically or based on bacterial culture results. Clinical outcomes were assessed by physical examination, regular serologic testing, visual analog scale (VAS), Oswestry Disability Index (ODI), and imaging studies. RESULTS The mean operative time was 110.1 ± 21.2 minutes (range 80-165 minutes), with intra-operative blood loss 47.8 ± 21.0 ml (range 20-120 ml). All patients reported relief of back pain, able to sit up, and partially ambulate the next day. Causative pathogens were identified in 32 of 45 biopsy specimens, staphylococcal bacteria being the most prevalent strain. However, there were 13 patients with post-operative complications. During 6-12 months' follow-up, inflammatory markers showed infection controlled. VAS and ODI values were significantly improved. DISCUSSION Satisfactory clinical and functional outcomes were achieved in our patients post-operatively. It is recommended that PED plus PPSF can be another alternative for spondylodiscitis. CONCLUSION PED supplementing PPSF offers a valid option in treating spondylodiscitis, as it is minimally invasive, shortens hospital stay, and avoids prolonged bed rest with an optimistic outcome.
Collapse
Affiliation(s)
- Kaidi Duan
- Dept. of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, China
| | - Yi Qin
- Dept. of Orthopedics, Zhuhai People’s Hospital, 79 Kangning Road, Zhuhai, China
| | - Jichao Ye
- Dept. of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, China
| | - Wei Zhang
- Dept. of Orthopedics, Xinsteel Center Hospital, Tuanjie West Road, Xinyu, China
| | - Xumin Hu
- Dept. of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, China
| | - Jinlang Zhou
- Dept. of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, China
| | - Liangbin Gao
- Dept. of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, China
| | - Yong Tang
- Dept. of Spine Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou, China
| |
Collapse
|
7
|
Juan Zepeda T, Jorge Morales S, Hugo Letelier A, Luis Delpiano M. [Bartonella henselae vertebral osteomyelitis: report of a case]. ACTA ACUST UNITED AC 2015; 87:53-8. [PMID: 26460082 DOI: 10.1016/j.rchipe.2015.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/15/2015] [Accepted: 08/24/2015] [Indexed: 11/17/2022]
Abstract
UNLABELLED Cat scratch disease (CSD) is caused by Bartonella henselae, with unknown prevalence and incidence in the Chilean paediatric population. Regional lymphadenopathy is the most common presentation, while atypical forms constitute a diagnostic challenge. OBJECTIVE To report a case of CSD with osteomyelitis and present guidelines regarding treatment. CLINICAL CASE An eight year-old patient, with prolonged febrile illness, back pain and neck stiffness. Laboratory studies highlight positive IgG for Bartonella henselae. The abdominal ultrasound showed splenic micro-abscesses, and the MRI showing vertebral lesions suggestive of osteomyelitis. DISCUSSION The diagnosis of atypical forms requires a high rate of suspicion, as in this case, in which the patient manifested the musculoskeletal symptoms simultaneously with the febrile syndrome, which led us to study possible complications of the disease. Current knowledge of the treatment of atypical or complicated CSD is derived from the observation of case studies, rather than randomized trials. It is suggested that antibiotic therapy is analysed individually, with the help of a specialist. CONCLUSION The importance of high clinical suspicion are emphasised and discussed, as well presenting some treatment options based on the evidence from the current literature.
Collapse
Affiliation(s)
- T Juan Zepeda
- Programa de Especialización en Pediatría, Universidad de Chile, Hospital San Borja Arriarán, Santiago Chile, Chile.
| | - S Jorge Morales
- Interno de Medicina, Universidad Católica del Maule, Talca, Chile
| | | | - M Luis Delpiano
- Servicio de Pediatría, Hospital San Borja Arriarán, Santiago, Chile
| |
Collapse
|
8
|
Jeong DK, Lee HW, Kwon YM. Clinical Value of Procalcitonin in Patients with Spinal Infection. J Korean Neurosurg Soc 2015; 58:271-5. [PMID: 26539272 PMCID: PMC4630360 DOI: 10.3340/jkns.2015.58.3.271] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/25/2015] [Accepted: 08/04/2015] [Indexed: 02/07/2023] Open
Abstract
Objective This study was designed to evaluation the diagnostic value of procalcitonin (PCT) in patients with spinal infection, compare to the classical biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count. Methods All patients who were diagnosed as a spinal infection between January, 2013 and July, 2014 were included in this study. Serum PCT, CRP, ESR, and WBC count were checked at initial hospital visit and once a week serially until they were discharged. Patient's medical history, causes and pathogens of spinal infection were reviewed. Results Total 34 (16 men, 18 women) patients were included in this study. Mean age of the patients was 65.6 year-old. Causes of spinal infection were pain block procedure (14, 41.2%) and post-operation (5, 14.7%). Out of 25 patients who showed elevated initial serum PCT level, 20 patients (80%) had a combined systemic infection. 14 patients (6.7%) had a sepsis, 3 patients (14.2%) had a urinary tract infection and 2 (9.6%) had a pneumonia. 14 patients (41.2%) showed elevation of serum PCT level during treatment. Among them, 9 patients (64.3%) had a combined infection such as sepsis and urinary tract infection. Conclusion Serum CRP showed more sensitivity compared to serum PCT in patients with spinal infection. Patients with spinal infection who showed elevated serum PCT level should be investigated for combined infection and proper antibiotics should be applied.
Collapse
Affiliation(s)
- Deok-Ki Jeong
- Department of Neurosurgery, College of Medicine, Dong-A University, Busan, Korea
| | - Hyun-Woo Lee
- Department of Neurosurgery, College of Medicine, Dong-A University, Busan, Korea
| | - Young-Min Kwon
- Department of Neurosurgery, College of Medicine, Dong-A University, Busan, Korea
| |
Collapse
|
9
|
Espondilitis infecciosa: treinta años después persisten los mismos problemas. ¿Debemos cambiar el enfoque? Rev Clin Esp 2015; 215:272-3. [DOI: 10.1016/j.rce.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 03/09/2015] [Indexed: 11/20/2022]
|
10
|
Raya Cruz M, Vilchez Rueda H, Marinescu C, Sarasíbar Ezcurra H, Riera Jaume M, Payeras Cifre A. Infectious spondylitis in the Balearic Islands: An analysis of 51 cases. Rev Clin Esp 2015. [DOI: 10.1016/j.rceng.2015.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
11
|
Raya Cruz M, Vilchez Rueda H, Marinescu C, Sarasíbar Ezcurra H, Riera Jaume M, Payeras Cifre A. Espondilitis infecciosa en Baleares: análisis de 51 casos. Rev Clin Esp 2015; 215:251-7. [DOI: 10.1016/j.rce.2015.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/31/2014] [Accepted: 01/20/2015] [Indexed: 12/17/2022]
|
12
|
Lin TY, Tsai TT, Lu ML, Niu CC, Hsieh MK, Fu TS, Lai PL, Chen LH, Chen WJ. Comparison of two-stage open versus percutaneous pedicle screw fixation in treating pyogenic spondylodiscitis. BMC Musculoskelet Disord 2014; 15:443. [PMID: 25519761 PMCID: PMC4300775 DOI: 10.1186/1471-2474-15-443] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 12/15/2014] [Indexed: 01/11/2023] Open
Abstract
Background Percutaneous pedicle screw instrumentation is a minimally invasive surgical technique; however, the effects of using percutaneous pedicle screw fixation in treating patients with spinal infections have not yet been well demonstrated. The aim of this study, therefore, was to determine whether percutaneous posterior pedicle screw instrumentation is superior to the traditional open approach in treating pyogenic spondylodiscitis. Methods We retrospectively reviewed data for 45 patients treated for pyogenic spondylodiscitis with anterior debridement and interbody fusion followed by a second-stage procedure involving either traditional open posterior pedicle screw fixation or percutaneous posterior pedicle screw fixation. Twenty patients underwent percutaneous fixation and 25 patients underwent open fixation. Demographic, operative, and perioperative data were collected and analyzed. Results The average operative time for the percutaneous procedure was 102.5 minutes, while the average time for the open procedure was 129 minutes. The average blood loss for the percutaneous patients was 89 ml versus a 344.8 ml average for the patients in the open group. Patients who underwent the minimally invasive surgery had lower visual analogue scale scores and required significantly less analgesia afterwards. After two years of follow-up, neither recurrent infection nor intraoperative complications, such as wound infection or screw loosening, were found in the percutaneous group. Moreover, there was no significant difference in outcome between the two groups in terms of Oswestry Disability Index scores. Conclusions Anterior debridement and interbody fusion with bone grafting followed by minimally invasive percutaneous posterior instrumentation is an alternative treatment for pyogenic spondylodiscitis which can result in less intraoperative blood loss, shorter operative time, and reduced postoperative pain with no adverse effect on infection control. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-443) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, No, 5, Fusing Street, Guishan Township, Taoyuan 333, Taiwan.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Jeong SJ, Choi SW, Youm JY, Kim HW, Ha HG, Yi JS. Microbiology and epidemiology of infectious spinal disease. J Korean Neurosurg Soc 2014; 56:21-7. [PMID: 25289121 PMCID: PMC4185315 DOI: 10.3340/jkns.2014.56.1.21] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 06/18/2014] [Accepted: 07/15/2014] [Indexed: 12/26/2022] Open
Abstract
Objective Infectious spinal disease is regarded as an infection by a specific organism that affects the vertebral body, intervertebral disc and adjacent perivertebral soft tissue. Its incidence seems to be increasing as a result of larger proportion of the older patients with chronic debilitating disease, the rise of intravenous drug abuser, and the increase in spinal procedure and surgery. In Korea, studies assessing infectious spinal disease are rare and have not been addressed in recent times. The objectives of this study are to describe the epidemiology of all kind of spinal infectious disease and their clinical and microbiological characteristics as well as to assess the diagnostic methodology and the parameters related to the outcomes. Methods A retrospective study was performed in all infectious spinal disease cases presenting from January 2005 to April 2010 to three tertiary teaching hospitals within a city of 1.5 million in Korea. Patient demographics, risk factors, clinical features, and outcomes were assessed. Risk factors entailed the presence of diabetes, chronic renal failure, liver cirrhosis, immunosuppressants, remote infection, underlying malignancy and previous spinal surgery or procedure. We comparatively analyzed the results between the groups of pyogenic and tuberculous spinal infection. SPSS version 14 statistical software was used to perform the analyses of the data. The threshold for statistical significance was established at p<0.05. Results Ninety-two cases fulfilled the inclusion criteria and were reviewed. Overall, patients of tuberculous spinal infection (TSI) and pyogenic spinal infection (PSI) entailed 20 (21.7%) and 72 (78.3%) cases, respectively. A previous spinal surgery or procedure was the most commonly noted risk factor (39.1%), followed by diabetes (15.2%). The occurrence of both pyogenic and tuberculous spondylitis was predominant in the lumbar spine. Discs are more easily invaded in PSI. At initial presentation, white cell blood count and C-reactive protein levels were higher in PSI compared to TSI (p<0.05). Etiological agents were identified in 53.3%, and the most effective method for identification of etiological agents was tissue culture (50.0%). Staphyococcus aureus was the most commonly isolated infective agent associated with pyogenic spondylitis, followed by E. coli. Surgical treatment was performed in 31.5% of pyogenic spondylitis and in 35.0% of tuberculous spondylitis cases. Conclusion Many previous studies in Korea usually reported that tuberculous spondylitis is the predominant infection. However, in our study, the number of pyogenic infection was 3 times greater than that of tuberculous spinal disease. Etiological agents were identified in a half of all infectious spinal disease. For better outcomes, we should try to identify the causative microorganism before antibiotic therapy and make every effort to improve the result of culture and biopsy.
Collapse
Affiliation(s)
- Se-Jin Jeong
- Department of Neurosurgery, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Seung-Won Choi
- Department of Neurosurgery, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Jin-Young Youm
- Department of Neurosurgery, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Hyun-Woo Kim
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
| | - Ho-Gyun Ha
- Department of Neurosurgery, Konyang University Hospital, Daejeon, Korea
| | - Jin-Seok Yi
- Department of Neurosurgery, The Catholic University of Korea College of Medicine, Daejeon St. Mary's Hospital, Daejeon, Korea
| |
Collapse
|
14
|
Santamaría Marín A, Monroy Gómez C, Clemente Tomé I, Pinardo Zabala A. Espondilodiscitis por Clostridium perfringens. Rev Clin Esp 2014; 214:286-7. [DOI: 10.1016/j.rce.2014.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/24/2014] [Indexed: 11/17/2022]
|
15
|
Establishing the diagnosis of tuberculous vertebral osteomyelitis. 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 2012; 22 Suppl 4:579-86. [PMID: 22576157 DOI: 10.1007/s00586-012-2348-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 04/22/2012] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this article has been to analyze the clinical and radiological data suggesting tuberculous vertebral osteomielitis (TVO), and then discuss the steps to be followed to achieve an aetiological diagnosis. METHODS A thorough literature search was carried out to identify the best clinical and microbiological evidence for a fast and efficient diagnosis of TVO. RESULTS The clinical and radiological diagnosis of spinal tuberculosis suffers from serious limitations, with a high percentage of cases requiring vertebral biopsy to reach a definitive diagnosis. The increasing incidence of multidrug-resistant tuberculosis has highlighted the insufficiency of the histopathological diagnosis and the need for microbiological diagnosis. Unfortunately, the maximum sensitivity of spinal tuberculosis cultures is 80 %, and traditional methods require 6 to 8 weeks for the isolation, identification and sensitivity study. New culture media and identification methods have improved sensitivity and reduced the time required for the identification. Molecular methods have now been integrated into a single test, with identification of the mycobacterium responsible and its sensitivity to rifampicin. Additionally, multiplex-PCR tests have been developed that allow a rapid differential diagnosis between granulomatous spondylodiscitis. CONCLUSIONS All patients with subacute inflammatory back or neck pain showing suggestive radiological findings should be studied to rule out TVO. If there is no clear evidence of tuberculosis from another location or indication for surgery, a percutaneous vertebral biopsy should be performed. When TVO is suspected, all spinal or paravertebral tissue samples should be sent simultaneously to pathology and microbiology laboratories for appropriate processing.
Collapse
|
16
|
Fernandez de Orueta L, Andrés R, Elías T, Pintado V. [Vertebral aspergillosis in a cirrhotic patient: an uncommon cause of spondylitis]. Enferm Infecc Microbiol Clin 2012; 30:219-20. [PMID: 22365181 DOI: 10.1016/j.eimc.2011.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 11/08/2011] [Accepted: 11/09/2011] [Indexed: 11/16/2022]
|
17
|
Merino P, Candel FJ, Gestoso I, Baos E, Picazo J. Microbiological diagnosis of spinal tuberculosis. INTERNATIONAL ORTHOPAEDICS 2012; 36:233-8. [PMID: 22252412 DOI: 10.1007/s00264-011-1461-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 12/02/2011] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study was to review the clinical features and diagnosis of spinal tuberculosis cases reported in the literature. METHODS A medical literature search in the Medline Pubmed database was undertaken to review tuberculosis spinal infection and extra-pulmonary tuberculosis diagnosis improvement. We introduced the following search items and boolean operators: "spinal infection", "spinal tuberculosis infection", "microbiological diagnosis of spinal tuberculosis" and "spinal tuberculosis PCR." Single cases or series without microbiological diagnosis were rejected. Manuscript language was restricted to Spanish, French, and English versions. RESULTS AND CONCLUSIONS Spinal tuberculosis is more common in developing countries and is probably underdiagnosed. Delayed diagnosis is characteristic; it worsens the prognosis and increases morbidity. The microbiological diagnosis is crucial for several reasons. Despite surgical treatment, medical treatment with anti-tuberculous drugs is always necessary. A total of 20-40% of the spinal tuberculosis patients show another locus of infection. Pulmonary location can become a public health problem. Previously treated patients for other tuberculosis locations, incomplete treatments, or poor adherence can change the M. tuberculosis sensitivity pattern. Drug resistance test becomes a major need in the microbiology laboratory. PCR diagnostic techniques advance the diagnosis and increase the sensitivity and specificity rate.
Collapse
Affiliation(s)
- Paloma Merino
- Clinical Microbiology Department, Clinico San Carlos Hospital, Madrid, Spain.
| | | | | | | | | |
Collapse
|
18
|
Iribarren-Marín MDA, Domínguez-Pérez Á, Pérez-Vega H, Martín-García C. [Spondylodiscitis caused by Streptococcus pneumonia associated with an infected abdominal aortic aneurysm]. Enferm Infecc Microbiol Clin 2011; 29:313-4. [PMID: 21333395 DOI: 10.1016/j.eimc.2010.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Revised: 10/28/2010] [Accepted: 11/05/2010] [Indexed: 10/18/2022]
|
19
|
Abstract
STUDY DESIGN We performed a retrospective review of 126 cases of infectious spondylodiscitis over a 4-year period. OBJECTIVE Differentiation between pyogenic spondylodiscitis (PS) and tuberculous spondylodiscitis (TS) is essential for deciding on the appropriate therapeutic regimen. The aim of this study was to compare the characteristics of the 2 forms of spondylodiscitis. SUMMARY OF BACKGROUND DATA There has been much effort to distinguish the radiologic findings in PS versus TS, but classification based on radiologic findings alone had limitations yet. METHODS We compared the predisposing factors or associated illnesses, clinical, radiologic, and laboratory features of microbiologically confirmed cases of PS and TS in 2 university hospitals. RESULTS Of 126 patients, 79 had PS and 47 TS. PS was more frequently associated with the followings: previous invasive spinal procedures (PS vs. TS: 32.9% vs. 8.5%), preceding bacteremia (13.9% vs. 0%), chronic renal failure (12.7% vs. 0%), liver cirrhosis (13.9% vs. 0%), fever (temperature >38°C) (48.1% vs. 17.0%), white blood cell counts over 10,000/mm (41.8% vs. 19.1%), fraction of neutrophils >75% (49.4% vs. 27.7%), C-reactive protein levels over 5 mg/dL (58.2% vs. 27.7%), erythrocyte sedimentation rate levels over 40 mm/h (84.4% vs. 66.0%), and ALP levels over 120 IU/L (45.6% vs. 17.0%). TS was frequently associated with active tuberculosis of other organs (0% vs. 31.9%), longer diagnostic delay (47.6 vs. 106.3 days), involvement of thoracic spines (21.5% vs. 38.3%), and involvement of ≥3 spinal levels (11.4% vs. 36.2%). CONCLUSION Previous invasive spinal procedures, preceding bacteremia, fever, higher white blood cell counts, C-reactive protein, ALP, and higher fraction of neutrophils are suggestive of PS. Concurrent active tuberculosis, more indolent course and involvement of thoracic spines are suggestive of TS. When the causative organism is not identified despite all efforts at diagnosis, combination of the clinical, radiologic, and laboratory characteristics of the patient is helpful.
Collapse
|
20
|
The management of aortic stent-graft infection: endograft removal versus conservative treatment. Ann Vasc Surg 2010; 24:554.e1-5. [PMID: 20097522 DOI: 10.1016/j.avsg.2009.11.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 10/18/2009] [Accepted: 11/09/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND Aortic stent-graft infections (ASGIs) are associated with significant mortality. We report our experience of two cases of ASGI treated differently and successfully. METHODS Two patients presented with constitutional symptoms some months after scheduled endovascular repair of aortic aneurysm (EVAR). Patient 1 had an abscess formation around the endograft in continuity with the right groin. Due to patient comorbidities, a conservative treatment was performed. Patient 2 had an abscess formation with air surrounding the stent graft. The patient was treated successfully by endograft removal. RESULTS Computed tomographic scan follow-up at 6 months from surgery showed no evidence of recurrent infection. CONCLUSION Despite the recommended treatment of ASGI being surgery, conservative treatment can be performed successfully in patients with high surgical risk, avoiding aortic clamping. We present the first reported case of ASGI due to Streptococcus haemolyticus, the second case due to a fungus, and the second reported case of spondylodiscitis after EVAR.
Collapse
|