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Kurowicki J, Changoor S, Coban D, Patel N, Sinha K, Hwang K, Emami A. The Impact of Patient Characteristics on Outcomes of Surgically Managed Vertebral Osteomyelitis in the United States: Insights from a National Database Study. J Long Term Eff Med Implants 2024; 34:83-94. [PMID: 38505897 DOI: 10.1615/jlongtermeffmedimplants.2023049402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
This study was conducted to assess the patient characteristics, types of treatment, and outcomes of patients who are surgically treated for vertebral osteomyelitis (VO) in the United States. VO can be treated with or without surgical intervention. Surgically treated cases of VO are associated with significant morbidity and mortality, and incur major healthcare costs. There are few studies assessing the characteristics and outcomes of patients with VO who are treated surgically, as well as the overall impact of surgically managed VO on the healthcare system of the United States. Utilizing the Nationwide Inpatient Sample (NIS) database, 44,401 patients were identified who underwent surgical treatment for VO over a fifteen year period. Severity of comorbidity burden was calculated using the Deyo Index (DI). Surgical approach and comorbidities were analyzed in regard to their impact on complications, mortality rate, LOS, and hospitalization charges. The incidence of surgical intervention for patients who had VO increased from 0.6 to 1.1 per U.S. persons over the study period. Surgically treated patients had a mean age of 56 years, were 75.8% white, were 54.5% male, 37.9% carried Medicare insurance, and they had a mean DI of 0.88. Anterior/posterior approach (OR: 3.53), thoracolumbar fusion (OR: 2.69), thoracolumbar fusion (OR: 19.94), and anterior/posterior approach (OR: 64.73) were the surgical factors that most significantly predicted any complication, mortality, increased LOS, and increased hospital charges, respectively (P < 0.001). The mean inflation-adjusted total hospital cost increased from $20,355 to $39,991 per patient over the study period. VO has been steadily increasing in the United States. Incidence and inflation-adjusted costs nearly doubled. Anterior/posterior approach and thoracolumbar fusion most significantly predicted negative outcomes. VO is associated with lengthy and expensive hospital stays resulting in a significant burden to patients and the healthcare system.
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Affiliation(s)
- Jennifer Kurowicki
- St. Joseph's University Medical Center, Department of Orthopedic Surgery, Paterson, New Jersey 07503
| | - Stuart Changoor
- St. Joseph's University Medical Center, Department of Orthopaedic Surgery, 703 Main Street, Paterson, NJ 07503
| | - Daniel Coban
- St. Joseph's University Medical Center, Department of Orthopaedic Surgery, 703 Main Street, Paterson, NJ 07503
| | - Neil Patel
- St. Joseph's University Medical Center, Department of Orthopaedic Surgery, Paterson, NJ 07503
| | - Kumar Sinha
- St. Joseph's University Medical Center, Department of Orthopaedic Surgery, 703 Main Street, Paterson, NJ 07503
| | - Ki Hwang
- St. Joseph's University Medical Center, Department of Orthopaedic Surgery, Paterson, NJ 07503
| | - Arash Emami
- St. Joseph's University Medical Center, Department of Orthopaedic Surgery, 703 Main Street, Paterson, NJ 07503
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Bazarov AY, Sergeyev KS, Sidoryak NP. Polysegmental and multilevel lesions in hematogenous vertebral osteomyelitis: assessment of immediate and long-term results. HIRURGIÂ POZVONOČNIKA (SPINE SURGERY) 2023. [DOI: 10.14531/ss2023.1.75-84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Objective. To analyze the results of treatment of disseminated (polysegmental and multilevel) forms of hematogenous vertebral osteomyelitis (HVO) as compared with those of monosegmental and monovertebral lesions.Material and Methods. A retrospective analysis of a monocenter cohort of 266 patients with hematogenous osteomyelitis of the spine for 2006 to 2019 was carried out. Patients were divided into two groups: Group A (polysegmental and multilevel lesions) included 33 (12.4 %) patients and Group B (monosegmental and monovertebral lesions) – 233 (87.6 %) patients. The main examination methods were: clinical, radiological (standardized roentgenography, CT), MRI, microbiological, histological and statistical ones.Results. Comparison revealed that involvement of the cervical (p < 0.001) and thoracic (p = 0.014) spine was more typical for polysegmental and multilevel lesions. There was a tendency to the predominance of type A lesions according to the Pola classification in patients with local forms (p = 0.078) and to the increase in type C lesions in polysegmental and multilevel processes (p = 0.035). The number of neurological complications was higher in polysegmental and multilevel lesions (p = 0.003). There were no significant differences in the treatment results, the number of relapses and mortality rate between the compared groups.Conclusion. Lesions of the cervical and thoracic spine and the presence of a neurological deterioration are typical for multilevel and polysegmental HVO. The formation of a multilevel lesion in different regions of the spine with a gap of 2–4 weeks or more requires a separate implementation of the diagnostic algorithm, defining of classification criteria and differentiated treatment tactics for each focus.
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Affiliation(s)
- A. Yu. Bazarov
- Tyumen Regional Clinical Hospital No. 2;
Tyumen State Medical University
75 Melnikaite str., Tyumen, 625039, Russia;
54 Odesskaya str., Tyumen, 625023, Russia
| | - K. S. Sergeyev
- Tyumen State Medical University
54 Odesskaya str., Tyumen, 625023, Russia
| | - N. P. Sidoryak
- Traumatology and Orthopedic Department No. 3
Regional Clinical Hospital No. 2
75 Melnikaite str., Tyumen, 625039, Russia
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Lu YA, Chen CY, Kuo G, Yen CL, Tian YC, Hsu HH. In-Hospital Outcomes and Recurrence of Infectious Spondylitis in Patients with and without Chronic Hemodialysis: A Nationwide Cohort Study. Int J Gen Med 2022; 15:2991-3001. [PMID: 35308570 PMCID: PMC8932927 DOI: 10.2147/ijgm.s348431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/07/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yueh-An Lu
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chao-Yu Chen
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - George Kuo
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chieh-Li Yen
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Hsiang-Hao Hsu
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Correspondence: Hsiang-Hao Hsu, Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan, Tel +886-3-328-1200 ext. 8181, Fax +886-3-3282173, Email
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Endoscopic treatment of spondylodiscitis: systematic review. 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; 31:1765-1774. [PMID: 35211807 DOI: 10.1007/s00586-022-07142-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 12/31/2021] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Spondylodiscitis is a severe condition where standalone antibiotic therapy resolves most cases. In refractory infections, open surgery may aid with infection debulking. However, significant morbidity can occur. Nowadays, endoscopic approaches are emerging as an alternative. However, until now, only small-scale studies exist. Being so, we carried the first systematic review on spondylodiscitis endoscopic debridement indications, technique details, and outcomes. METHODS Search for all English written original studies approaching the spondylodiscitis endoscopic treatment was performed using PubMed and EBSCO host. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and a pre-specified protocol was registered at PROSPERO (CRD42020183657). RESULTS Fourteen studies involving 342 participants were included for analysis. Data overall quality was fair. Indications for the endoscopic approach were poorly defined. The most consensual indication was refractory infection to conservative treatment. Spinal instability or neurological deficits were common exclusion criteria. All authors described similar techniques, and despite the frequent severe co-morbidities, procedure morbidity was low. Re-interventions were common. Microorganism identification varied from 54.2 to 90.4%. Treatment failure among studies ranged from 0 to 33%. Pain, functional status, and neurological deficits had satisfactory improvement after procedures. CONCLUSIONS The endoscopic debridement of spondylodiscitis seems to be an effective and safe approach for refractory spondylodiscitis. A novel approach with initial endoscopic infection debulking and antibiotic therapy could improve the success of spondylodiscitis treatment.
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Vettivel J, Bortz C, Passias PG, Baker JF. Pyogenic Vertebral Column Osteomyelitis in Adults: Analysis of Risk Factors for 30-Day and 1-Year Mortality in a Single Center Cohort Study. Asian Spine J 2019; 13:608-614. [PMID: 30866620 PMCID: PMC6680037 DOI: 10.31616/asj.2018.0295] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 12/16/2018] [Indexed: 11/23/2022] Open
Abstract
Study Design Retrospective cohort study. Purpose To describe our experience in the management and outcomes of vertebral column osteomyelitis (VCO), particularly focusing on the risk factors of early and late mortality. Overview of Literature Previous reports suggest a global increase in spinal column infections highlighting significant morbidity and mortality. To date, there have been no reports from our local population, and no previous report has assessed the potential relationship of frailty with mortality in a cohort of patients with VCO. Methods We reviewed 76 consecutive patients with VCO between 2009 and 2016 in Waikato Hospital, New Zealand. Demographic, clinical, microbiological, and treatment data were collected. Comorbidities were noted to calculate the modified Frailty Index (mFI). Mortality at 30 days and 1 year was recorded. Univariate and multivariate analyses were used to identify the predictors of mortality. Results The mean age of patients was 64.1 years, with 77.6% being male. Most patients presented with axial back pain (71.1%), with the lumbar spine most commonly affected (46%). A mean of 2.1 vertebral bodies was involved. Methicillin-sensitive Staphylococcus aureus was the most common organism of infection (35.5%), and 15.8% of patients exhibited polymicrobial infection. Twenty patients (26.3%) underwent surgical intervention, which was more likely in patients with concomitant spinal epidural abscess (odds ratio [OR], 4.88) or spondylodiscitis (OR, 3.81). Mortality rate was 5.2% at 30 days and 22.3% at 1 year. The presence of frailty (OR, 13.62) and chronic renal failure (OR, 13.40) elevated the 30-day mortality risk only in univariate analysis. An increase in age (OR, 1.07) and the number of vertebral levels (OR, 2.30) elevated the 1-year mortality risk in both univariate and multivariate analyses. Conclusions Although the mFI correlated with 30-day mortality in univariate analysis, it was not a significant predictor in multivariate analysis. An increase in age and the number of levels involved elevated the 1-year mortality risk.
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Affiliation(s)
- Jeevan Vettivel
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Cole Bortz
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Peter Gust Passias
- Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Joseph Frederick Baker
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
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Segreto FA, Beyer GA, Grieco P, Horn SR, Bortz CA, Jalai CM, Passias PG, Paulino CB, Diebo BG. Vertebral Osteomyelitis: A Comparison of Associated Outcomes in Early Versus Delayed Surgical Treatment. Int J Spine Surg 2018; 12:703-712. [PMID: 30619674 DOI: 10.14444/5088] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The recommended timing of surgical intervention for vertebral osteomyelitis (VO) is controversial; however, most studies are not sufficiently powered. Our goal was to investigate the associated effects of delaying surgery in VO patients on in-hospital complications, neurologic deficits, and mortality. Methods Retrospective review of the National Inpatient Sample. Patients who underwent surgery for VO from 1998 to 2013 were identified using codes from the International Classification of Disease, Ninth Revision, Clinical Modification. Patients were stratified into groups based on incremental delay of surgery: 0-day delay (same-day surgery), 1-day delay, 2-day delay, 3- to 6-day delay, 7- to 14-day delay, and 14- to 30-day delay. Univariate analysis compared demographics and outcomes between groups. Multivariate logistic regression models calculated independent predictors of any complication, mortality, and neurologic deficits. A 0-day delay was the reference group. Results A total of 34 465 patients were identified. Delayed groups were older (same day: 53.5 vs. 7-14-day delay: 61.1) and had a higher Deyo-Charlson score (same day: 0.4901 vs. 14-30-day delay: 1.66), length of stay (same day: 4.2 vs. 14-30-day delay: 34.04 days), and total charges (same day: $63,390.78 vs. 14-30-day delay: $245,752.4), all P < .001. Delayed groups had higher surgical combined-approach rates (same day: 9.1% vs. 14-30-day delay: 31.5%) and lower anterior-approach rates (same day: 42.4% vs. 14-30-day delay: 24.2%). Delayed groups had increased mortality and complication rates. Regressions showed delayed groups as the strongest independent indicators of any complication (14-30-day delay: odds ratio [OR] 3.384), mortality (14-30-day delay: OR 10.658), and neurologic deficits (14-30-day delay: OR 3.464), all P < .001. Conclusion VO patients who operate within 24 hours of admission are more likely to have desirable outcomes. Patients with delayed surgery had a significantly increased risk of developing any complication, mortality, and discharging with neurologic deficits. Level of Evidence III. Clinical Relevance Medically fit patients may benefit from earlier surgical management in order to reduce risk of postoperative complications, improve outcomes, and reduce overall hospital costs.
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Affiliation(s)
- Frank A Segreto
- Department of Orthopaedics, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | | | - Preston Grieco
- Department of Orthopaedic Surgery, SUNY Downstate, Brooklyn, New York
| | - Samantha R Horn
- Department of Orthopaedics, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - Cole A Bortz
- Department of Orthopaedics, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - Cyrus M Jalai
- Department of Orthopaedics, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - Peter G Passias
- Department of Orthopaedics, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - Carl B Paulino
- Department of Orthopaedic Surgery, SUNY Downstate, Brooklyn, New York
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate, Brooklyn, New York
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7
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Lee YM, Cho OH, Park SY, Moon C, Chong YP, Kim SH, Lee SO, Choi SH, Lee MS, Bae IG, Kim YS, Woo JH, Kang KC, Lee JH, Park KH. Factors associated with sequelae after treatment of hematogenous pyogenic vertebral osteomyelitis. Diagn Microbiol Infect Dis 2018; 94:66-72. [PMID: 30594411 DOI: 10.1016/j.diagmicrobio.2018.11.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 11/22/2018] [Accepted: 11/24/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Functional disability may persist after completing treatment for hematogenous pyogenic vertebral osteomyelitis (HPVO). The objective of this study was to identify factors associated with residual sequelae after treatment of HPVO. METHODS We conducted a retrospective study of patients diagnosed with HPVO at 5 tertiary-care hospitals between January 2005 and December 2012. Sequelae were defined as an inability to walk without assistance, bladder/bowel incontinence, and/or unresolved pain that required analgesic therapy at 12 months after completing the HPVO treatment. RESULTS Of the 279 patients with microbiologically proven HPVO, 79 (28.3%) had sequelae at 12 months posttherapy. Independent risk factors for sequelae were neurologic deficit (adjusted odds ratio [aOR], 3.38), recurrence within 12 months (aOR, 2.45), age ≥ 65 years (aOR, 2.05), C-reactive protein level ≥ 10 mg/dL (aOR, 2.01), and epidural/paravertebral abscess (aOR, 2.00). Among 58 patients with neurologic deficit, sequelae rates differed according to the surgical strategy, as follows: 28.6% (early surgery [<48 h]), 55.0% (delayed surgery [≥48 h]), and 66.7% (no surgery) (P = 0.03). Among the 170 patients with abscess, early drainage (<72 h) was an independent protective factor for sequelae (aOR, 0.35). The 12-month recurrence rates differed according to the total duration of antibiotic treatment, as follows: 20.5% (4-6 weeks), 18.4% (6-8 weeks), and 5.2% (≥8 weeks) (P < 0.001). CONCLUSIONS A substantial proportion of patients with HPVO experienced sequelae after completing treatment. Early surgery for neurologic deficit, early drainage of abscess, and antibiotic therapy of appropriate duration to reduce recurrence may prevent development of sequelae in patients with HPVO.
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Affiliation(s)
- Yu-Mi Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Oh-Hyun Cho
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Seong Yeon Park
- Division of Infectious Diseases, Department of Internal Medicine, Dongguk University Ilsan Hospital, University of Dongguk College of Medicine, Goyang-si, Republic of Korea
| | - Chisook Moon
- Department of Infectious Diseases, Busan Paik Hospital, Inje University College of Medicine, Busan
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan college of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan college of Medicine, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan college of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan college of Medicine, Seoul, Republic of Korea
| | - Mi Suk Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - In-Gyu Bae
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan college of Medicine, Seoul, Republic of Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan college of Medicine, Seoul, Republic of Korea
| | - Kyung-Chung Kang
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Jung-Hee Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Ki-Ho Park
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
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Chong BSW, Brereton CJ, Gordon A, Davis JS. Epidemiology, Microbiological Diagnosis, and Clinical Outcomes in Pyogenic Vertebral Osteomyelitis: A 10-year Retrospective Cohort Study. Open Forum Infect Dis 2018; 5:ofy037. [PMID: 29564362 PMCID: PMC5846292 DOI: 10.1093/ofid/ofy037] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/22/2018] [Indexed: 11/18/2022] Open
Abstract
Background Pyogenic vertebral osteomyelitis (PVO) is rising in incidence, but optimal methods of investigation and duration of antibiotic therapy remain controversial. Methods We conducted a single-center retrospective cohort study of PVO at an Australian teaching hospital. We included all adults with a first episode of PVO between 2006 and 2015. PVO was defined based on the presence of prespecified clinical and radiological criteria. The main exposures of interest were investigation strategy and antibiotic treatment. The main outcome measures were duration of hospital admission, mortality during index admission, symptom resolution during index admission, and attributable readmission within 2 years. Results Of 129 included patients, 101 (78%) had a causative organism identified. Patients with an identified pathogen were more likely to be febrile (75% compared with 29%, P < .001) and had a higher mean admission C-reactive protein (207 vs 54, P < .001) compared with patients without an identified pathogen. However, they were less likely to experience an adverse outcome (death or attributable readmission within 2 years; adjusted odds ratio, 0.36; 95% confidence interval, 0.13–0.99; P = .04). Open biopsy of vertebral tissue had a higher diagnostic yield (70%) than fine needle aspirate (41%) or core biopsy (30%). Despite receiving a median of 6 weeks of intravenous antibiotics, only 15% of patients had a full recovery on discharge from index admission. Conclusions Clinical outcomes for patients with PVO were poor. Obtaining a microbiological diagnosis is associated with a better outcome. However, prospective and randomized studies are essential to establishing optimal investigation and treatment pathways.
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Affiliation(s)
- Brian S W Chong
- Division of Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Christopher J Brereton
- Division of Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - Alexander Gordon
- Division of Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Joshua S Davis
- Division of Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, NSW, Australia.,Global and Tropical Health Division, Menzies School of Health Research, Darwin, NT, Australia
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Dragsted C, Aagaard T, Ohrt-Nissen S, Gehrchen M, Dahl B. Mortality and health-related quality of life in patients surgically treated for spondylodiscitis. J Orthop Surg (Hong Kong) 2018. [PMID: 28639530 DOI: 10.1177/2309499017716068] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess mortality, disability, and health-related quality of life (HRQL) in patients surgically treated for spondylodiscitis. METHODS A retrospective longitudinal study was conducted on all patients surgically treated for spondylodiscitis over a 6-year period at a single tertiary spine center. Indications for surgery, pre- and postoperative neurological impairment, comorbidities, and mortality were recorded. A survey was conducted on all eligible patients with the EuroQol 5-dimension (EQ-5D) questionnaire and Oswestry Disability Index (ODI). RESULTS Sixty-five patients were diagnosed with spondylodiscitis not related to recent spine surgery. One-year mortality rate was 6%. In all, 36% and 27% had pre- and postoperative neurological impairment, respectively, with only one patient experiencing deterioration postoperatively. At final follow-up (median 2 years), mean ODI was 31% (SD = 22) and mean EQ-5D time trade-off score was 0.639 (SD = 0.262); this was significantly lower than that in the normal population ( p < 0.001). Patients with neurological impairment prior to index surgery had lower EQ-5D scores ( p = 0.005) and higher ODI ( p = 0.02) at final follow-up compared with patients without neurological impairment. CONCLUSIONS Several years after surgery, patients surgically treated for spondylodiscitis have significantly lower HRQL and more disability than the background population. Neurological impairment prior to index surgery predicts adverse outcome in terms of disability and lower HRQL.
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Affiliation(s)
- Casper Dragsted
- 1 Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Theis Aagaard
- 2 Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Søren Ohrt-Nissen
- 1 Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Gehrchen
- 1 Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Benny Dahl
- 1 Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Kong Q, Jin Y, Yan S, Wang Y, Zhao J, Feng Z, Wei J, Wang Y, Kong L, Guo L, Yang J. Examining the association of MMP-1 gene -1607 (2G/1G) and -519 (A/G) polymorphisms with the risk of osteomyelitis: A case-control study. Medicine (Baltimore) 2017; 96:e4969. [PMID: 29049163 PMCID: PMC5662329 DOI: 10.1097/md.0000000000004969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
To investigate the effects of matrix metalloproteinase-1 (MMP-1) gene polymorphisms on the onset of osteomyelitis in Chinese Han population.In all, 80 osteomyelitis patients (case group) and 81 healthy people (control group) were recruited into this case-control study. Polymerase chain reaction-restriction fragment length polymorphism method was utilized to examine the genotypes of MMP-1 polymorphisms (-1607 2G/1G and -519A/G) in the 2 groups. Genotype and allele differences between the case and control groups were analyzed by chi-square test. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated to present the association strength between MMP-1 gene polymorphisms and osteomyelitis.Frequencies of -1607 2G/2G genotype between the case and control groups were statistically significant (P = .025). Compared with 1G/1G genotype carriers, the 2G/2G genotype carriers had 1.605 times risk of developing osteomyelitis (OR 2.605, 95% CI 1.116-6.082). Meanwhile, the 2G allele significantly associated with the risk of osteomyelitis (OR 1.735, 95% CI 1.115-2.701). In addition, frequency of -519GG genotype was obviously higher in case group than that in control group (P = .024), and GG genotype related to an increased risk of osteomyelitis (OR 2.792, 95% CI 1.127-6.917). Whereas, the -519G allele may be a susceptible factor for osteomyelitis (OR 1.622, 95% CI 1.038-2.536).The MMP-1 -1607 (2G/1G) and -519 (A/G) polymorphisms may contribute to the onset of osteomyelitis.
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Affiliation(s)
- Qingzhu Kong
- Trauma 2 Ward, Southern District of Affiliated Hospital of Chengde Medical College
| | - Yu Jin
- Trauma 2 Ward, Southern District of Affiliated Hospital of Chengde Medical College
| | - Shi Yan
- Trauma 2 Ward, Southern District of Affiliated Hospital of Chengde Medical College
| | - Yin Wang
- Trauma 2 Ward, Southern District of Affiliated Hospital of Chengde Medical College
| | - Jingxin Zhao
- Trauma 2 Ward, Southern District of Affiliated Hospital of Chengde Medical College
| | - Zhen Feng
- Trauma 2 Ward, Southern District of Affiliated Hospital of Chengde Medical College
| | - Junqiang Wei
- Trauma 2 Ward, Southern District of Affiliated Hospital of Chengde Medical College
| | - Yu Wang
- Trauma 2 Ward, Southern District of Affiliated Hospital of Chengde Medical College
| | - Lingwei Kong
- Trauma 2 Ward, Southern District of Affiliated Hospital of Chengde Medical College
| | - Litao Guo
- Department of Ophthalmology, Affiliated Hospital of Chengde Medical College
| | - Jianing Yang
- Second Spine Surgery, Southern District of Affiliated Hospital of Chengde Medical College, Chengde, Hebei, China
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York J, Fisahn C, Chapman J. Vertebral Osteomyelitis Due to Granulicatella Adiacens, a Nutritionally Variant Streptococci. Cureus 2016; 8:e808. [PMID: 27800289 PMCID: PMC5085831 DOI: 10.7759/cureus.808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Vertebral osteomyelitis is a common pathology affecting the spine. We present the case of a 46-year-old male who was diagnosed with progressive L2 vertebral osteomyelitis due to a rare pathogen, Granulicatella adiacens. Granulicatella adiacens is part of the normal body flora and is often difficult to culture on traditional mediums. The patient required a lateral corpectomy and posterior fixation for spinal stabilization and source control.
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Affiliation(s)
| | - Christian Fisahn
- Orthopedic Surgery, Swedish Neuroscience Institute ; Department of Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Jens Chapman
- Orthopedics Spine Surgery, Swedish Neuroscience Institute
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Mitić R, Stojanović N, Kostić A, Cvetković I, Dželebdžić Z. ANTERIOR AND POSTERIOR FUSION OF CERVICAL SPINE IN OSTEOMYELITIC PROCESS OF SEVERAL VERTEBRAL BODIES: A CASE REPORT. ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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