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Gamada H, Funayama T, Yamaji A, Okuwaki S, Asada T, Izawa S, Kumagai H, Fujii K, Amano K, Shiina I, Tatsumura M, Uesugi M, Nakagawa T, Yamazaki M, Koda M. Treatment of Thoracolumbar Pyogenic Spondylitis with Minimally Invasive Posterior Fixation without Anterior Lesion Debridement or Bone Grafting: A Multicenter Case Study. J Clin Med 2023; 12:jcm12030932. [PMID: 36769580 PMCID: PMC9918103 DOI: 10.3390/jcm12030932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 01/27/2023] Open
Abstract
The usefulness of minimally invasive posterior fixation without debridement and autogenous bone grafting remains unknown. This multicenter case series aimed to determine the clinical outcomes and limitations of this method for thoracolumbar pyogenic spondylitis. Patients with thoracolumbar pyogenic spondylitis treated with minimally invasive posterior fixation alone were retrospectively evaluated at nine affiliated hospitals since April 2016. The study included 31 patients (23 men and 8 women; mean age, 73.3 years). The clinical course of the patients and requirement of additional anterior surgery constituted the study outcomes. The postoperative numerical rating scale score for lower back pain was significantly smaller than the preoperative score (5.8 vs. 3.6, p = 0.0055). The preoperative local kyphosis angle was 6.7°, which was corrected to 0.1° after surgery and 3.7° at the final follow-up visit. Owing to failed infection control, three patients (9.6%) required additional anterior debridement and autogenous bone grafting. Thus, in this multicenter case series, a large proportion of patients with thoracolumbar pyogenic spondylitis could be treated with minimally invasive posterior fixation alone, thereby indicating it as a treatment option for pyogenic spondylitis.
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Affiliation(s)
- Hisanori Gamada
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
- Department of Orthopaedic Surgery, Ibaraki Western Medical Center, 555 Otsuka, Chikusei 308-0813, Japan
- Correspondence: ; Tel.: +81-29-853-3219
| | - Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Akihiro Yamaji
- Department of Orthopaedic Surgery, Ichihara Hospital, 3691 Osone, Tsukuba 300-3253, Japan
| | - Shun Okuwaki
- Department of Orthopaedic Surgery, Kenpoku Medical Center, Takahagi Kyodo Hospital, 1006-9 Kamiteduna-Agehocho, Takahagi 318-0004, Japan
| | - Tomoyuki Asada
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Shigeo Izawa
- Department of Orthopaedic Surgery, Tsukuba Central Hospital, 1589-3 Kashiwada-Cho, Ushiku 300-1211, Japan
| | - Hiroshi Kumagai
- Department of Orthopaedic Surgery, Ichihara Hospital, 3691 Osone, Tsukuba 300-3253, Japan
| | - Kengo Fujii
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakonagei, Kodaira 187-0002, Japan
| | - Kuniaki Amano
- Department of Orthopaedic Surgery, Tsukuba Central Hospital, 1589-3 Kashiwada-Cho, Ushiku 300-1211, Japan
| | - Itsuo Shiina
- Department of Orthopaedic Surgery, Moriya Daiichi Hospital, 1-17 Matsumaedai, Moriya 302-0102, Japan
| | - Masaki Tatsumura
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, 3-2-7 Miyamachi, Mito 310-0015, Japan
| | - Masafumi Uesugi
- Department of Orthopaedic Surgery, Ibaraki Seinan Medical Center Hospital, 2190 Sashima, Sakai 306-0433, Japan
| | - Tsukasa Nakagawa
- Department of Orthopaedic Surgery, Ibaraki Western Medical Center, 555 Otsuka, Chikusei 308-0813, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
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Yamada K, Ieguchi M, Takahashi S, Nakamura H. Life Expectancy Is Poor in Patients with Diffuse Idiopathic Skeletal Hyperostosis-Related Pyogenic Vertebral Osteomyelitis. Spine Surg Relat Res 2022; 6:654-663. [PMID: 36561153 PMCID: PMC9747224 DOI: 10.22603/ssrr.2022-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/03/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction Pyogenic vertebral osteomyelitis (PVO) is an uncommon but life-threatening infectious disease. Diffuse idiopathic skeletal hyperostosis (DISH) is an age-related disorder and sometimes problematic in terms of spinal instability or high mortality, especially in cases of DISH-related fracture. Meanwhile, no reports have focused on the impact of DISH on the clinical outcomes after treatment for PVO. We hypothesized that PVO occurring at DISH-related segments might contribute to poor clinical results or high mortality rates. The purpose of this study was to investigate the impact of DISH on mortality after treatment for PVO in a retrospective cohort study. Methods This study involved patients who were hospitalized and treated for PVO at a single institution. DISH-related PVO was defined as PVO within a segment ossified by DISH or PVO at the neighboring intervertebral level of the segment ossified by DISH. Differences in mortality between patients with DISH-related and non-DISH-related PVO were investigated. Results This study included 55 patients. DISH-related PVO was observed in 13 patients. The mortality rate was significantly higher in patients with DISH-related PVO than in those with non-DISH-related PVO (62% and 23%, respectively; p=0.016). Propensity score-adjusted analysis showed that DISH-related PVO was an independent risk factor for mortality (adjusted hazard ratio, 2.79; p=0.034). The survival probability was significantly shorter in patients with DISH-related PVO than in those with non-DISH-related PVO (p=0.006). PVO in which the intravertebral body was the center of involvement was significantly more common in DISH-related PVO than in non-DISH-related PVO (38% and 5%, respectively; p=0.006). Conclusions DISH-related PVO was associated with a higher mortality rate and shorter life expectancy than non-DISH-related PVO. Similar to advanced age, PVO at the segment ossified by DISH should be recognized as a risk factor for mortality when choosing the optimal treatment strategy.
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Affiliation(s)
- Kentaro Yamada
- Department of Orthopaedic Surgery, Fuchu Hospital, Izumi, Japan,Department of Orthopaedic Surgery, Osaka Metropolitan University, Osaka, Japan
| | - Makoto Ieguchi
- Department of Orthopaedic Surgery, Fuchu Hospital, Izumi, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka Metropolitan University, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University, Osaka, Japan
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Guo W, Wang M, Chen G, Chen KH, Wan Y, Chen B, Zou X, Peng X. Early surgery with antibiotic medication was effective and efficient in treating pyogenic spondylodiscitis. BMC Musculoskelet Disord 2021; 22:288. [PMID: 33736624 PMCID: PMC7977180 DOI: 10.1186/s12891-021-04155-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 03/08/2021] [Indexed: 12/31/2022] Open
Abstract
Background Pyogenic spondylodiscitis (PSD) is challenging to the orthopedist with regards to diagnosis and treatment. The present study was designed to assess and suggest the most indicative diagnostic method and evaluate the effect of surgery comprising of debridement, instrumentation and fusion in treating PSD. Methods Seventy-six patients with PSD who underwent surgical intervention were retrospectively enrolled. Their medical documents, corrections of spinal alignment and improvements in neurological function were assessed. Surgical approaches were compared in lumbar surgeries regarding the improvements in lordotic angle and neurological function. Results Elevated c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were found in 77.6 and 71.1% patients respectively. Infectious lesions were found at lumbar (85.5%), cervical (10.5%) and thoracic (3.9%), ascertained with contrast-enhanced MRI. For lumbar patients, surgery was performed through the anterior (26.2%), posterior (49.2%) or combined approach (24.6%), and differences in improvement of lordosis and neurological function between each approach were insignificant. The pathogen was identified in 22.4% of the patients. Postoperative antibiotic therapy was managed against the result of susceptibility test, or empirically given to patients with negative cultures. All antibiotic therapy was initiated intravenously for 4–6 weeks and orally for 6 weeks. Conclusion Elevated CRP and/or ESR, with focal hyper-intensity on contrast-enhanced MRI are suggestive of possible PSD. Surgical intervention comprising of debridement, short-segment instrumentation and fusion that early applied to the PSD patients followed by postoperative antibiotic therapy have demonstrated preferable outcomes, but require further study. The translational potential of this article This article advocates early surgery to enable prompt diagnosis and treatment of PSD, and thus guarantee favorable outcomes for patients, as is shown in our study. In addition, different surgical approaches to the lesions were compared and discussed in this manuscript, but no differences in outcome between approaches were found. This suggests that thorough debridement should be prioritized over selection of surgical approach. In summary, this article has large translational potential to be applied clinically.
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Affiliation(s)
- Wei Guo
- Department of Orthopedic Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, China
| | - Min Wang
- Department of Spinal Surgery, Chancheng Central Hospital, Foshan, China
| | - Guangfu Chen
- Department of Spinal Surgery, Chancheng Central Hospital, Foshan, China
| | - Kuan-Hung Chen
- Department of Orthopedic Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, China
| | - Yong Wan
- Department of Orthopedic Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, China
| | - Bailing Chen
- Department of Orthopedic Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, China
| | - Xuenong Zou
- Department of Orthopedic Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, China
| | - Xinsheng Peng
- Department of Orthopedic Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. .,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou, China.
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One-stage posterior debridement, autogenous spinous process bone graft and instrumentation for single segment lumbar pyogenic spondylitis. Sci Rep 2021; 11:3065. [PMID: 33542353 PMCID: PMC7862586 DOI: 10.1038/s41598-021-82695-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/22/2021] [Indexed: 11/08/2022] Open
Abstract
To compare the surgical outcomes of autogenous spinous process with iliac bone graft in managing single segment lumbar pyogenic spondylitis (PS) after posterior debridement and instrumentation. We performed a retrospective study for adult patients with single level lumbar PS. 60 patients with single segment lumbar PS underwent one-stage posterior debridement, autogenous bone graft and instrumentations. The patients were divided into Group A (autogenous iliac bone) and Group B (autogenous spinous process). Preoperative Charlson comorbidity index (CCI) was analyzed to assess the comorbidity. Low back pain was evaluated using the visual analog scale (VAS). Neurological status was assessed with the American Spinal Injury Association (ASIA) scale. Clinical infection index including the C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) was also reviewed. Moreover, fusion and changes of sagittal alignment were investigated radiologically. There was a significantly longer operative time, hospital stay and greater blood loss in group A. The VAS scores improved significantly at each follow-up interval and post-operative VAS score was significantly lower in group B. At the last follow-up, ESR and CRP returned to normal for all patients. There was at least one grade level improvement in ASIA score. No statistical difference in corrected rate, loss of sagittal angle and lumbar lordosis was found between the two groups. There was no significant difference in fusion rate, mean fusion time and complications between the two groups. Compared with iliac bone graft, the autogenous spinous process bone graft can be less invasive and painful for the single segment lumbar PS. One-stage posterior debridement, autogenous spinous process bone graft and instrumentation can provide satisfactory results for appropriate cases.
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Pingel A. [Spondylodiscitis]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:687-703. [PMID: 32851619 DOI: 10.1055/a-1129-9246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Spondylodiscitis is an infection of the spine that first affects the vertebral endplates ("spondylitis") and then spreads to the adjacent intervertebral disc ("spondylodiscitis"). As it is a potentially life-threatening systemic disease rapid, often surgical treatment is required. Due to the multimorbidity of the patients and the complexity of the therapy, a multidisciplinary approach is essential. The vast majority of the cases heals under conservative therapy. An absolute indication for surgical therapy is given for acute septic courses or if there are new relevant neurological deficits. In addition, urgent surgical treatment is required for epidural abscesses that can be diagnosed by means of magnetic resonance imaging. In developed countries, over 90% of all spondylodiscitis cases come to a complete recovery.
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Nagata K, Ando T, Nakamoto H, Kato S, Sasaki K, Oshima Y. Adaptation and limitation of anterior column reconstruction for pyogenic spondylitis in lower thoracic and lumbar spine. J Orthop Sci 2019; 24:219-223. [PMID: 30318425 DOI: 10.1016/j.jos.2018.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/12/2018] [Accepted: 09/10/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Surgical strategy for pyogenic spondylitis is controversial when vertebral body erosion is severe. Radical debridement and anterior column reconstruction is indicated for the purpose of early ambulatory to prevent secondary complication for long bed rest. However, such aggressive debridement and risk of perioperative complications are trade-off. The purpose of this study was to evaluate the risk factor of poor prognosis after anterior column debridement and reconstruction for pyogenic spondylitis in lower thoracic and lumbar spine. METHODS We performed a retrospective review of 40 patients diagnosed with pyogenic spondylitis in lower thoracic and lumbar spine who were introduced to our institution due to losing ambulatory ability and underwent anterior column debridement and reconstruction between January 2008 and May 2016. After the patient population was split into a regaining ambulatory group (Group A; n = 23) and a poor prognosis group (Group P; n = 17), we used Fisher exact tests and t-tests as appropriate for univariate analyses to compare patient characteristics and outcomes between the 2 groups. RESULTS Univariate analysis showed that the significant variables were massive bleeding (>2000 ml) (P < 0.01), Charlson Comorbidity Index ≥3 (P = 0.01), and two-stage surgery needed (P = 0.04). Logistic regression analysis showed that the factors associated with poor prognosis were massive bleeding (Odds Ratio 11.9; 95% confidence interval 1.8 to 119.7; P = 0.04). CONCLUSIONS Massive bleeding was associated with poor prognosis after debridement followed by anterior column reconstruction for pyogenic spondylitis in lower thoracic and lumbar spine.
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Affiliation(s)
- Kosei Nagata
- The University of Tokyo Hospital, Japan; Hitachi General Hospital, Japan.
| | | | | | - So Kato
- The University of Tokyo Hospital, Japan
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Xu Z, Zheng Y. Percutaneous endoscopic debridement and irrigation for thoracic infections. ACTA ACUST UNITED AC 2018; 64:518-524. [PMID: 30304309 DOI: 10.1590/1806-9282.64.06.518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 08/05/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the safety and efficacy of percutaneous endoscopic debridement and irrigation for thoracic infections and to make an appropriate choice according to the patient's condition. METHODS. Thirty patients with thoracic infections who received surgical treatment from August 2014 to December2016 were retrospectively analyzed. There were 16 males and 14 females, aged from 41 to 90 years, with an average of 64.4 years. A total of 9 cases were treated with percutaneous endoscopic debridement and irrigation (minimal group), and 21 cases were treated with open debridement in combination with pedicle screw fixation (conventional group). Patients underwent follow-up for 1 month. General condition, operative index, laboratory results, and imaging features were recorded. RESULTS. Compared with the conventional group, there were more comorbidities in patients in the minimal group (8 cases in the minimal group, 10 cases in the conventional group, P=0.049), shorter hospital stay (10.1 + 2.26 days in the minimal group, 16.1 + 6.81 days in the conventional group, P=0.016), less bleeding volume (383.3 + 229.86ml in the minimal group, 90 + 11.18ml in the conventional group, P=0.000), lower VAS score at discharge (2.9 + 0.93 in the minimal group, 3.9 + 0.91 in the conventional group, P=0.013). There was no spinal instability case in the minimal group, 10 cases in the conventional group, P=0.013. There were significant differences. The C reaction protein prior to operation in the minimal group was 28.4±7.50mg/L. Compared with 45.1 + 15.78mg/L in the conventional group, P=0.005, it was lower. CONCLUSIONS. Percutaneous endoscopic debridement and irrigation are an effective surgery for treatment of thoracic infections, especially suitable for patients with comorbidities and poor general condition. However, for severe infection and spinal instability, we tend to choose open surgery in combination with fixation.
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Affiliation(s)
- Zhongyang Xu
- Jining No.1 people's Hospital, Jining Shi, Shandong Sheng, China
| | - Yanping Zheng
- Shandong University, Qilu Hospital, Jinan Shi, Shandong Sheng, China
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Kwon JW, Hyun SJ, Han SH, Kim KJ, Jahng TA. Pyogenic Vertebral Osteomyelitis: Clinical Features, Diagnosis, and Treatment. KOREAN JOURNAL OF SPINE 2017; 14:27-34. [PMID: 28704905 PMCID: PMC5518432 DOI: 10.14245/kjs.2017.14.2.27] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 04/07/2017] [Accepted: 06/20/2017] [Indexed: 12/18/2022]
Abstract
Pyogenic vertebral osteomyelitis (PVO) may result in neurological deficits and sequelae, so early diagnosis and appropriate treatment are critical. Many previous studies on PVO exist, but our paper has aimed to comprehensively summarize the clinical aspects of PVO. Through review of the vast literature on the clinical research of PVO an overview of the clinical characteristics, diagnostic methods, treatment and prognosis is provided.
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Affiliation(s)
- Ji-Woong Kwon
- Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Hyun Han
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Tae-Ahn Jahng
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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