1
|
Chaniotakis C, Koutserimpas C, Tsantes AG, Papadopoulos DV, Tsiridis CA, Karantanas A, Alpantaki K, Hadjipavlou A. Post-Discectomy Infection: A Critical Review and Suggestion of a Management Algorithm. J Clin Med 2024; 13:1478. [PMID: 38592315 PMCID: PMC10935210 DOI: 10.3390/jcm13051478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/18/2024] [Accepted: 03/01/2024] [Indexed: 04/10/2024] Open
Abstract
Postoperative discitis (POD) accounts for 20% to 30% of all cases of pyogenic spondylodiscitis, while POD may be mis-or-under-diagnosed, due to the vague related symptomatology and the non-specific imaging findings. Most studies report infection rate of less than 1%, which increases with the addition of non-instrumented fusion to 2.4% to 6.2%. It remains controversial whether POD is caused by an aseptic or infectious process. Positive cultures are presented only in 42-73% of patients with Staphylococcus species being the most common invading organisms, while Staphylococcus aureus is isolated in almost 50% of cases. The onset of POD symptoms usually occurs at 2-4 weeks after an apparently uneventful operation. Back pain and muscle spasms are usually refractory to bed rest and analgesics. Magnetic Resonance Imaging (MRI) is the most sensitive and specific imaging diagnostic technique. Antimicrobial therapy depends on the results of tissue cultures, and along with bracing represents the mainstay of management. Surgical intervention is necessary in patients failing conservative treatment. For the majority of cases, extensive surgical debridement, antibiotic therapy, and orthosis immobilization are effective in eliminating the infection. According to this, we recommend an Algorithmic approach for the management of POD. Postoperative infections after spinal surgery pose a certain clinical challenge, and in most cases can be treated conservatively. Nevertheless, disability may be persistent, and surgery could be necessary. The purpose of this concise review is to describe the manifestation of post-discectomy infection, its pathogenesis and particularly a rational approach for its management.
Collapse
Affiliation(s)
- Constantinos Chaniotakis
- Department of Orthopaedics and Trauma Surgery, “Venizeleion” General Hospital of Heraklion, 71409 Crete, Greece; (C.C.); (K.A.)
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Andreas G. Tsantes
- Laboratory of Haematology and Blood Bank Unit, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece;
- Microbiology Department, Saint Savvas Oncology Hospital, 11522 Athens, Greece
| | - Dimitrios V. Papadopoulos
- Second Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 14233 Athens, Greece;
| | | | | | - Kalliopi Alpantaki
- Department of Orthopaedics and Trauma Surgery, “Venizeleion” General Hospital of Heraklion, 71409 Crete, Greece; (C.C.); (K.A.)
| | - Alexander Hadjipavlou
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX 77550, USA;
| |
Collapse
|
2
|
Norisyam Y, Jayamalar T, Foo CH, Ohn KM. Typhoid spondylodiscitis of the cervical spine. BMJ Case Rep 2023; 16:e255033. [PMID: 38129083 DOI: 10.1136/bcr-2023-255033] [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] [Indexed: 12/23/2023] Open
Abstract
Spinal infection comprises pyogenic and non-pyogenic spondylodiscitis. This condition may manifest with non-specific clinical symptoms, elevated infective parameters and imaging findings that are difficult to distinguish. The cornerstone of a definitive diagnosis and subsequent successful treatment lies in tissue analysis through culture and histopathological studies. In this context, we present a case of Salmonella pyogenic spondylodiscitis affecting the C5/C6 vertebrae, complicated by Salmonella bacteraemia and characterised by mechanical neck pain that curtails daily activities and overall functioning, although without neurological deficits. The uniqueness of this case stems from its occurrence in an immunocompetent individual from a non-endemic area, with no identifiable sources of Salmonella infection or preceding gastrointestinal symptoms.
Collapse
Affiliation(s)
- Yusoff Norisyam
- Department of Orthopaedic, Hospital Sultan Ismail, Johor Bharu, Malaysia
| | | | - Choong Hoon Foo
- Orthopaedic Department, Hospital Queen Elizabeth, Kota Kinabalu, Malaysia
| | - Khin Maung Ohn
- Department of Orthopaedic Surgery, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| |
Collapse
|
3
|
Kitov B, Davarski A, Kitova T, Angelova P, Kehayov I. Letter to Editor Regarding "Management of Lumbar Pyogenic Spondylodiscitis in Germany: A Cross-Sectional Analysis of Spine Specialists". World Neurosurg 2023; 179:250. [PMID: 38078393 DOI: 10.1016/j.wneu.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Borislav Kitov
- Clinic of Neurosurgery, Sv. Georgi University Hospital, Plovdiv, Bulgaria
| | - Atanas Davarski
- Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Tanya Kitova
- Department of Anatomy, Histology and Embryology, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Polina Angelova
- Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria.
| | - Ivo Kehayov
- Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| |
Collapse
|
4
|
Kitov B, Kehayov I, Davarski A, Kitova T. Letter to the Editor: Does Operative Management of Epidural Abscesses Increase Healthcare Expenditures up to 1 Year After Treatment? Clin Orthop Relat Res 2023; 481:1858-1859. [PMID: 37466440 PMCID: PMC10427034 DOI: 10.1097/corr.0000000000002789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/29/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Borislav Kitov
- Professor, Clinic of Neurosurgery, St. George University Hospital, Plovdiv, Bulgaria
| | - Ivo Kehayov
- Associate Professor, Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Atanas Davarski
- Assistant Professor, Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Tanya Kitova
- Professor, Department of Anatomy, Histology and Embryology, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| |
Collapse
|
5
|
Wang X, Long Y, Li Y, Guo Y, Mansuerjiang M, Tian Z, Younusi A, Cao L, Wang C. Biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation for lumbar brucellosis spondylitis. Front Surg 2023; 9:1024510. [PMID: 36684311 PMCID: PMC9852336 DOI: 10.3389/fsurg.2022.1024510] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/10/2022] [Indexed: 01/08/2023] Open
Abstract
Objective This study aims to investigate the effectiveness and feasibility of biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation for lumbar brucellosis spondylitis (LBS). Methods The data of 13 patients with LBS were retrospectively analyzed, who underwent biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation from May 2020 to June 2022. The patients' clinical data, the duration of operation, the estimated blood loss (including postoperative drainage), and complications were recorded. Clinical outcomes include serum agglutination test (SAT) measures Brucella antibody titer, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the visual analog scale (VAS) scores of low back and leg, Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), American Spinal Injury Association neurological classification, and lordotic angle were analyzed. All patients were assessed using the modified Macnab criteria at the final follow-up. The intervertebral bone graft fusion was assessed using the Bridwell grading criteria. Results The mean operation duration was 177.31 ± 19.54 min, and the estimated blood loss was 176.15 ± 43.79 ml (including postoperative drainage was 41.15 ± 10.44 ml). The mean follow-up period was 13.92 ± 1.5 months. SAT showed that the antibody titers of 13 patients were normal 3 months after the operation and at the final follow-up. ESR and CRP levels returned to normal by the end of the 3-month follow-up. VAS scores of low back and leg, JOA score, and ODI significantly improved after the operation throughout the follow-up period (P < 0.05). Based on the modified Macnab criteria, 92.3% showed excellent to good outcomes. One patient had only a percutaneous screw internal fixation on the decompression side due to severe osteoporosis. One case suffered a superficial incision infection postoperatively that healed with dressing change and effective antibiotic treatment. Bony fusion was obtained in all patients at the last follow-up, including 12 cases with grade I and 1 case with grade II, with a fusion rate of 92.31%. Conclusion Biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation is an effective, safe, and viable surgical procedure for the treatment of LBS.
Collapse
Affiliation(s)
- Xiangbin Wang
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yubin Long
- Department of Spinal Surgery, Hunan Shaoyang Central Hospital, Shaoyang, China
| | - Yong Li
- Department of Spinal Surgery, Hunan Shaoyang Central Hospital, Shaoyang, China
| | - Yun Guo
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Maiwulan Mansuerjiang
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zheng Tian
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Aikebaier Younusi
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Li Cao
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China,Correspondence: Chong Wang Li Cao
| | - Chong Wang
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China,Correspondence: Chong Wang Li Cao
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Ahsan MK, Hasan MS, Khan MSI, Sakeb N. Management of post-operative discitis following discectomy in a tertiary-level hospital. J Orthop Surg (Hong Kong) 2021; 29:2309499020988213. [PMID: 33570021 DOI: 10.1177/2309499020988213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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 perform retrospective analysis of 75 post-operative disc space infections after open lumbar discectomy (OLD) and to assess the outcome of their medical and surgical management in a tertiary-level hospital. METHODS Records of 50 men and 25 women aged 26-65 (mean, 42.53) years who underwent treatment for post-operative discitis (POD) after single level OLD at L3-4 (n = 8), L4-5 (n = 42), L5-S1 (n = 25) level. The POD was diagnosed according to specific clinical signs, laboratory and radiographic investigations and all of them received initial intravenous antibiotics (IVA) for at least 4-6 weeks followed by oral ones. Successful responders (n = 55) were considered in Group-C and remainder [Group-S (n = 20)] were operated at least after 4 weeks of failure. Demographic data, clinical variables, hospital stay, duration of antibiotic treatment and post-treatment complications were collected from the hospital record and assessment before and after treatment were done by using visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score. Comprehensive outcome was evaluated by modified criteria of Kirkaldy-Willis. RESULTS The mean follows up was 36.38 months. Significant improvement of mean VAS and JOA score was achieved in both conservative (76.36% satisfactory) and operative (90% satisfactory) groups although the difference was statistically insignificant. CONCLUSION Although insignificant, early surgical intervention provided better results (e.g. functional outcomes, length of hospital stay and duration of antibiotic treatment therapy) than conventional conservative treatment in post-operative discitis.
Collapse
Affiliation(s)
- Md Kamrul Ahsan
- Department of Orthopaedic Surgery, 74464Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Md Sariful Hasan
- Department of Orthopaedic Surgery, 74464Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Md Shahidul Islam Khan
- Department of Orthopaedic Surgery, 74464Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Najmus Sakeb
- Department of Orthopaedic surgery, 468778Dhaka Community Medical College and Hospital, Dhaka, Bangladesh
| |
Collapse
|
8
|
Mohamed AA, Soffar HM, El Zayat HH, Aboul-Ela HM. Prognosis of spinal infections managed by minimal debridement: A case series in two tertiary centers. Surg Neurol Int 2021; 12:83. [PMID: 33767887 PMCID: PMC7982097 DOI: 10.25259/sni_29_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/13/2021] [Indexed: 12/18/2022] Open
Abstract
Background Spinal infections can be challenging in their management and include spondylitis, epidural abscess, and spondylodiscitis. Usual treatment is conservative through antimicrobials or surgery to decompress neural tissue, debride all infected tissues, and fix if needed. We propose the concept of surgery without formal debridement aiming at neural protection. Methods The study was performed at two tertiary centers on 25 patients with clinical findings. One patient was treated conservatively and the rest surgically by laminectomy and fixation if needed. Evacuation of fluid pus was performed. In the cervical and the thoracic region, if the granulation tissue was anterior to the cord, only decompression by laminectomy was done. Results Low back pain was present in 22 cases (88%), 16 cases (64%) had lower limb pain, and 12 cases (48%) had weakness. The level of spinal infection was lumbar in 15 cases (60%), thoracic in 9 cases (36%) cases, and cervical in 1 case (4%). The type of infection was epidural abscess in 20 cases (80%), discitis in 16 cases (64%), and vertebral osteomyelitis in 12 cases (48%). Laminectomy was performed in 20 cases (80%) and fixation in 17 cases (68%). The symptoms improved in all cases. On follow-up, the lesion was reduced in 14 patients (56%) and disappeared in 11 cases (44%). One case required ventriculoperitoneal shunt placement due to postinfectious hydrocephalus. Conclusion Dealing with spinal infections surgically through decompression or fixation with minimal debridement of infected tissue appears to be a safe and effective method of management.
Collapse
Affiliation(s)
- Ahmed Ali Mohamed
- Department of Neurosurgery, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | | | - Hazem Hassan El Zayat
- Department of Neurosurgery, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | | |
Collapse
|
9
|
Ibrahim F, Elkhateeb TM, Abd El-Rady A, Zayan M. Transforaminal Posterior Approach Is Effective for Treatment of Lower Thoracic Spine Spondylodiscitis. HSS J 2020; 16:515-520. [PMID: 33380990 PMCID: PMC7749920 DOI: 10.1007/s11420-019-09688-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/18/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with lower-thoracic spine pathologies that affect anterior column stability and compress the neural tissues need anterior decompression and reconstruction. Anterior approaches result in long-term morbidities. Posterior laminectomy and fixation alone may not be sufficient to maintain spine stability. QUESTIONS/PURPOSES To evaluate the results of a posterior-only transforaminal thoracic interbody fusion approach for patients with thoracic disc space infection in terms of the improvement in neurologic status, resolution of infection, correction of kyphotic deformity, and assessment of post-operative complications. METHODS A prospective study was done on 40 patients with lower thoracic spine spondylodiscitis. All patients were assessed with pre-operative imaging. Neurologic assessment was performed using the American Spinal Injury Association (ASIA) Impairment Scale and functionally by the modified Japanese Orthopedic Association (JOA) scale. Pre-operative and post-operative white blood cell count, erythrocyte sedimentation rate, and C-reactive protein levels were compared. All patients were operated on through a posterior approach using the transforaminal thoracic interbody fusion for decompression, reconstruction, and anterior fusion. RESULTS Mean age of patients was 49 years; mean operative period was 188 min; mean blood loss was 611 mL. Twelve patients' ASIA scores improved and only two patients' scores declined. One patient died 11 months post-operatively due to septicemia. The mean follow-up period was 27.8 months. The modified JOA score improved from 6.3 ± 1.6 to 9.5 ± 0.6. The local kyphosis angle was improved from 13.8 to 6.9° post-operatively, with insignificant loss of correction at the end of follow-up. Thirty-eight out of 40 patients had solid anterior fusion at the end of follow-up. CONCLUSION The clinical outcomes of this study showed that the transforaminal thoracic interbody approach is effective for both decompression and anterior reconstruction of the lower thoracic spine in patients with spondylodiscitis.
Collapse
Affiliation(s)
- Fady Ibrahim
- Department of Orthopedic, Spine Surgery, Faculty of Medicine, Ain Shams University, Abbasseya, Cairo Egypt
| | - Tameem Mohamed Elkhateeb
- Department of Orthopedic, Spine Surgery, Faculty of Medicine, Ain Shams University, Abbasseya, Cairo Egypt
| | - Abdelrady Abd El-Rady
- Department of Orthopedic, Spine Surgery, Faculty of Medicine, Ain Shams University, Abbasseya, Cairo Egypt
| | - Mohammed Zayan
- Department of Orthopedic, Spine Surgery, Faculty of Medicine, Ain Shams University, Abbasseya, Cairo Egypt
| |
Collapse
|
10
|
Quanping X, Niu H, Li S. Preliminary clinical study: percutaneous lumbar discectomy combined with external drainage for treatment of intervertebral disc infections with epidural abscess. Wideochir Inne Tech Maloinwazyjne 2020; 15:625-631. [PMID: 33294079 PMCID: PMC7687665 DOI: 10.5114/wiitm.2020.94152] [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: 01/12/2020] [Accepted: 02/10/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Percutaneous lumbar discectomy (PLD) combined with external drainage (ED) is a new technique for the treatment of intervertebral disc infection with epidural abscess. AIM To discuss the feasibility, safety and efficacy of PLD and ED for the treatment of intervertebral disc infections with epidural abscess. MATERIAL AND METHODS We enrolled 12 patients who underwent intervertebral disc infections with epidural abscess. The clinical efficacy was evaluated by visual analog scale (VAS) and standard Macnab's evaluation. Postoperative computed tomography and magnetic resonance imaging were also used to evaluate the clinical efficacy. RESULTS The technical success rate is 100%. Preoperation mean VAS score was 8.18 ±0.98; 5.36 ±1.50 postoperation 1 month; 3.36 ±2.24 postoperation 6 months; 2.77 ±0.31 postoperation 12 months. The comparison of preoperation and postoperation VAS showed a significant difference (p < 0.05). According to standard Macnab's evaluation, of all 12 cases, postoperation 12 months - excellent 4 cases, good 7 cases, poor 1 case. The efficacy rate was 91.6%. No serious complications were recorded. CONCLUSIONS Percutaneous lumbar discectomy combined with external drainage may be a safe and efficacy method for the treatment of intervertebral disc infections with epidural abscess.
Collapse
Affiliation(s)
- Xiao Quanping
- Interventional Department, The First Affliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Huanzhang Niu
- Interventional Department, The First Affliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Shuangying Li
- Urology Department, The LuoYang DongFang Hospital, Luoyang, China
| |
Collapse
|
11
|
Posterior stabilisation without formal debridement for the treatment of non-tuberculous pyogenic spinal infection in frail and debilitated population - A systematic review and meta-analysis. J Clin Orthop Trauma 2020; 15:9-15. [PMID: 33717910 PMCID: PMC7920149 DOI: 10.1016/j.jcot.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/14/2020] [Accepted: 11/12/2020] [Indexed: 11/20/2022] Open
Abstract
Non-tuberculous pyogenic spinal infection (PSI) incorporates a variety of different clinical conditions. Surgical interventions may be necessary for severe cases where there is evidence of spinal instability or neurological compromise. The primary surgical procedure, for late-stage PSI, focuses on the anterior approach with aggressive debridement of the infected tissue regions. An alternative treatment method that employs a posterior approach without any formal debridement, is seen as controversial. To the best of our knowledge, few case series and no systematic reviews are assessing the value of this posterior technique. We aim to evaluate the effectiveness of the posterior approach without formal debridement and the associated clinical outcomes, for PSI cases requiring surgical intervention. Several databases including MEDLINE, NHS Evidence, and the Cochrane database were searched from the date of creation of each database to December 16, 2019. A selection of the keywords used includes: "posterior approach", "debridement" and "discitis". Studies were excluded if they involved the anterior approach, carried out formal debridement, or were tuberculous spinal infection cases. We accepted any study type which included adult patients, with spinal infection at any level of the vertebral column. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used to follow standard systematic review structure. The main clinical outcomes evaluated include pain, neurological recovery (Frankel Grading System, FGS) post-operative complications, and functional outcomes (Kirkaldy-Willis Criteria and Spine Tango Combined Outcome Measure Index, COMI). Post-surgical neurological improvement was demonstrated with a mean FGS improvement of 1.12 in 102 patients over the included four articles. Post-operative neurological function was found to be improved at a statistically significant level when a random-effects model was applied, with the effect size found to be at 0.68 (p < 0.001). Pain level was improved significantly postoperatively. There were also enhanced functional outcomes post-intervention when the Kirkaldy-Willis criteria and COMI scores were assessed in certain studies. Within the limit of the available literature, our results showed that the posterior approach with posterior stabilisation without formal debridement can result in successful infection resolution, improved pain scores and neurological outcomes. However, Larger series with longer follow-up duration is strongly recommended.
Collapse
|
12
|
Ahsan K, Hasan S, Khan SI, Zaman N, Almasri SS, Ahmed N, Chaurasia B. Conservative versus operative management of postoperative lumbar discitis. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:198-209. [PMID: 33100770 PMCID: PMC7546051 DOI: 10.4103/jcvjs.jcvjs_111_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 07/20/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Treatment option of postoperative discitis (POD) is either conservative or operative, but till date, there are no established validated protocols of the treatment of postoperative lumbar discitis. Aim: The aim of this study was to assess the outcome of conservative versus operative management of POD following single-level lumbar discectomy. Methods: We prospectively studied a total of 38 cases of POD. The patients were diagnosed clinically, radiologically, and by laboratory investigations and followed up with serial erythrocyte sedimentation rate (ESR), C-reactive protein, X-ray, computed tomography (CT), and magnetic resonance imaging. Demographic data, clinical variables, length of hospital stay, duration of antibiotic treatment, and posttreatment complications were collected, and pre- and postoperative assessment was done using the Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) score. Functional outcome of the study was measured by the modified criteria of Kirkaldy–Willis. Results: VAS score for pain was significantly decreased in both groups after treatment. However, posttreatment differences were not statistically significant. In posttreatment mean JOA score, differences were not statistically significant in both groups except the mean difference (−0.47) of restriction of daily activities, which was statistically significant (95% confidence interval: −0.88–−0.07, P = 0.025, unpaired t-test). About 73.7% and 84.2% of the patients had a satisfactory functional outcome in conservative and operative management groups, respectively, at the end of 12-month follow-up. Conclusions: Operative management yielded better outcomes than traditional conservative treatment in terms of functional outcomes, length of hospital stays, and duration of antibiotic treatment as determined by both the pain and daily activity levels.
Collapse
Affiliation(s)
- Kamrul Ahsan
- Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sariful Hasan
- Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Shahidul Islam Khan
- Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Naznin Zaman
- Department of Anesthesiology, Sarkari Karmachari Hospital, Dhaka, Bangladesh
| | | | - Nazmin Ahmed
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| |
Collapse
|
13
|
Screven R, Noureldine MHA, Krafft PR, Alikhani P. Expandable Titanium Cages in the Emergent Treatment of Severe Spinal Deformity Secondary to Osteomyelitis: A Series of Three Complex Cases. Asian J Neurosurg 2020; 15:397-404. [PMID: 32656140 PMCID: PMC7335120 DOI: 10.4103/ajns.ajns_28_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/26/2020] [Accepted: 03/11/2020] [Indexed: 12/19/2022] Open
Abstract
The literature lacks robust evidence on the benefits versus risks of instrumenting and fusing the spinal column in the setting of active osteomyelitis. We report three patients with vertebral osteomyelitis and subsequent severe and complex kyphotic deformities. Patients 1 and 2 had previous instrumentation that required revision because of hardware failure in the thoracic and thoracolumbar regions, respectively. Patient 3 developed a severe cervical kyphotic deformity at 2 months after being diagnosed and treated with antibiotics for osteomyelitis, necessitating emergent instrumentation and fusion. All the three patients are doing very well so far. Spinal instrumentation and fusion for correction of kyphotic deformity is sometimes necessary in the context of active osteomyelitis and should be done emergently and without hesitation when spinal cord injury from spinal instability is of concern.
Collapse
Affiliation(s)
- Ryan Screven
- Department of Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Mohammad Hassan A Noureldine
- Department of Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Johns Hopkins University School of Medicine, Saint Petersburg, Florida, USA
| | - Paul R Krafft
- Department of Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Puya Alikhani
- Department of Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine, Tampa, USA
| |
Collapse
|
14
|
Abstract
In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 9 focused on implants questions in spine surgery, for which this article provides the recommendations, voting results, and rationales.
Collapse
|
15
|
Heary RF, Agarwal N, Agarwal P, Goldstein IM. Surgical Treatment With Thoracic Pedicle Screw Fixation of Vertebral Osteomyelitis With Long-Term Follow-up. Oper Neurosurg (Hagerstown) 2019; 17:443-451. [PMID: 30690618 DOI: 10.1093/ons/opy398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 01/11/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND While recent data has demonstrated the utility of lumbar pedicle screws for the treatment of vertebral osteomyelitis, the data are limited for thoracic pedicle screws. OBJECTIVE To investigate the effectiveness of thoracic pedicle screws for the surgical treatment of vertebral osteomyelitis. METHODS A retrospective review of all operations performed by 2 spinal neurosurgeons from 1999 to 2012 yielded 30 cases of vertebral osteomyelitis that were treated with thoracic pedicle screws. Sixteen (53%) of which underwent combined anterior and posterior fusion and 14 patients (47%) underwent standalone posterior fusion. Postoperative records were analyzed for pertinent clinical, laboratory, and radiographic data. RESULTS Of the 30 patients, 21 were males (70%), 8 were females (27%), and 1 was transsexual (3%). The mean age was 47 yr (range 18-69). The most common organism cultured was Staphylococcus aureus in 12 cases (50%). The mean patient stay in the hospital was 12.4 d after surgery (range 5-38 d). The mean antibiotic duration after discharge was 8 wk (range 1-24 wk). Of the 25 patients with long-term follow-up (mean, 49 mo), 92% had improved back pain (6/25 marked improvement, 17/25 complete resolution), 83% had improved muscle weakness (8/18 marked improvement, 7/18 complete resolution), and 100% had improved urinary incontinence (3/8 marked improvement, 5/8 complete resolution). Two patients (7%) required additional surgical revision due to instrumentation failure or wound infection. CONCLUSION This study demonstrates the efficacy of utilizing thoracic pedicle screws as a primary intervention to treat vertebral osteomyelitis.
Collapse
Affiliation(s)
- Robert F Heary
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Prateek Agarwal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ira M Goldstein
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| |
Collapse
|
16
|
Bohl MA, Hlubek RJ, Turner JD, Reece EM, Kakarla UK, Chang SW. Novel Surgical Treatment Strategies for Unstable Lumbar Osteodiscitis: A 3-Patient Case Series. Oper Neurosurg (Hagerstown) 2019; 14:639-646. [PMID: 28961732 DOI: 10.1093/ons/opx162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 06/27/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lumbar osteomyelitis frequently affects patients with medical comorbidities and poor preoperative health. Surgery is indicated when medical management fails or patients present with spinal instability or neural compromise. Successful arthrodesis can be difficult and sometimes requires alternative surgical techniques. OBJECTIVE To report 3 novel methods, each illustrated by a case, for achieving arthrodesis for lumbar osteomyelitis. METHODS A retrospective review was performed of 3 cases of surgical treatment of lumbar osteomyelitis. Novel aspects of the surgical techniques are reported, as are perioperative clinical details and imaging results. RESULTS In the first patient, a vascularized iliac crest graft on a quadratus lumborum pedicle was rotated into the posterolateral fusion bed of the affected level. In the second, an anterior approach with debridement of affected lumbar levels was followed by rotation of a vascularized iliac crest graft on an iliacus muscle pedicle into the anterior lumbar defect. In the third, a structural, nonvascularized iliac crest graft was harvested via a lateral approach to provide better surgical access, and an autologous tricortical bone graft was obtained for placement in the debridement defect. Follow-up imaging suggested successful early incorporation of all the grafts in the fusion beds. CONCLUSION Patients with multiple risk factors for pseudarthrosis and recurrent infection often require alternative surgical strategies to augment fusion. These 3 novel methods for lumbar debridement, fixation, and fusion using vascularized or nonvascularized autograft accommodate posterior, anterior, and lateral surgical approaches. Further experience with these techniques is required to compare outcomes with those of traditional techniques.
Collapse
Affiliation(s)
- Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Randall J Hlubek
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Edward M Reece
- Arizona Center for Hand Surgery-Reconstructive Plastic Surgery, Phoenix, Arizona
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| |
Collapse
|
17
|
Arslan A, Çavuş G, Bilgin E, Ökten Aİ, Gezercan Y, Atmiş A, Çelik Ü. Brucella Case That Led to Atlantoaxial Spinal Instability in Childhood. World Neurosurg 2019; 131:108-111. [PMID: 31323407 DOI: 10.1016/j.wneu.2019.07.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atlantoaxial subluxation caused by Brucella infection is rarely seen in children. CASE DESCRIPTION C1-C2 dislocation, erosion in the odontoid bone, and compression to the brainstem were detected on cervical computed tomography and magnetic resonance imaging in a 6-year-old patient who suffered neck pain, deviation to the right in the neck, fever, and pain in his extremities. He was hospitalized in the Clinic of Pediatric Infectious Diseases. Positive Brucella agglutination tests were obtained, so C1-C2 stabilization and fusion were performed. Antibrucellosis antibiotic treatment was administered for 6 months. It was suggested that the dislocation was related to odontoid erosion and laxity of the atlantoaxial ligamentous structures during Brucella infection. CONCLUSIONS Atlantoaxial dislocation and instability develops secondarily to paravertebral abscesses, only rarely. Like brucellosis of childhood, granulomatous infectious diseases rarely cause atlantoaxial subluxation or dislocation. Torticollis and neck pains should be taken seriously for the purpose of early diagnosis of patients at risk in endemic regions. Stabilization and fusion should be performed when instability is detected, and these patients should be assessed with both pediatric infectious diseases and neurosurgery clinics. Our case is the first one in the literature in which atlantoaxial instability developed due to Brucella infection and stabilization was performed.
Collapse
Affiliation(s)
- Ali Arslan
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Gökhan Çavuş
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey.
| | - Emre Bilgin
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Ali İhsan Ökten
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Yurdal Gezercan
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Anıl Atmiş
- Department of Pediatric Infectious Diseases and Neurology, Adana City Training and Research Hospital, Adana, Turkey
| | - Ümit Çelik
- Department of Pediatric Infectious Diseases and Neurology, Adana City Training and Research Hospital, Adana, Turkey
| |
Collapse
|
18
|
Giordan E, Marton E, Scotton G, Canova G. Outcomes and risk factors for spontaneous spondylodiscitis: Case series and meta-analysis of the literature. J Clin Neurosci 2019; 68:179-187. [PMID: 31300250 DOI: 10.1016/j.jocn.2019.06.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 06/07/2019] [Accepted: 06/21/2019] [Indexed: 11/26/2022]
Abstract
Despite recent improvements in surgical and antimicrobial therapies, few generally applicable guidelines exist for spondylodiscitis management. We reviewed a consecutive series of patients as well as the past 18 years of the literature and analyzed outcomes for either conservative or surgical treatment. We analyzed a consecutive series of adults with spontaneous spondylodiscitis treated at our institution over the last 6 years. We analyzed predictors for neurological deficits, vertebral collapse, and surgical treatment. We also performed a meta-analysis of the literature between 2000 and 2018, stratifying the results between surgical and conservative treatment outcomes. A younger age at diagnosis, cervical location, tubercular infection, coexistence of morbidities, and vertebral collapse were predictors of surgical intervention. Cervical spondylodiscitis, vertebral collapse, and epidural collection were associated with a higher risk of developing neurological deficits, while tubercular spondylodiscitis was associated with a higher risk of vertebral collapse. Based on the current literature, conservative treatment has success rates similar to those of surgical treatment but lower complication and mortality rates. In cases without an absolute indication for surgery, a conservative approach should be considered as the first-line treatment. A closer diagnostic and clinical follow-up should be recommended in patients with cervical tract or tubercular spondylodiscitis because of the higher risk of developing bone collapse and neurological deficits.
Collapse
Affiliation(s)
- E Giordan
- Department of Neurologic Surgery, Treviso Regional Hospital, Treviso, Italy.
| | - E Marton
- Department of Neurologic Surgery, Treviso Regional Hospital, Treviso, Italy
| | - G Scotton
- Department of Infectious Diseases, Treviso Regional Hospital, Treviso, Italy
| | - G Canova
- Department of Neurologic Surgery, Treviso Regional Hospital, Treviso, Italy
| |
Collapse
|
19
|
Rustemi O, Raneri F, Alvaro L, Gazzola L, Beggio G, Rossetto L, Cervellini P. Single-approach vertebral osteosynthesis in the treatment of spinal osteolysis by spondylodiscitis. Neurosurg Focus 2019; 46:E9. [PMID: 30611171 DOI: 10.3171/2018.10.focus18442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/22/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEBoth spontaneous and iatrogenic spondylodiscitis are becoming ever more frequent, yet there are no definite treatment guidelines. For many years the treatment protocol was conservative medical management or surgical debridement with patients immobilized or bedridden for weeks and often resulting in spinal deformity. The eventual development of spinal deformity can be difficult to treat. Over the last few years, the authors have preferred a single-approach instrumented arthrodesis when spondylolysis that evolves in deformity from somatic wedging occurs.METHODSThe authors retrospectively reviewed the clinical, radiological, and surgical records of 11 patients treated over the past 3 years for spondylodiscitis with osteosynthesis.RESULTSOverall, the authors treated 11 patients: 3 cases with tuberculous spondylodiscitis (1 dorsal, 2 lumbar); 6 cases with Staphylococcus aureus spondylodiscitis (1 cervical, 2 dorsal, 2 lumbar, 1 dorsolumbar); 1 spondylodiscitis with postsurgical lumbar deformity; and in 1 dorsolumbar case the germ was not identified. Surgical approaches were chosen according to spinal level: In 8 dorsolumbar cases a posterior osteosynthesis was achieved. In 1 cervical case an anterior approach was performed with autologous bone graft from iliac crest. In 2 thoracolumbar cases a posterolateral costotransversectomy was needed. In 1 lumbosacral case iliac somatic grafting was used. Ten patients received adequate antibiotic treatment with clinical remission, and 1 case is in initial follow-up. No complications due to instrumentation were recorded. Spinal deformity was prevented in 10 cases, whereas preexisting spinal deformity was partially corrected in 1 case. In all cases, arthrodesis achieved vertebral stability.CONCLUSIONSThis study has the limitations of a retrospective review with a limited number of patients. Instrumentation does not appear to hamper healing from infection. Moreover, spinal stabilization, which is assisted by the infectious process even in the absence of bone graft, allows early mobilization. Instrumented osteosynthesis should be preferred for spondylodiscitis with osteolysis and spinal instability because it allows early mobilization and rehabilitation whenever necessary. It prevents spinal deformity and does not hamper healing of infections.
Collapse
|
20
|
Yin XH, Liu ZK, He BR, Hao DJ. One-stage surgical management for lumber brucella spondylitis with anterior debridement, autogenous graft, and instrumentation. Medicine (Baltimore) 2018; 97:e11704. [PMID: 30045331 PMCID: PMC6078670 DOI: 10.1097/md.0000000000011704] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Literature reporting on lumber brucella spondylitis (LBS) is rare, therefore, the purpose of this study was to evaluate the outcomes of one-stage surgical management for lumber brucella spondylitis by anterior debridement, autogenous grafts, and instrumentation. This was a retrospective cohort study including 16 patients with lumber brucella spondylitis by treated from January 2009 to October 2011 in our department. All cases underwent one-stage anterior internal fixation, debridement, and bone fusion; clinical and radiographic results were analyzed and compared. All patients were followed up for an average of 35.3 ± 8.1 months (range, 24-48 months). Brucella spondylitis was completely cured in all patients with bone fusion achieved in 4.8 ± 1.3 months. Visual analog scale (VAS) scores were significantly improved between the preoperative and last follow-up visit and neurological function classification showed significant improvement after surgical intervention. Preoperatively, the Cobb angle was 20.7 ± 9.8°, and measured 8.1 ± 1.3° at the last follow-up visit. The outcomes of follow-up demonstrated that one-stage surgical treatment with anterior debridement, fusion, and instrumentation can be an effective and feasible treatment method for lumber brucella spondylitis.
Collapse
|
21
|
Cheng W, Lian K, Luo D, Lin D, Feng W, Xian H, Li T. Salmonella potsdam causing lumbar vertebral osteomyelitis: A case report. Medicine (Baltimore) 2018; 97:e0682. [PMID: 29718896 PMCID: PMC6392897 DOI: 10.1097/md.0000000000010682] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/17/2018] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Salmonella osteomyelitis is an uncommon complication of salmonella infection, especially the salmonella vertebral osteomyelitis (SVO). PATIENT CONCERNS We reported a case of a 29-year-old female who presented with serious lower back pain and severe limitation of motion for 50 days with no obvious inducements. She once had a fever up to 39.5°C. Physical examination only revealed limited motion of lower back without neurological complications. The laboratory results revealed no specificity. MRI of the lumbar spine revealed a spondylodiscitis at L4-L5. She underwent anterior lateral approach debridement and percutaneous posterior instrumentation. DIAGNOSES Tissue and abscess culture grew showed Salmonella Potsdam infection. INTERVENTIONS With susceptibility testing guidance, the patient was treated with intravenous levofloxacin and ceftazidime for a period of 3 weeks and another 3-week oral antibiotics therapy. OUTCOMES The patient recovered well with no neurological deficits during the follow-up time. LESSONS SVO is really rare and it alerts us the importance to consider uncommon pathogens in the differential diagnosis in which the etiological evidences are crucial of healthy individuals.
Collapse
|
22
|
Petkova AS, Zhelyazkov CB, Kitov BD. Spontaneous Spondylodiscitis - Epidemiology, Clinical Features, Diagnosis and Treatment. Folia Med (Plovdiv) 2017; 59:254-260. [DOI: 10.1515/folmed-2017-0024] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/08/2016] [Indexed: 11/15/2022] Open
Abstract
AbstractSpontaneous spondylodiscitis is a rare but serious infectious disease which is a combination of an inflammatory process, involving one or more adjacent vertebral bodies (spondylitis), the intervertebral discs (discitis) and finally - the neighboring neural structures. In most cases the condition is due to a hematogenous infection and can affect all regions of the spinal cord, but it is usually localized in the lumbar area. The most common clinical symptom is a pronounced, constant and increasing nocturnal paravertebral pain, while consequently different degrees of residual neurological symptoms from nerve roots and/or spinal cord may appear. The disease course is chronic and the lack of specific symptoms often prolongs the time between its debut and the diagnosis. This delay in diagnosis determines its potentially high morbidity and mortality. Treatment is conservative in cases with no residual neurological symptoms and consists of antibiotic therapy and immobilization. Surgical treatment is necessary in patients with neurological deficit, spinal instability or drug resistance.
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
Mesh cage for treatment of hematogenous spondylitis and spondylodiskitis. How safe and successful is its use in acute and chronic complicated cases? A systematic review of literature over a decade. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:753-61. [PMID: 27324195 DOI: 10.1007/s00590-016-1803-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/27/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Surgical treatment of hematogenous pyogenic spondylitis and spondylodiskitis includes anterior debridement, stabilization, and fusion. Titanium mesh cage (TMC) has been advocated to immediately correct deformity and eradicate infection with low recurrence rates. There are no comprehensive reviews on TMC. PURPOSE To evaluate recorded information regarding surgical outcome with the use of TMC for treating patients with pyogenic spinal infection. STUDY DESIGN Comprehensive review. METHODS The terms "titanium cage", "spine", "infection" were searched. A total of 486 peer-reviewed papers published from 2002 to 2012 were obtained from PubMed search. Fifteen Level IV articles with 363 patients were enrolled for consideration. Finally, 192 (53 %) patients who received TMC were eligible and included in this review. Age, comorbidities, indications for surgery, abscess formation, time lapsed between symptoms initiation and surgery, microbiology, radiological spine restoration, neurological outcome, and complications following surgery are evaluated. RESULTS The average age at the index surgery was 57 years, range 15-85 years. The reported time lapsed from symptoms presentation to diagnosis varied significantly from 1 week to 2 years. On admission, there reported paravertebral and/or epidural abscess in 48 % and neurological impairment in 51 % of the patients. One hundred and seventy-seven comorbidities were recorded in 192 patients. Bone biopsy and culture revealed gram (+) bacteria in 71 %, gram (-) in 24 %, and multiple bacteria in 1 %, while it was negative in 3.1 % of the patients. TMC was most commonly (49 %) implanted in the lumbar spine. The follow-up observation following surgery averaged 26 months, range 10-116 months. Most of the studies reported decrease in segmental kyphosis and neurological improvement in incomplete lesions postoperatively. TMC was primarily revised for early dislodgment or cage misplacement in 3.2 % of the patients. Infection recurrence was recorded in two patients (1.3 %), but revision surgery needed in one (0.65 %) patient. Mortality was reported in 5.8 % of the patients. CONCLUSIONS TMC offers an advantageous and safe technique for spinal debridement and fusion for hematogenous spinal infection. TMC safeguarded medium-term spinal stability with low infection recurrence rates, which were independent form causative pathogen, age, and comorbidities.
Collapse
|
25
|
Posterior Titanium Screw Fixation without Debridement of Infected Tissue for the Treatment of Thoracolumbar Spontaneous Pyogenic Spondylodiscitis. Asian Spine J 2016; 10:465-71. [PMID: 27340525 PMCID: PMC4917764 DOI: 10.4184/asj.2016.10.3.465] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/04/2015] [Accepted: 10/04/2015] [Indexed: 12/04/2022] Open
Abstract
Study Design Retrospective study. Purpose The aim of our study was to analyze the safety and effectiveness of posterior pedicle screw fixation for treatment of pyogenic spondylodiscitis (PSD) without formal debridement of the infected tissue. Overview of Literature Posterior titanium screw fixation without formal debridement of the infected tissue and anterior column reconstruction for the treatment of PSD is still controversial. Methods From March 2008 to June 2013, 18 patients with PSD underwent posterior titanium fixation with or without decompression, according to their neurological deficit. Postero-lateral fusion with allograft transplantation alone or bone graft with both the allogenic bone and the autologous bone was also performed. The outcome was assessed using the visual analogue scale (VAS) for pain and the Frankel grading system for neurological status. Normalization both of C-reactive protein (CRP) and erythrocyte sedimentation rate was adopted as criterion for discontinuation of antibiotic therapy and infection healing. Segmental instability and fusion were also analyzed. Results At the mean follow-up time of 30.16 months (range, 24–53 months), resolution of spinal infection was achieved in all patients. The mean CRP before surgery was 14.32±7.9 mg/dL, and at the final follow-up, the mean CRP decreased to 0.5±0.33 mg/dL (p <0.005). Follow-up computed tomography scan at 12 months after surgery revealed solid fusion in all patients. The VAS before surgery was 9.16±1.29 and at the final follow-up, it improved to 1.38±2.03, which was statistically significant (p <0.05). Eleven patients out of eighteen (61.11%) with initial neurological impairment had an average improvement of 1.27 grades at the final follow-up documented with the Frankel grading system. Conclusions Posterior screw fixation with titanium instrumentation was safe and effective in terms of stability and restoration of neurological impairment. Fixation also rapidly reduced back pain.
Collapse
|
26
|
Pourtaheri S, Issa K, Stewart T, Shafa E, Ajiboye R, Buerba RA, Lord E, Hwang K, Mangels D, Emami A. Comparison of Instrumented and Noninstrumented Surgical Treatment of Severe Vertebral Osteomyelitis. Orthopedics 2016; 39:e504-8. [PMID: 27135455 DOI: 10.3928/01477447-20160427-07] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 11/11/2015] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to compare the outcomes of instrumented versus noninstrumented (decompression) surgical treatment of vertebral osteomyelitis. The study population included 104 patients with spinal osteomyelitis who were treated at the authors' institution between 2004 and 2012. This included 62 men and 42 women who underwent either instrumented (n=57) or noninstrumented (n=47) surgery. Mean patient age was 59 years, and mean follow-up was 38 months (range, 12-78 months). Specifically, the following criteria were assessed: mortality rates, infection clearance rates, clinical outcomes measured by Oswestry Disability Index (ODI), mean length of stay, and baseline differences between the 2 cohorts. Although patients in the instrumented cohort had more instability, more neurologic symptoms, and larger volume infection, they had similar clearance of infection (54% vs 42.5%; odds ratio [OR], 1.55; 95% confidence interval [CI], 0.61-3.9; P=.35), mortality rate (9% vs 17%; OR, 0.47; 95% CI, 0.14-1.54; P=.21), and ODI scores (40 vs 45 points; P=.32) compared with patients in the noninstrumented group. However, mean length of stay (19 vs 13 days; P=.02) was significantly higher for patients in the instrumented group. Even in more severe cases of vertebral osteomyelitis, instrumentation resulted in comparable outcomes to decompression. [Orthopedics. 2016; 39(3):e504-e508.].
Collapse
|
27
|
Zhang H, Zeng K, Yin X, Huang J, Tang M, Guo C. Debridement, internal fixation, and reconstruction using titanium mesh for the surgical treatment of thoracic and lumbar spinal tuberculosis via a posterior-only approach: a 4-year follow-up of 28 patients. J Orthop Surg Res 2015; 10:150. [PMID: 26391477 PMCID: PMC4578672 DOI: 10.1186/s13018-015-0292-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 09/07/2015] [Indexed: 12/23/2022] Open
Abstract
Background The standard recommended method for surgical treatment of spinal tuberculosis is an anterior approach for debridement and fusion combined with posterior instrumentation. However, the method has its disadvantages. The aim of this study was to analyze the effectiveness and safety of treating thoracic and lumbar spinal tuberculosis with debridement, internal fixation reconstruction, and using specially formed titanium mesh cages via a posterior-only approach. Methods The authors retrospectively reviewed the cases of 28 patients with spinal tuberculosis treated by debridement, internal fixation, and reconstruction with a specially formed titanium mesh cage via a posterior-only approach. The levels involved were less than two contiguous vertebrae: 13 thoracic vertebrae, 5 thoracolumbar vertebrae, and 10 lumbar vertebrae. All patients suffered from back pain, and nine patients had neurologic deficits (two were class C and seven were in class D according to the American Spinal Injury Association classification). All patients were followed up every 3 months after surgery, with a minimum 48-month follow-up. The clinical efficacy was evaluated based on the visual analog scale (VAS), the Oswestry Disability Index (ODI), neurological status, kyphosis angle, and erythrocyte sedimentation rate (ESR). Results All patients obtained solid bony fusions without failure of fixation. The infections were resolved in all patients, as noted by normalization of their ESR. The average surgery time was 2 h and 15 min, with an average blood loss of 435 ml. The VAS scores dropped from a preoperative level of 6.31 ± 1.25 to the final follow-up level of 0.57 ± 0.14. The ODI scores dropped from 39.14 ± 12.38 preoperatively to 7.29 ± 3.09 at 1 year postoperatively and 6.77 ± 2.53 at final follow-up. The kyphosis Cobb’s angle was corrected from 22.31° ± 4.26° preoperatively to 5.86° ± 0.57° at final follow-up. No subsidence of titanium mesh cage or posterior instrumentation failure was observed postoperatively. The neurological outcome increased by 1–2 grades in the patients with neurological deficits. Conclusions Debridement, internal fixation, and reconstruction using specially formed titanium mesh cages via a posterior-only approach is effective and safe for treating adults with thoracic and lumbar spinal tuberculosis involving less than two contiguous levels.
Collapse
Affiliation(s)
- Hongqi Zhang
- Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, China.
| | - Kefeng Zeng
- Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, China.
| | - Xinghua Yin
- Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, China.
| | - Jia Huang
- Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, China.
| | - Mingxing Tang
- Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, China.
| | - Chaofeng Guo
- Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, China.
| |
Collapse
|
28
|
A Retrospective Analysis of the Management of Postoperative Discitis: A Single Institutional Experience. Asian Spine J 2015; 9:559-64. [PMID: 26240715 PMCID: PMC4522446 DOI: 10.4184/asj.2015.9.4.559] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 01/19/2015] [Accepted: 01/20/2015] [Indexed: 11/08/2022] Open
Abstract
Study Design Retrospective study. Purpose The aim of the study was to study the impact and outcome of conservative management and surgical intervention in cases of postoperative discitis. Overview of Literature Postoperative discitis is a rare but often misdiagnosed cause of failed back syndrome. There is paucity of literature regarding management guidelines of postoperative discitis. Methods The study was carried out over a period of 6 years. Eighteen patients with postoperative discitis were included in the study. Results Conservative management with antibiotics, analgesics and bed rest were started in all the study cases. Posterior transpedicular fixation after re-exploration debridement and curettage of disc space granulation tissue was conducted in five patients in whom conservative management failed. Conclusions Early diagnosis and appropriate management is the key to effective treatment of postoperative discitis. Conservative management leads to excellent results in majority of cases. Surgical intervention with posterior interbody fusion and debridement is helpful when conservative treatment fails.
Collapse
|
29
|
Than KD, Mummaneni PV. Spinal Instrumentation in the Setting of Primary Infection. World Neurosurg 2014; 82:e713-4. [DOI: 10.1016/j.wneu.2014.08.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/14/2014] [Indexed: 11/28/2022]
|
30
|
Mohamed AS, Yoo J, Hart R, Ragel BT, Hiratzka J, Hamilton DK, Barnes PD, Ching AC. Posterior fixation without debridement for vertebral body osteomyelitis and discitis. Neurosurg Focus 2014; 37:E6. [DOI: 10.3171/2014.6.focus14142] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors evaluated the efficacy of posterior instrumentation for the management of spontaneous spinal infections. Standard surgical management of spontaneous spinal infection is based on debridement of the infected tissue. However, this can be very challenging as most of these patients are medically debilitated and the surgical debridement requires a more aggressive approach to the spine either anteriorly or via an expanded posterior approach. The authors present their results using an alternative treatment method of posterior-only neuro-decompression and stabilization without formal debridement of anterior tissue for treating spontaneous spinal infection.
Methods
Fifteen consecutive patients were treated surgically by 2 of the authors. All patients had osteomyelitis and discitis and were treated postoperatively with intravenous antibiotics for at least 6 weeks. The indications for surgery were failed medical management, progressive deformity with ongoing persistent spinal infection, or neurological deficit. Patients with simple epidural abscess without bony instability were treated with laminectomy and were not included in this series. Fourteen patients were treated with posterior-only decompression and long-segment rigid fixation, without formal debridement of the infected area. One patient was treated with staged anterior and posterior surgery due to delay in treatment related to medical comorbidities. The authors examined as their outcome the ambulatory status and recurrence of deep infection requiring additional surgery or medical treatment.
Results
Of the initial 15 patients, 10 (66%) had a minimum 2-year follow-up and 14 patients had at least 1 year of followup. There were no recurrent spinal infections. There were 3 unplanned reoperations (1 for loss of fixation, 1 for early superficial wound infection, and 1 for epidural hematoma). Nine (60%) of 15 patients were nonambulatory at presentation. At final followup, 8 of 15 patients were independently ambulatory, 6 required an assistive device, and 1 remained nonambulatory.
Conclusions
Long-segment fixation, without formal debridement, resulted in resolution of spinal infection in all cases and in significant neurological recovery in almost all cases. This surgical technique, when combined with aggressive antibiotic therapy and a multidisciplinary team approach, is an effective way of managing serious spinal infections in a challenging patient population.
Collapse
Affiliation(s)
| | - Jung Yoo
- Departments of 1Orthopedics and Rehabilitation and
| | - Robert Hart
- Departments of 1Orthopedics and Rehabilitation and
| | - Brian T. Ragel
- 2Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | | | - D. Kojo Hamilton
- 2Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Penelope D. Barnes
- 2Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | | |
Collapse
|
31
|
Menon VK, Kumar KM, Al Ghafri K. One-stage biopsy, debridement, reconstruction, and stabilization of pyogenic vertebral osteomyelitis. Global Spine J 2014; 4:93-100. [PMID: 25072003 PMCID: PMC4078165 DOI: 10.1055/s-0034-1370789] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 01/21/2014] [Indexed: 11/17/2022] Open
Abstract
Study Design Retrospective cohort study. Objective To evaluate whether the proposed one-stage biopsy, culture, debridement, and reconstruction with stabilization strategy is a viable option for pyogenic vertebral osteomyelitis (PVO). PVO is increasing in frequency globally, particularly in immunologically compromised individuals. Typically, biopsy and culture sensitivity followed by staged surgery and long-term antibiotic therapy is the mainstay of therapy. Methods This is a study of a group of 32 consecutive cases of PVO (spondylodiskitis) treated in our institution from 2010 to 2012. All cases had one-stage biopsy, culture sensitivity, debridement, reconstruction with iliac bone graft, and stabilization with titanium implants. The mean age in this series was 51 years, and the male-to-female ratio was 2.2:1. Approximately 50% of the patients had impaired immunity status. The commonest organism isolated was Pseudomonas aeruginosa. Culture-specific antibiotics were given for a minimum of 6 weeks to all patients. The follow-up period ranged from 6 months to a maximum of 2 years. All patients were assessed for wound healing, recurrence of infection, deformity progression, pain, and healing by radiologic and biochemical parameters. No generic or disease-specific outcome tools were used for this study. Results All patients had good wound healing, although there was one case of superficial infection that was resolved with debridement. There were two implant failures with pseudarthrosis and one localized kyphosis in this series. Conclusions The one-stage technique of biopsy, debridement, bone grafting, and stabilization can be recommended for most cases of PVO.
Collapse
Affiliation(s)
- Venugopal K. Menon
- Department of Orthopaedics, Khoula Hospital, Muscat, Sultanate of Oman,Address for correspondence Venugopal K. Menon, MBBS, MS, MChOrth Department of Orthopaedics, Khoula HospitalPO Box 90, MuscatSultanate of Oman
| | - Kishore M. Kumar
- Department of Orthopaedics, Khoula Hospital, Muscat, Sultanate of Oman
| | - Khalifa Al Ghafri
- Department of Orthopaedics, Khoula Hospital, Muscat, Sultanate of Oman
| |
Collapse
|
32
|
Literature review and clinical presentation of cervical spondylitis due to salmonella enteritidis in immunocompetent. Asian Spine J 2014; 8:206-10. [PMID: 24761205 PMCID: PMC3996347 DOI: 10.4184/asj.2014.8.2.206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 05/31/2013] [Accepted: 06/29/2013] [Indexed: 11/24/2022] Open
Abstract
A 48-year-old woman was presented to our clinic with some fever and neck pains for about one month. Based on the symptoms and results of image, an empirical diagnosis of tuberculous cervical spondylitis was made. The pain was not significantly decreased after anti-tuberculosis therapy. And, 3 weeks later, she was re-admitted to our hospital for the unbearable pain. An exploration of the C4/5 by the anterior medial approach was recommended to evaluate the germ and debridement. Bacteriological tests showed that the pathogen was Salmonella Enteritidis. The pain was relieved significantly after operation and sensitive antibiotic treatments. Infections with Salmonella Typhi or Salmonella Paratyphi have been well-documented, while there are few reports of cervical spondylitis caused by Salmonella Enteritidis. We reported a case of a healthy woman with whom pyogenic cervical spondylitis of Salmonella Enteritidis was corroborated and treated and reviewed according to previous reports about spondylitis caused by Salmonella Enteritidis in the literature.
Collapse
|
33
|
Papanastassiou ID, Gerochristou M, Aghayev K, Vrionis FD. Defining the indications, types and biomaterials of corpectomy cages in the thoracolumbar spine. Expert Rev Med Devices 2014; 10:269-79. [DOI: 10.1586/erd.12.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
34
|
Lee BH, Park JO, Kim HS, Lee HM, Cho BW, Moon SH. Transpedicular curettage and drainage versus combined anterior and posterior surgery in infectious spondylodiscitis. Indian J Orthop 2014; 48:74-80. [PMID: 24600067 PMCID: PMC3931157 DOI: 10.4103/0019-5413.125508] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hematogeneous infectious spondylodiscitis usually occurs in older immunocompromised patients with other comorbidities. They are usually unable to undergo reconstructive anterior and posterior surgeries. Therefore, an alternative, less aggressive surgical method of transpedicular curettage and drainage was suggested. This study was designed to compare the surgical outcomes for the treatment of hematogeneous infectious spondylodiscitis between transpedicular curettage and drainage technique and conventional combined anterior and posterior surgery. MATERIALS AND METHODS Between January 2002 and July 2011, 26 patients underwent surgical treatment for hematogeneous infectious spondylodiscitis. The patients were classified into two groups depending on surgical modality: a transpedicular curettage and drainage (TCD) group and a combined anterior and posterior surgery (CAPS) group. RESULTS The TCD group consisted of 10 patients (mean age 68.0 years), and the CAPS group consisted of 16 patients (mean age 58.4 years). The mean postoperative followup periods were 36.9 (months) in the TCD group and 69.9 (months) in the CAPS group. The operation time was 180.6 ± 33.6 minutes in the TCD group and 332.7 ± 74.5 minutes in the CAPS group (P < 0.05). Postoperative independent ambulation began at postoperative 4.9 ± 2.4 days in the TCD group but at postoperative 15.1 ± 15.3 days in the CAPS group (P < 0.05). The postoperative hospital stays were 19.9 ± 7.8 days in the TCD group and 35.4 ± 33.3 days in the CAPS group (P < 0.05). The level of C-reactive proteins decreased significantly in both groups after surgery (P < 0.05). CONCLUSION Transpedicular curettage and drainage technique proved to be a useful technique for treating hematogeneous infectious spondylodiscitis in patients who were in poor heath with multiple comorbidities unable to undergo the conventional combined anterior and posterior surgery in a single day in terms of earlier ambulation, shorter hospitalization and similar clinical success rate.
Collapse
Affiliation(s)
- Byung Ho Lee
- Department of Orthopaedic Surgery, International St. Mary's Hospital, Incheon, Korea
| | - Jin-Oh Park
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hak-Sun Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan-Mo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Woo Cho
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seong-Hwan Moon
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea,Address for correspondence: Dr. Seong-Hwan Moon, Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul - 120752, Korea. E-mail:
| |
Collapse
|
35
|
Bacteria detected after instrumentation surgery for pyogenic vertebral osteomyelitis in a canine model. 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 2013; 23:838-45. [PMID: 24121752 DOI: 10.1007/s00586-013-3061-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/22/2013] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study was designed to identify the presence, type and origin of bacteria adjacent to the metal implant in the infected region in a canine model of pyogenic vertebral osteomyelitis treated with single-stage anterior autogenous bone grafting and instrumentation. METHODS Dogs with pyogenic spondylodiscitis underwent one-stage debridement, autogenous bone grafting and titanium plate instrumentation and perioperative antibiotic therapy. The implants and adjacent vertebral bones were removed surgically at various postoperative time points (4, 8, 12 and 24 weeks) for bacteria detection. Bacteria were detected from retrieved spinal implants as well as surrounding bones by culture and/or pyrosequencing methods in 17 (85%) of all 20 animals. The positive rate for bacteria presence was 45% by culture and 80% by pyrosequencing method. RESULTS Radiological or macroscopic examination showed no signs for infection recurrence in any animal regardless of bacteria presence at the surgical site. However, organism identical with the causative bacterium for spinal infection was found in only two of nine culture-positive animals. CONCLUSION Within the confines of the study, the use of metallic implants in an infected area did not lead to a clinically relevant infection although bacteria may exist at the surgical site. The use of metallic implants in an infected area of the spine is safe. The metallic implants may not be the “culprit” for the persistence or recurrence of infection.
Collapse
|
36
|
Ahmad FU, Sidani C, Fourzali R, Wang MY. Postoperative magnetic resonance imaging artifact with cobalt-chromium versus titanium spinal instrumentation: presented at the 2013 Joint Spine Section Meeting. Clinical article. J Neurosurg Spine 2013; 19:629-36. [PMID: 24053373 DOI: 10.3171/2013.7.spine1359] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Cobalt-chromium alloy (CoCr) rods haves some preferred biomechanical properties over titanium rods for spinal fixation. The use of CoCr rods in spinal fusion is relatively new, and there is no study in the existing world literature assessing the artifact caused by these rods in patients undergoing postoperative MRI. The purpose of this study is to compare the amount of imaging artifact caused by these implants and to assess its impact on the visualization of neighboring neural structures. METHODS This study investigated MR images in patients who underwent implantation of thoracolumbar instrumentation using 5.5-mm-diameter CoCr rods between November 2009 and March 2011 and images obtained in a comparison group of patients who had 5.5-mm titanium rods implanted during the same time period. Axial measurements of the artifact created by the rods between the screw heads were compared between the groups. Two blinded board-certified radiologists performed the measurements independently. They scored the visualization of the spinal canal using a subjective scoring system of 1-3, with 1 representing very good visualization and 2 and 3 representing reduced (good or suboptimal, respectively) visualization as a result of rod-related artifact. All measurements and scores were independently provided for T1-weighted and T2-weighted fast spin echo sequences (1.5-T magnet, 5-mm slice thickness). RESULTS A total of 40 levels from the CoCr group (6 patients) and 30 levels from the titanium group (9 patients) were included in the analysis. Visualization of the canal at all levels was rated a score of 1 (very good) by both evaluators for both the CoCr and titanium groups. The average artifact on T1-weighted images measured 11.8 ± 1.8 mm for the CoCr group and 8.5 ± 1.2 mm for the titanium group (p < 0.01). The corresponding measurements on T2-weighted images were 11.0 ± 2.3 mm and 8.3 ± 1.7 mm (p < 0.01), respectively. In a mixed regression model, the mean artifact measurement for the CoCr group was, on average, 3.5 mm larger than for the control group. There was no significant difference between the measurements of the 2 evaluators (p = 0.99). CONCLUSIONS The artifact caused by CoCr rods is approximately 3.5 mm larger than that caused by titanium rods on axial T1- and T2-weighted MRI. However, artifact from either CoCr or titanium was not found to interfere with the evaluation of the spinal canal and surrounding neural elements.
Collapse
|
37
|
Crabtree KL, Spurgeon A, Arzi H, Beaver B, Arnold PM. L5 vertebral osteomyelitis treated with L5 corpectomy and anterior instrumentation: case report. EVIDENCE-BASED SPINE-CARE JOURNAL 2013; 2:49-54. [PMID: 23637682 PMCID: PMC3621851 DOI: 10.1055/s-0030-1267105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Study design: A case report. Objective: Pyogenic osteomyelitis is the most common form of vertebral infection and typically resolves following conservative treatment with antibiotics administered long term and immobilization. In cases of spinal instability, severe neurological deficit or disease refractory to medical management, neurosurgical intervention is warranted. Historically, these patients have undergone radical vertebral debridement and grafting with or without posterior instrumentation. We report the case of a 46-year-old female intravenous drug user presenting with L5 pyogenic osteomyelitis with L5 vertebral compression and cortex retropulsion following L2–L4 laminectomy for epidural abscess 8
weeks prior. Methods: The patient underwent an anterior approach single-stage L5 corpectomy, L4/5 and L5/S1 discectomies, expandable titanium-cage insertion and anterior plating from
L4 to the sacrum. Results: The patient recovered without any complications. The infection was successfully eradicated and her fusion remains solid 18 months postoperatively. Conclusions: To our knowledge, this is the first case of L5 vertebral osteomyelitis treated with a single-stage corpectomy and anterior instrumentation.
Collapse
Affiliation(s)
- Kelli L Crabtree
- Department of Neurosurgery University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | | | | |
Collapse
|
38
|
Kshettry VR, Hardy S, Weil RJ, Angelov L, Barnett GH. Immediate titanium cranioplasty after debridement and craniectomy for postcraniotomy surgical site infection. Neurosurgery 2012; 70:8-14; discussion 14-5. [PMID: 22343833 DOI: 10.1227/neu.0b013e31822fef2c] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND For postcraniotomy surgical site infection (SSI) involving the bone, typical management involves craniectomy, debridement, and delayed cranioplasty. Disadvantages to delayed cranioplasty include cosmetic deformity, vulnerability of unprotected brain, and risks and costs associated with an additional operation. Many authors have attempted bone flap salvage by using various techniques. OBJECTIVE We evaluate our experience with immediate titanium mesh cranioplasty at the time of craniectomy and debridement. METHODS We retrospectively reviewed SSIs in patients that underwent craniotomy for treatment of a brain tumor. These patients were treated with craniectomy, debridement, and immediate titanium mesh cranioplasty followed by antibiotics. The primary outcome was recurrent infection. RESULTS Twelve patients met the inclusion criteria. Risk factors for infection included preoperative radiation therapy (33%), prior craniotomy (33%), and postoperative CSF leak (25%). Median follow-up was 14 months. Ten (83%) patients had long-term resolution without recurrent infection. One patient required additional surgical debridement for persistent infection with successful placement of new titanium mesh. Another patient developed recurrent infection but opted for hospice care because of tumor progression. CONCLUSION This series demonstrates the safety and feasibility of performing immediate titanium cranioplasty at the time of craniectomy and debridement in patients with postcraniotomy infections. This has been shown in patients with risk factors for poor wound healing. Immediate cranioplasty avoids the drawbacks, risks, and costs of delayed cranioplasty.
Collapse
Affiliation(s)
- Varun R Kshettry
- The Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, The Neurological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
| | | | | | | | | |
Collapse
|
39
|
Subach BR, Copay AG, Martin MM, Schuler TC, DeWolfe DS. Epidural abscess and cauda equina syndrome after percutaneous intradiscal therapy in degenerative lumbar disc disease. Spine J 2012; 12:e1-4. [PMID: 23131581 DOI: 10.1016/j.spinee.2012.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 05/14/2012] [Accepted: 10/10/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Percutaneous intradiscal therapies are gaining popularity as a regenerative treatment option for spinal disc degeneration. The risks, benefits, and possible complications associated with such procedures have been poorly defined. As these procedures are performed with increasing frequency, the likelihood that clinicians will be faced with significant complications also increases. PURPOSE The purpose of this study is to describe a significant complication of a percutaneous intradiscal bone marrow and adipose tissue transplantation for symptomatic lumbar disc degeneration. STUDY DESIGN The study design is a case report. METHODS Two weeks after an injection of adipose cells, bone marrow aspirate and plasma into his L3-L4 and L5-S1 lumbar discs, a 64-year-old patient presented to the emergency room with cauda equina syndrome, fever, and back pain. Magnetic resonance imaging diagnosed L3-L4 disc extrusion, discitis with osteomyelitis, and epidural abscess, resulting in emergency decompressive surgery. An epidural abscess was drained, extruded disc material was removed, and cultures obtained. Five days later, once afebrile on antibiotics, he underwent a definitive interbody arthrodesis and stabilization. RESULTS Cauda equina syndrome resolved, osteomyelitis (methicillin-resistant Staphylococcus epidermidis) was treated, and instrumented arthrodesis stabilized the involved segment. CONCLUSIONS Complications associated with the intradiscal injection of agents, such as stem cells, fibrin glue, adipose tissue, or bone marrow, have been poorly defined. Given the nature of the degenerating disc, serious adverse events, including discitis, osteomyelitis, and extrusion of disc contents, may occur.
Collapse
Affiliation(s)
- Brian R Subach
- The Virginia Spine Institute, 1831 Wiehle Ave., Reston, VA, USA
| | | | | | | | | |
Collapse
|
40
|
Lee BH, Lee HM, Kim TH, Kim HS, Moon ES, Park JO, Chong HS, Moon SH. Transpedicular curettage and drainage of infective lumbar spondylodiscitis: technique and clinical results. Clin Orthop Surg 2012; 4:200-8. [PMID: 22949951 PMCID: PMC3425650 DOI: 10.4055/cios.2012.4.3.200] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 04/04/2012] [Indexed: 12/03/2022] Open
Abstract
Background Infective spondylodiscitis usually occurs in patients of older age, immunocompromisation, co-morbidity, and individuals suffering from an overall poor general condition unable to undergo reconstructive anterior and posterior surgeries. Therefore, an alternative, less aggressive surgical method is needed for these select cases of infective spondylodiscitis. This retrospective clinical case series reports our novel surgical technique for the treatment of infective spondylodiscitis. Methods Between January 2005 and July 2011, among 48 patients who were diagnosed with pyogenic lumbar spondylodiscitis or tuberculosis lumbar spondylodiscitis, 10 patients (7 males and 3 females; 68 years and 48 to 78 years, respectively) underwent transpedicular curettage and drainage. The mean postoperative follow-up period was 29 months (range, 7 to 61 months). The pedicle screws were inserted to the adjacent healthy vertebrae in the usual manner. After insertion of pedicle screws, the drainage pedicle holes were made through pedicles of infected vertebra(e) in order to prevent possible seeding of infective emboli to the healthy vertebra, as the same instruments and utensils are used for both pedicle screws and the drainage holes. A minimum of 15,000 mL of sterilized normal saline was used for continuous irrigation through the pedicular pathways until the drained fluid looked clear. Results All patients' symptoms and inflammatory markers significantly improved clinically between postoperative 2 weeks and postoperative 3 months, and they were satisfied with their clinical results. Radiologically, all patients reached the spontaneous fusion between infected vertebrae and 3 patients had the screw pulled-out but they were clinically tolerable. Conclusions We suggest that our method of transpedicular curettage and drainage is a useful technique in regards to the treatment of infectious spondylodiscitic patients, who could not tolerate conventional combined anterior and posterior surgery due to multiple co-morbidities, multiple level infectious lesions and poor general condition.
Collapse
Affiliation(s)
- Byung Ho Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
Postoperative spondylodiscitis after anterior cervical decompression and fusion (ACDF) is rare, but the same occurring at adjacent levels without disturbing the operated level is very rare. We report a case, with 5 year followup, who underwent ACDF from C5 to C7 for cervical spondylotic myelopathy. He showed neurological improvement after surgery but developed discharging sinus after 2 weeks, which healed with antibiotics. He improved on his preoperative symptoms well for the first 2 months. He started developing progressive neck pain and myelopathy after 3 months and investigations revealed spondylodiscitis at C3 and C4 with erosion, collapse, and kyphosis, without any evidence of implant failure or graft rejection at the operated level. He underwent reexploration and implant removal at the operated level (there was good fusion from C5 to C7) followed by debridement/decompression at C3, C4 along with iliac crest bone grafting and stabilization with plate and screws after maximum correction of kyphosis. The biopsy specimen grew Pseudomonas aeruginosa and appropriate sensitive antibiotics (gentamycin and ciprofloxacin) were given for 6 weeks. He was under regular followup for 5 years his myelopathy resolved completely and he is back to work. Complete decompression of the cord and fusion from C2 to C7 was demonstrable on postoperative imaging studies without any evidence of implant loosening or C1/C2 instability at the last followup.
Collapse
Affiliation(s)
- Saumyajit Basu
- Park Clinic, Gorky Terrace, Kolkata, India,Address for correspondence: Dr. Saumyajit Basu, Park Clinic, 4. Gorky Terrace, Kolkata, India. E-mail:
| | | |
Collapse
|
42
|
Basu S, Ghosh JD, Malik FH, Tikoo A. Postoperative discitis following single-level lumbar discectomy: Our experience of 17 cases. Indian J Orthop 2012; 46:427-33. [PMID: 22912518 PMCID: PMC3421933 DOI: 10.4103/0019-5413.98831] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The established protocols of treatment of postoperative lumbar discitis have not been validated till date. We report a retrospective analysis of a series of patients with discitis following single level lumbar discectomy. We analyzed the outcome of conservative treatment of postoperative discitis with the objective to define when and what surgery was required when the conservative treatment failed. MATERIALS AND METHODS A total of 17 cases of postoperative discitis treated from 2002 to 2009 were followed up and evaluated clinically, radiologically and by laboratory investigations. All the patients were treated initially conservatively with rest and antibiotic therapy after diagnosis and those who did not respond to conservative treatment of at least 4 weeks were treated surgically. The cases were followed up with serial C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), X-ray, computed tomography (CT) scan and magnetic resonance imaging (MRI) for at least 1 year. RESULTS The mean followup was 40.38 months (range 12-86 months). Four cases failed to respond to conservative therapy and were treated surgically. In three of these four cases, open debridement, transpedicular fixation and posterolateral fusion was performed, and in the fourth case percutaneous transpedicular fixation was done. In the former group, one case was diagnosed to be tubercular, in another case Staphylococcus aureus was cultured where as the third case culture was sterile. All operated patients showed evidence of interbody fusion at 1 year followup. CONCLUSIONS Early detection and aggressive treatment are paramount in managing postoperative discitis and the majority do well with conservative treatment. Surgical management in the form of transpedicular fixation and debridement, when required, gives excellent results.
Collapse
Affiliation(s)
- Saumyajit Basu
- Department of Neurosciences, Park Clinic, 4 Gorky Terrace, Minto Park, Kolkata, India
| | - Jay Deep Ghosh
- Department of Neurosciences, Park Clinic, 4 Gorky Terrace, Minto Park, Kolkata, India
| | - Farid H Malik
- Department of Neurosciences, Park Clinic, 4 Gorky Terrace, Minto Park, Kolkata, India
| | - Agnivesh Tikoo
- Department of Neurosciences, Park Clinic, 4 Gorky Terrace, Minto Park, Kolkata, India,Address for correspondence: Dr. Agnivesh Tikoo, Department of Neurosciences, Park Clinic, 4 Gorky Terrace, Minto Park, Kolkata – 700 017, India. E-mail:
| |
Collapse
|
43
|
|
44
|
Pyogenic spondylitis. INTERNATIONAL ORTHOPAEDICS 2011; 36:397-404. [PMID: 22033610 PMCID: PMC3282872 DOI: 10.1007/s00264-011-1384-6] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 09/29/2011] [Indexed: 12/19/2022]
Abstract
Pyogenic spondylitis is a neurological and life threatening condition. It encompasses a broad range of clinical entities, including pyogenic spondylodiscitis, septic discitis, vertebral osteomyelitis, and epidural abscess. The incidence though low appears to be on the rise. The diagnosis is based on clinical, radiological, blood and tissue cultures and histopathological findings. Most of the cases can be treated non-operatively. Surgical treatment is required in 10–20% of patients. Anterior decompression, debridement and fusion are generally recommended and instrumentation is acceptable after good surgical debridement with postoperative antibiotic cover.
Collapse
|
45
|
Influence of bacteria on spinal implant-centered infection: an in vitro and in vivo experimental comparison between Staphylococcus aureus and mycobacterium tuberculosis. Spine (Phila Pa 1976) 2011; 36:103-8. [PMID: 20543766 DOI: 10.1097/brs.0b013e3181cb46ba] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN an in vitro and in vivo experimental study. OBJECTIVE this study was undertaken to evaluate differences in the capability of inducing an implant-centered infection between Staphylococcus aureus and Mycobacterium tuberculosis. SUMMARY OF BACKGROUND DATA bacterial infection is still one of the most serious and devastating complications after orthopedic implant surgery despite the advent of new antibiotics and treatment methods. METHODS S. aureus and M. tuberculosis were separately cultured with titanium plates. The bacteria colonized on the plates were isolated and cultured on culture medium. They were evaluated and compared by colony-forming units enumeration. Scanning electron microscopy was used to evaluate the difference in the colonization features of the 2 pathogens. In the in vivo experiment, 22 dogs were used to assess the susceptibility to infection after a local bacterial challenge with either S. aureus or M. tuberculosis. RESULTS S. aureus showed heavy adhesion and multiplication on the surface of titanium plates in vitro, whereas M. tuberculosis rarely adhered to the surface of the plates. Under scanning electron microscopy, S. aureus colonization was observed: the coccoid was widespread on the surface of the plates but only a few M. tuberculosis cells scattered on the surface of the plates. In in vivo test, the infection rateforthe S. aureus inoculation was higher than that for the M. tuberculosis challenge. The infection rate for the entire test population (n = 44 sites) was 39.58% (19/48). The infection rates were 54.17% (13/24) for the S. aureus challenge and 25% (6/24) for the M. tuberculosis challenge, respectively (P < 0.05). CONCLUSION it is less likely for M. tuberculosis to adhere and form a biofilm on an implant surface than S. aureus. Under otherwise identical conditions, M. tuberculosis contamination following instrumented spine surgery might lead to less occurrence of infection than S. aureus contamination.
Collapse
|
46
|
Single stage anterior reconstruction using titanium mesh cages in neglected kyphotic tuberculous spondylodiscitis of the cervical spine. 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 2010; 20:308-13. [PMID: 20676701 DOI: 10.1007/s00586-010-1537-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 06/20/2010] [Accepted: 07/18/2010] [Indexed: 10/19/2022]
Abstract
Cervical tuberculous spondylodiscitis is a serious, hazardous disorder and to our knowledge, hardly any reports focused on the use of titanium mesh cages in its treatment. The aim of this work is to evaluate the efficacy of using a titanium mesh cage compared to iliac crest grafting regarding correction of the deformity, fusion rate and to report the incidence of complications. A prospective, non-randomized multicentre study of 30 patients with cervical tuberculous spondylodiscitis presenting with a neglected kyphotic deformity. The average age was 44.5 years; 18 had neurological deficits. All patients had a single stage radical debridement, decompression, and instrumentation. The anterior column was reconstructed with a titanium mesh cage in 16 patients (Group 1) and an autogenous iliac bone strut graft in 14 (Group 2). Both groups were followed for a minimum of 2 years. Group 1 showed a better sagittal profile and local kyphosis was corrected from an average of 36° (10°-62°) to an average of -6° (+4° to -16°) compared to Group 2 corrected from an average of 30° (6°-48°) to an average of -1° (+2° to -13°). Group 1 patients showed a solid bony fusion without any recurrence of infection while Group 2 showed a higher incidence of nonunion and of persistent donor site morbidity. The use of titanium mesh cages effectively restores the sagittal profile while adding immediate stability. There is no donor site morbidity, recurrence, or persistence of infection associated with their implantation.
Collapse
|
47
|
Rayes M, Colen CB, Bahgat DA, Higashida T, Guthikonda M, Rengachary S, Eltahawy HA. Safety of instrumentation in patients with spinal infection. J Neurosurg Spine 2010; 12:647-59. [PMID: 20515351 DOI: 10.3171/2009.12.spine09428] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Treatment of spine infection remains a challenge for spine surgeons, with the most effective method still being a matter of debate. Most surgeons agree that in early stages of infection, antibiotic treatment should be pursued; under certain circumstances, however, surgery is recommended. The goals of surgery include radical debridement of the infective focus. In some cases, when surgery causes mechanical spinal instability, the question arises whether the risk of recurrent infection outweighs the benefits of spinal instrumentation and stabilization. The authors report their series of cases in which instrumentation was placed in actively infected sites and review the relevant literature. METHODS The authors performed a retrospective analysis of all cases of spinal infection that were surgically treated with debridement and placement of instrumentation at their institution between 2000 and 2006. Patient presentation, risk factor, infective organism, surgical indication, level of involvement, type of procedure, and ultimate outcome were reviewed. Improved outcome was based on improvement of initial American Spinal Injury Association Impairment Score. RESULTS Forty-seven patients (32 men, 15 women) were treated with instrumented surgery for spinal infection. Their average age at presentation was 54 years (range 37-78 years). Indications for placement of instrumentation included instability, pain after failure of conservative therapy, or both. Patients underwent surgery within an average of 12 days (range 1 day to 5 months) after their presentation to the authors' institution. The average length of hospital stay was 25 days (range 9-78 days). Follow-up averaged 22 months (range 1-80 months). Eight patients died; causes of death included sepsis (4 patients), cardiac arrest (2), and malignancy (2). Only 3 patients were lost to follow-up. Using American Spinal Injury Association scoring as the criterion, the patients' conditions improved in 34 cases and remained the same in 5. Complications included hematoma (2 cases), the need for hardware revision (1), and recurrent infection (2). Hardware replacement was required in 1 of the 2 patients with recurrent infection. CONCLUSIONS Instrumentation of the spine is safe and has an important role in stabilization of the infected spine. Despite the presence of active infection, we believe that instrumentation after radical debridement will not increase the risk of recurrent infection. In fact, greater benefit can be achieved through spinal stabilization, which can even promote accelerated healing.
Collapse
Affiliation(s)
- Mahmoud Rayes
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
| | | | | | | | | | | | | |
Collapse
|
48
|
Lu DC, Wang V, Chou D. The use of allograft or autograft and expandable titanium cages for the treatment of vertebral osteomyelitis. Neurosurgery 2009; 64:122-9; discussion 129-30. [PMID: 19145160 DOI: 10.1227/01.neu.0000336332.11957.0b] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The results of the surgical treatment of osteomyelitis with expandable titanium cages and either allograft or autograft are presented. METHODS Thirty-six patients with vertebral osteomyelitis are presented. There were 7 cervical, 17 thoracic, 4 thoracolumbar (involving T12-L1), 5 lumbar, and 3 lumbosacral (involving L5-S1) lesions. The most frequently identified organisms were Staphylococcus aureus, Mycobacterium tuberculosis, and Coccidioides immitis. Imaging studies included x-rays, computed tomographic scans, and magnetic resonance imaging scans. All patients were treated with corpectomies and expandable cage reconstruction. Fusion was performed with rib autograft, iliac crest autograft, or allograft. Most patients who had an anterior approach also underwent posterior instrumentation, whereas a few had anterior instrumentation only. Four patients underwent a posterior approach (transpedicular corpectomy) only. RESULTS The median follow-up period was 21 months. There were no implant failures. Two recurrences of infection were noted: 1 case involved allograft, and the other involved autograft. At follow-up, neurological deficits improved in all patients, and 81% of patients were pain-free. CONCLUSION This study suggests that the treatment of vertebral column osteomyelitis can be performed with expandable titanium cages, and allograft does not appear to increase the rate of recurrence, as compared with autograft.
Collapse
Affiliation(s)
- Daniel C Lu
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143-0350, USA
| | | | | |
Collapse
|
49
|
D'Aliberti G, Talamonti G, Villa F, Debernardi A, Sansalone CV, LaMaida A, Torre M, Collice M. Anterior approach to thoracic and lumbar spine lesions: results in 145 consecutive cases. J Neurosurg Spine 2008; 9:466-82. [DOI: 10.3171/spi.2008.9.11.466] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
ObjectThe authors report on a series of 145 consecutive patients with different types of spine lesions surgically treated via an anterior approach (AA) at the thoracic and lumbar levels during the past 10 years. Indications, techniques, and surgical results are described.MethodsThis series included 92 patients with fractures, 30 with neoplasms, 13 with thoracic disc hernias, and 10 with spinal infections. Based on the lesion to be addressed, the AA was used for lesion excision, corpectomy, vertebral body reconstruction with cages, realignment, and/or plating or screwing. The approach was extracavitary in 55 patients and intracavitary in 90. In 126 patients (86.8%), neural decompression and spine stabilization were achieved via a stand-alone AA (SA-AA), whereas 19 patients (13.1%) were treated using a 2-stage anteroposterior approach. This circumferential approach was reserved for select cases of severe traumatic dislocation, particular types of tumors, or specific anatomical locations. The authors developed a simple neuronavigation-based method of identifying the severely injured patients who were eligible for the SA-AA by evaluating the angle of lateral dislocation.ResultsThere were no deaths and no instances of major surgery-related morbidity. Minor morbidity was almost always transitory and was reported in 13 patients (8.9%). Neurological improvement was reported in 20% of injured patients with a preoperative incomplete lesion. Postoperatively, all patients were able to stand or at least sit without load pain. During the follow-up (mean ± standard deviation 3.8 ± 2.4 years), there were no cases of failure, fracture, dislocation, or bending of the anterior instrumentation, and the rate of pseudarthrosis was 0%.ConclusionThe anterior route provides direct access to most spine diseases and allows optimal neural decompression and the possibility of adequate realignment and strong reconstruction/fixation. Stability of the vertebral column is achieved, resolution of clinical pain is rapid and almost complete, and the rate of surgical complications is very low. The authors assert that the SA-AA offers so many advantages and has such good results that the 2-stage anteroposterior approach can be reserved for a minority of select cases and that the time for using the posterior approach alone is over.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Massimo Torre
- 4Thoracic Surgery, Niguarda Cà Granda Hospital, Milan, Italy
| | | |
Collapse
|
50
|
Parthiban CJ, Majeed SA, Mahalingam SS. Candida tropicalis spondylodiskitis in a patient with carcinoma of sigmoid colon: a case report. CASES JOURNAL 2008; 1:66. [PMID: 18664282 PMCID: PMC2515092 DOI: 10.1186/1757-1626-1-66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 07/29/2008] [Indexed: 12/02/2022]
Abstract
Fungal spondylodiskitis is being increasingly reported in immunocompromised patients. A patient who presented with severe back pain three months following laparoscopic resection of Carcinoma of Sigmoid colon is presented here. Magnetic Resonance Imaging of the spine showed evidence of multilevel lumbar spondylodiskitis. Biopsy done via the posterior approach showed Candida tropicalis sensitive to fluconazole and resistant to Amphotericin B. Patient was treated with fluconazole and had good relief. Posterior pedicle screw stabilization was done to provide mechanical stability.
Collapse
|