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Wangaryattawanich P, Condos AM, Rath TJ. Bacterial and Viral Infectious Disease of the Spine. Magn Reson Imaging Clin N Am 2024; 32:313-333. [PMID: 38555143 DOI: 10.1016/j.mric.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Spinal infections are a diverse group of diseases affecting different compartments of the spine with variable clinical and imaging presentations. Diagnosis of spinal infections is based on a combination of clinical features, laboratory markers, and imaging studies. Imaging plays a pivotal role in the diagnosis and management of spinal infections. The characteristic imaging manifestations of bacterial and viral infections in the spine are discussed with key teaching points emphasized.
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Affiliation(s)
- Pattana Wangaryattawanich
- Department of Radiology, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195-7115, USA.
| | - Amy M Condos
- Department of Radiology, University of Washington School of Medicine, 2545 Northeast 85th Street Seattle, WA 98115, USA
| | - Tanya J Rath
- Neuroradiology Section, Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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Mangkalamanee O, Rotcheewaphan S, Phuensan P, Ponpinit T, Hemachudha T, Torvorapanit P. The first human case report of molecularly confirmed co-infection of Brucella melitensis and Coxiella burnetii: A case report. Heliyon 2024; 10:e29685. [PMID: 38681594 PMCID: PMC11053185 DOI: 10.1016/j.heliyon.2024.e29685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024] Open
Abstract
Co-infection with Brucella melitensis and Coxiella burnetii has been rarely reported. To date, there are only two co-infection case reports from Croatia and China which diagnosed the infections mainly through the use of serological tests. In this report, we present the first case of molecularly confirmed B. melitensis bacteremia and C. burnetii spondylodiscitis co-infection in a goat dairy farmer who presented with lumbosacral spondylodiscitis and bilateral psoas abscesses. From the blood culture, B. melitensis was identified by using 16S rRNA gene sequencing and specific PCR. Lumbar bone tissue was found to be positive for C. burnetii using multiplex real-time PCR and was confirmed with a positive result from conventional PCR which detected the infection through the identification of the IS1111 gene. The patient's condition improved after decompressive laminectomy was performed and administration of antibiotics regimen: intravenous gentamicin, oral rifampicin, and oral doxycycline. From our case, it is important to raise awareness of this underreported co-infection with multiple zoonotic diseases, especially Q fever and brucellosis, which share the same exposure risk. Moreover, we also emphasize the use of advanced molecular techniques to improve the diagnostic efficiency and reduce the use of time-consuming procedures among patients who are continuously exposed to such risk factors in areas with high seroprevalence of these zoonotic diseases.
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Affiliation(s)
- Onjira Mangkalamanee
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University, And King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873, Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand
| | - Suwatchareeporn Rotcheewaphan
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, 1873, Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand
- Center of Excellence of Antimicrobial Stewardship, Chulalongkorn University, 1873, Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand
| | - Pawat Phuensan
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University, And King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873, Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand
- Division of Hospital and Ambulatory Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, And King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873, Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand
| | - Teerada Ponpinit
- Thai Red Cross Emerging Infectious Diseases Health Science Centre, World Health Organization Collaborating Centre for Research and Training on Viral Zoonoses, King Chulalongkorn Memorial Hospital-The Thai Red Cross Society, Bangkok 10330, Thailand
| | - Thiravat Hemachudha
- Thai Red Cross Emerging Infectious Diseases Health Science Centre, World Health Organization Collaborating Centre for Research and Training on Viral Zoonoses, King Chulalongkorn Memorial Hospital-The Thai Red Cross Society, Bangkok 10330, Thailand
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Pattama Torvorapanit
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University, And King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873, Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand
- Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873, Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand
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Sunnerhagen T, Rasmussen M. Lower specificity of the ESC2023 diagnostic criteria for infective endocarditis when spondylodiscitis is regarded as a vascular phenomenon. Clin Infect Dis 2024:ciae223. [PMID: 38655757 DOI: 10.1093/cid/ciae223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/02/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
The ESC diagnostic criteria for infective endocarditis (IE) added spondylodiscitis as minor diagnostic criterion. Of patients with Staphylococcus aureus, streptococcal or Enterococcus faecalis bacteremia, 11 of 1807 episodes were reclassified to definite IE of which nine were not treated as IE. Spondylodiscitis as a minor criterion decreases specificity of the criteria.
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Affiliation(s)
- Torgny Sunnerhagen
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Clinical Microbiology and Infection Control, Region Skåne Office for Medical Services, SE-221 00 Lund, Sweden
| | - Magnus Rasmussen
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, SE-221 00 Lund, Sweden
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Rezvani M, Ahmadvand A, Yazdanian T, Azimi P, Askariardehjani N. Value of Spinal Infection Treatment Evaluation Score, Pola Classification, and Brighton Spondylodiscitis Score from Decision to Surgery in Patients with Spondylodiscitis: A Receiver-Operating Characteristic Curve Analysis. Asian Spine J 2024:asj.2023.0317. [PMID: 38650093 DOI: 10.31616/asj.2023.0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/01/2024] [Indexed: 04/25/2024] Open
Abstract
Study Design This was a retrospective study. Purpose This study aimed to assess the value of the Spinal Infection Treatment Evaluation (SITE) score, Brighton Spondylodiscitis Score (BSDS), and Pola classification to predict the need for surgical intervention in patients with spondylodiscitis. Overview of Literature Spondylodiscitis is a rare disease, and the prediction of its outcome is crucial in the decision-making process. Methods All case records were assessed to extract information on the American Spinal Injury Association (ASIA), Visual Analog Scale (VAS), and Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores before and after surgery. The SITE score, Pola classification, and BSDS were recorded. The receiver-operating characteristic (ROC) curve analysis and the area under the curve (AUC) were applied to estimate the predictive ability of the scoring systems. Patients' satisfaction with surgery outcomes was evaluated using the VAS, ASIA, JOABPEQ, and Likert scale for quality-of-life evaluation. Results In all 148 patients, case records were reviewed. The mean±standard deviation age of the patients was 54.6±14.7 years. Of these, 112 patients underwent surgery. The AUC scores were 0.86, 0.81, and 0.73 for the SITE score, BSDS, and Pola classification, respectively. In the comparison of the AUC of ROC curves, SITE score vs. BSDS showed a significantly greater AUC, 0.13 (Z =2.1, p =0.037); SITE score vs. Pola classification, 0.05 (Z =0.82, p =0.412); and Pola classification vs. BSDS, 0.08 (Z =1.22, p =0.219). The optimal cutoff score was 8.5 (sensitivity, 80.6%; specificity, 81.2%) for the SITE score and 9.5 (sensitivity, 52.8%; specificity, 83.0%) for the BSDS in the decision to surgery. VAS back pain and JOABPEQ subscales showed a significant difference when compared with preoperative scores. According to ASIA grading, none of the patients experienced neurological deterioration. Overall, patients' satisfaction was observed. Conclusions The findings suggest that the SITE score is a useful measure and helps clinicians make clinically sound decisions in patients with spondylodiscitis.
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Affiliation(s)
- Majid Rezvani
- Department of Neurosurgery, Neuroscience Research Center, Al-Zahra Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Ahmadvand
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Parisa Azimi
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Soudack M, Shimoni HY, Plotkin S, Jacobson JM. Sonographic diagnosis of spondylodiscitis in a young child. Pediatr Radiol 2024:10.1007/s00247-024-05920-w. [PMID: 38592502 DOI: 10.1007/s00247-024-05920-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
Sonographic diagnosis of spondylodiscitis is described in a 21-month-old girl who presented with altered gait. Spondylodiscitis, also referred to as discitis-osteomyelitis, is an infection of the intervertebral disc and adjacent vertebrae. The imaging modality of choice is spinal magnetic resonance imaging. Our case is the first description in the English language of the sonographic diagnosis of spondylodiscitis. Pediatric radiologists and sonographers should be acquainted with its features, for both incidental and intentional diagnosis.
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Affiliation(s)
- Michalle Soudack
- Division of Diagnostic Imaging, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Israel, 5266202.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel.
| | - Hadar-Yafit Shimoni
- Division of Diagnostic Imaging, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Israel, 5266202
| | - Simyon Plotkin
- Department of Pediatric Emergency Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Jeffrey M Jacobson
- Division of Diagnostic Imaging, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Israel, 5266202
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Heck VJ, Prasse T, Klug K, Vinas-Rios JM, Oikonomidis S, Klug A, Kernich N, Weber M, von der Höh N, Lenz M, Walter SG, Himpe B, Eysel P, Scheyerer MJ. The projected increase of vertebral osteomyelitis in Germany implies a demanding challenge for future healthcare management of aging populations. Infection 2024:10.1007/s15010-024-02243-8. [PMID: 38592659 DOI: 10.1007/s15010-024-02243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/18/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Since an increase in the occurrence of native vertebral osteomyelitis (VO) is expected and reliable projections are missing, it is urgent to provide a reliable forecast model and make it a part of future health care considerations. METHODS Comprehensive nationwide data provided by the Federal Statistical Office of Germany were used to forecast total numbers and incidence rates (IR) of VO as a function of age and gender until 2040. Projections were done using autoregressive integrated moving average model on historical data from 2005 to 2019 in relation to official population projections from 2020 to 2040. RESULTS The IR of VO is expected to increase from 12.4 in 2019 to 21.5 per 100,000 inhabitants [95% CI 20.9-22.1] in 2040. The highest increase is predicted in patients over 75 years of age for both men and women leading to a steep increase in absolute numbers, which is fourfold higher compared to patients younger than 75 years. While the IR per age group will not increase any further after 2035, the subsequent increase is due to a higher number of individuals aged 75 years or older. CONCLUSIONS Our data suggest that increasing IR of VO will seriously challenge healthcare systems, particularly due to demographic change and increasing proportions of populations turning 75 years and older. With respect to globally fast aging populations, future health care policies need to address this burden by anticipating limitations in financial and human resources and developing high-level evidence-based guidelines for prevention and interdisciplinary treatment.
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Affiliation(s)
- Vincent Johann Heck
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
- Center for Spinal Surgery, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.
| | - Tobias Prasse
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Department of Neurological Surgery, University of Washington, Seattle, WA, 98105-3901, USA
| | - Kristina Klug
- Department of Psychology, Goethe-University Frankfurt, Theodor-W.-Adorno Platz 6, PEG, 60629, Frankfurt am Main, Germany
| | - Juan Manuel Vinas-Rios
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Stavros Oikonomidis
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Alexander Klug
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - Nikolaus Kernich
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Maximilian Weber
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Nicolas von der Höh
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, University of Leipzig Medical Faculty, Leipzig, Germany
| | - Maximilian Lenz
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Sebastian Gottfried Walter
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Bastian Himpe
- Interdisciplinary Center for Spinal Surgery, St. Elisabethen-Krankenhaus Frankfurt, Ginnheimer Straße 3, 60487, Frankfurt am Main, Germany
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Max Joseph Scheyerer
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Department of Orthopedics and Trauma Surgery, Medical Faculty, University Duesseldorf, 40225, Duesseldorf, Germany
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Tinelli A, Yassa M, Marzo G, Romualdi D, Frigerio M, Melcarne A, Scambia G, Pecorella G, Morciano A. Spondylodiscitis after sacral colpopexy: diagnose early to treat earlier. Int J Clin Exp Pathol 2024; 17:90-95. [PMID: 38577696 PMCID: PMC10988091 DOI: 10.62347/rerc7901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/21/2024] [Indexed: 04/06/2024]
Abstract
Spondylodiscitis following sacral colpopexy for Pelvic Organ Prolapse (POP) represents a rare complication with severe consequences. Authors performed a literature search, from 2000 to 2022, to set a narrative review of literature. Spondylodiscitis is an uncommon but dangerous side effect of a routine surgical treatment that needs to be identified and treated right away to prevent worsening clinical consequences. Suboptimal dissection of the sacral promontory and/or site infection are associated with spondylodiscitis. When spondylodiscitis is suspected, advanced imaging methods should be used, and surgical excision shouldn't be put off after a failed course of treatment. Authors presented a case-video of a 68-year-old woman who reported severe lower back pain 7 weeks after surgery, in which sacral spondylodiscitis was diagnosed and laparoscopically treated. In this case, a laparoscopic tack and mesh removal from promontory was carried out following the patient's continued lower back pain and the antibiotic therapy's incomplete radiological remission of spondylodiscitis. The patient's radiological findings and symptoms completely resolved two weeks following the procedure.
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Affiliation(s)
- Andrea Tinelli
- Department of Gynaecology and Obstetrics, “Veris Delli Ponti” Hospital, and CERICSAL (CEntro di RIcerca Clinico SALentino), “Veris delli Ponti Hospital”Scorrano, Lecce, Italy
| | - Murat Yassa
- Department of Obstetrics and Gynecology, Sağlık Bilimleri Üniversitesi, Şişli Etfal Hastanesiİstanbul, Turkey
| | - Giuseppe Marzo
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione “Card. G. Panico”Tricase, Italy
| | - Daniela Romualdi
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario “A. Gemelli” - IRCCS, Università Cattolica del Sacro CuoreRoma, Italy
| | - Matteo Frigerio
- Department of Obstetrics and Gynecology, ASST Monza, San Gerardo HospitalMonza, Italy
| | - Alessio Melcarne
- Department of Radiology, Pia Fondazione “Card. G. Panico”Tricase, Italy
| | - Giovanni Scambia
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario “A. Gemelli” - IRCCS, Università Cattolica del Sacro CuoreRoma, Italy
| | - Giovanni Pecorella
- Department of Obstetrics, Gynecology and Reproductive Medicine, Saarland UniversityKirrbergerstraße 100, Gebäude 9, 66421 Homburg/Saar, Germany
| | - Andrea Morciano
- Panico Pelvic Floor Center, Department of Gynaecology and Obstetrics, Pia Fondazione “Card. G. Panico”Tricase, Italy
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Husseini JS, Hanly A, Omeroglu E, Nelson SB, Jesse MK, Simeone FJ, Chang CY. Can gas and infection coexist in the intervertebral disc? A retrospective analysis of percutaneously biopsied suspected discitis-osteomyelitis cases. Skeletal Radiol 2024:10.1007/s00256-024-04631-5. [PMID: 38413401 DOI: 10.1007/s00256-024-04631-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES To retrospectively evaluate the correlation between intradiscal gas and infection in patients percutaneously biopsied for suspected discitis-osteomyelitis. MATERIALS AND METHODS We retrospectively reviewed all CT-guided discitis-osteomyelitis biopsies performed between 2002 and 2022. Two independent trained musculoskeletal radiologists evaluated for presence of gas on CT and/or MRI within 1 week of the biopsy. Disagreements were resolved by a third musculoskeletal radiologist. CT was considered the gold standard for the detection of intradiscal gas. Pathology, microbiology, and imaging and clinical follow-up were used as the gold standard for presence of infection. Interrater agreement on CT and MRI, sensitivity, and positive predictive value were calculated, using the presence of gas as an indicator (test positive) for "no infection." RESULTS There were 284 biopsies in 275 subjects (mean age 58 ± 1.0 (range 4-99) years; 101 (37%) females and 174 (63%) males). Of the biopsies, 12 (4%) were cervical, 80 (28%) were thoracic, 192 (68%) were lumbar, and 200 (70%) were considered true discitis-osteomyelitis based on pathology, imaging, and clinical follow-up. Interrater agreement was excellent for CT (kappa = 0.83) and poor for MRI (kappa = - 0.021). The presence of gas had a 94% specificity and 76% negative predictive value for the absence of infection. CONCLUSION CT is the preferred method for detecting intradiscal gas. The presence of gas means that discitis-osteomyelitis is unlikely. If intradiscal gas is present in the setting of discitis-osteomyelitis, the gas bubbles tend to be smaller and fewer in number.
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Affiliation(s)
- Jad S Husseini
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Arnau Hanly
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Emre Omeroglu
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Sandra B Nelson
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Mary Kate Jesse
- Department of Radiology, University of Colorado, Aurora, CO, USA
| | - F Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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Borde MD, Menon VK, Kanade UP, Rajale SS, Mane AV, Varma H. Drug eluting bioactive glass ceramics for fusion in spondylodiscitis: a pilot study. Neurosurg Rev 2024; 47:80. [PMID: 38355838 DOI: 10.1007/s10143-024-02317-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/16/2024]
Abstract
Retrospective observational study. To determine the efficacy and safety of bioactive glass ceramics mixed with autograft in the treatment of spondylodiscitis. Thirty-four patients with spondylodiscitis underwent surgery using autologous bone graft augmented by antibiotic loaded bioactive glass ceramic granules. Twenty-five patients aging 6 to 77, completed 1-year follow-up. The lumbosacral junction was affected in 3, lumbar spine in 13, one each in the dorso-lumbar junction and sacrum, and 7 dorsal spines. The organism isolated was Mycobacterium tuberculosis in 15, Methicillin sensitive Staphylococcus aureus (MSSA) in 4, Pseudomonas aeruginosa in 4, Klebsiella pneumoniae in one, Burkholderia pseudomallei in 1, and mixed infections in 2. All patients had appropriate antibiotic therapy based on culture and sensitivity. Clinical and radiological evaluation of all the patients was done at 6 weeks, 3 months, 6 months, and 12 months after the surgery. Twenty-three patients improved clinically and showed radiographic fusion between 6 and 9 months. The patient with Burkholderia infection died due to fulminant septicemia with multi organ failure while another patient died at 9 months due to an unrelated cardiac event. The mean Visual Analogue Score (VAS) at the end of 1-year was 2 with radiological evidence of fusion in all patients. There were no re-infections or discharging wounds, and the 30-day re-admission rate was 0. Bioactive glass ceramics is a safe and effective graft expander in cases of spondylodiscitis. The absorption of antibiotics into the ceramic appears to help the elimination of infection.
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Affiliation(s)
- Mandar D Borde
- Department of Spine Surgery, Bharati Vidyapeeth Medical College Hospital, Pune, India.
| | - Venugopal K Menon
- Department of Spine Surgery, Bharati Vidyapeeth Medical College Hospital, Pune, India
| | - Umesh P Kanade
- Department of Orthopaedics, Bharati Vidyapeeth Medical College Hospital, Pune, India
| | - Sangram S Rajale
- Department of Orthopaedics, Bharati Vidyapeeth Medical College Hospital, Pune, India
| | - Akash V Mane
- Department of Orthopaedics, Bharati Vidyapeeth Medical College Hospital, Pune, India
| | - Harikrishna Varma
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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AlTarayra M, Abuzaina KNM, Hassouneh AWM, Aljabarein OYA. Spondylodiscitis following perforated acute appendicitis in a 14-year-old female: A case report. Int J Surg Case Rep 2024; 115:109184. [PMID: 38211554 PMCID: PMC10788785 DOI: 10.1016/j.ijscr.2023.109184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Acute appendicitis is a common surgical emergency, often resulting in perforation and increased morbidity. Up to 55 % of children with complicated appendicitis may experience a complication such as infection, bowel obstruction, or unplanned hospital re-admission (Blakely et al., 2011 [23]). However, the development of infectious spondylodiscitis following appendectomy is an extremely rare complication, particularly in pediatric patients. We present the first reported case of lumbar spondylodiscitis occurring post-perforated appendicitis in a 14-year-old female, highlighting the importance of recognizing and managing uncommon complications. CASE PRESENTATION A previously healthy 14-year-old female underwent urgent appendectomy for perforated appendicitis. Postoperatively, she developed severe back pain and immobility. Imaging revealed early lumbar discitis, and Pseudomonas aeruginosa was isolated from the surgical site. The patient received multiple antibiotic regimens, including vancomycin, ceftazidime, and meropenem, resulting in clinical improvement. CLINICAL DISCUSSION Infectious spondylodiscitis is typically hematogenously spread or due to direct inoculation. In this case, the spread from a contiguous focus of infection without vascular insufficiency is suspected. The coexistence of appendicitis and spondylodiscitis poses diagnostic challenges, requiring a multidisciplinary approach for accurate diagnosis and appropriate treatment. CONCLUSION This unique case highlights the need for vigilance in recognizing rare complications of appendicitis, such as infectious spondylodiscitis. Early diagnosis and tailored antibiotic therapy are crucial for optimal outcomes. Further research is needed to explore the underlying mechanisms and risk factors associated with this rare complication.
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Rezvani M, Veisi S, Sourani A, Ahmadian H, Foroughi M, Mahdavi SB, Nik Khah R. Spondylodiscitis instrumented fusion, a prospective case series on a standardized neurosurgical protocol with long term follow up. Injury 2024; 55:111164. [PMID: 37923678 DOI: 10.1016/j.injury.2023.111164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE To investigate the fusion construct properties, construct length, intervertebral prosthesis (IVP) selection, bone grafting methods, complications management, and follow-up outcomes of spondylodiscitis fusion. METHOD This case series was conducted in Al-Zahra University referral hospital from March 2016 to November 2021. All the surgery-eligible patients were enrolled. Those who did not participate or failed the neurosurgical intervention were excluded. A unified neurosurgical protocol was defined. After operation and follow-up, all variables were documented. IBM SPSS v.26 was used for data analysis. P-value ≤ 0.05 was considered significant. RESULT Ninety-two patients were reviewed in the final analysis with 65.2 % males. The mean age was 55.07 ± 14.22 years old. The most frequent level of pathology and surgery was the lumbar spine (48.9 %). Short and long constructs were almost equally used (57.6 and 42.4 %, respectively). Bone graft mixture was the dominant IVP (75 %). The most frequent persistent postoperative symptom was back pain (55.4 %), while the neurological deficits resolution rate was 76.7 %. The fusion rate was 92.3 %. Proximal junctional kyphosis incidence was 16.3 % and had a significant association with on-admission neurological symptoms, thoracic and thoracolumbar junction involvements (p < 0.05). Follow-up Oswestry disability index scores showed 44.6 % of the patients had mild or no functional disabilities. Advanced age, On-admission deficits, comorbidities, titanium cages, and poor fusion status were associated with poor functional outcomes and higher mortality rates (P < 0.05). CONCLUSION The introduced neurosurgical protocol could effectively achieve acceptable SD treatment, spine stabilization, and fusion with low long-term surgical complications. Autologous bone graft mixture in comparison to titanium cages showed a higher fusion rate with a lower mortality rate. Patients with older age, neurological symptoms, and comorbidities are expected to experience less favorable clinical outcomes.
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Affiliation(s)
- Majid Rezvani
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shaahin Veisi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Arman Sourani
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran; Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamed Ahmadian
- Department of Neurosurgery, Babol University of Medical Sciences, Mazandaran, Iran
| | - Mina Foroughi
- Isfahan Medical Students' Research Committee (IMSRC), Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sadegh Baradaran Mahdavi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Student Research Committee, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan, Iran
| | - Roham Nik Khah
- Isfahan Medical Students' Research Committee (IMSRC), Isfahan University of Medical Sciences, Isfahan, Iran
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Gaultier S, Jousset AB, Soudani M, Durroux A, Mihaila L, Neiss M, Collarino R, Jauréguiberry S, Escaut L. Campylobacter coli enteritis associated with Campylobacter fetus bacteremia, spondylodiscitis, and late CIED-related endocarditis, a case report. Heliyon 2024; 10:e24418. [PMID: 38293406 PMCID: PMC10825340 DOI: 10.1016/j.heliyon.2024.e24418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/11/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
Campylobacter sp. is widely considered a leading causative agent of bacterial food-borne gastrointestinal illness. Discitis and endocarditis caused by Campylobacter spp. are extremely rare. We describe the case of a 94-year-old man who was admitted for recent lumbar pain, diarrhea, and fever. C. fetus and C. coli were identified by MALDI-TOF from blood and stool samples respectively. MRI of the spine showed L5-S1 discitis. Patient was treated with 6 weeks of amoxicillin with clinical and microbiological response until cardiac implantable electronic device (CIED) related endocarditis occurred four weeks after the end of the antibiotic treatment. He was treated with another 6 weeks amoxicillin regimen, with a favorable outcome after a 6-month follow-up. Enteric infection with Campylobacter spp. in a debilitated patient should raise the possibility of a co-infection with another more invasive species such as C. fetus, leading to systemic invasion. In case of Campylobacter fetus bacteremia, a search for endocarditis and spondylodiscitis is recommended even in the absence of specific clinical signs.
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Affiliation(s)
- Sébastien Gaultier
- Service de Maladies Infectieuses et Tropicales, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris-Saclay, 78 avenue du General Leclerc 92470 Le Kremlin-Bicêtre, France
| | - Agnès B. Jousset
- Service de microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Mary Soudani
- Unité de Gériatrie aigue, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Alix Durroux
- Service de Gériatrie, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Liliana Mihaila
- Service de microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Marie Neiss
- Service de Gériatrie, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Rocco Collarino
- Service de Gériatrie, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Stéphane Jauréguiberry
- Service de Maladies Infectieuses et Tropicales, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris-Saclay, 78 avenue du General Leclerc 92470 Le Kremlin-Bicêtre, France
| | - Lelia Escaut
- Service de Maladies Infectieuses et Tropicales, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Université Paris-Saclay, 78 avenue du General Leclerc 92470 Le Kremlin-Bicêtre, France
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Hijazi MM, Siepmann T, El-Battrawy I, Schröttner P, Podlesek D, Schackert G, Juratli TA, Eyüpoglu IY, Filis A. The importance of the bacterial spectrum in the clinical diagnostics and management of patients with spontaneous pyogenic spondylodiscitis and isolated spinal epidural empyema: a 20-year cohort study at a single spine center. BMC Infect Dis 2024; 24:39. [PMID: 38166791 PMCID: PMC10762996 DOI: 10.1186/s12879-023-08946-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Personalized clinical management of spondylodiscitis (SD) and isolated spinal epidural empyema (ISEE) is challenging due to limited evidence of microbiologic findings and their clinical impact during the clinical course of the disease. We aimed to characterize clinico-microbiological and imaging phenotypes of SD and ISEE to provide useful insights that could improve outcomes and potentially modify guidelines. METHODS We performed chart review and collected data on the following parameters: bacterial antibiogram-resistogram, type of primary spinal infection, location of spinal infection, source of infection, method of detection, clinical complications (sepsis, septic embolism, and endocarditis), length of hospital and intensive care unit (ICU) stay, relapse rate, and disease-related mortality in patients with proven pyogenic SD and ISEE treated surgically in a university hospital in Germany between 2002 and 2022. RESULTS We included data from 187 patients (125 SD, 66.8% and 62 ISEE, 33.2%). Gram-positive bacteria (GPB) were overall more frequently detected than gram-negative bacteria (GNB) (GPB: 162, 86.6% vs. GNB: 25, 13.4%, p < 0.001). Infective endocarditis was caused only by GPB (GPB: 23, 16.5% vs. GNB: 0, 0.0%, p = 0.046). Methicillin-susceptible Staphylococcus aureus was the most frequently isolated strain (MSSA: n = 100, 53.5%), occurred more frequently in the cervical spine compared to other bacteria (OB) (MSSA: 41, 41.0% vs. OB: 18, 20.7%, p = 0.004) and was most frequently detected in patients with skin infection as the primary source of infection (MSSA: 26, 40.6% vs. OB: 11, 16.7%, p = 0.002). Streptococcus spp. and Enterococcus spp. (SE: n = 31, 16.6%) were more often regarded as the cause of endocarditis (SE: 8, 27.6% vs. OB: 15, 11.4%, p = 0.037) and were less frequently detected in intraoperative specimens (SE: 19, 61.3% vs. OB: 138, 88.5%, p < 0.001). Enterobacterales (E: n = 20, 10.7%) were identified more frequently in urinary tract infections (E: 9, 50.0% vs. OB: 4, 3.6%, p < 0.001). Coagulase-negative Staphylococci (CoNS: n = 20, 10.7%) were characterized by a lower prevalence of sepsis (CoNS: 4, 20.0% vs. OB: 90, 53.9%, p = 0.004) and were more frequently detected in intraoperative specimens (CoNS: 20, 100. 0% vs. OB: 137, 82.0%, p = 0.048). Moreover, CoNS-associated cases showed a shorter length of ICU stay (CoNS: 2 [1-18] days vs. OB: 6 [1-53] days, median [interquartile range], p = 0.037), and occurred more frequently due to foreign body-associated infections (CoNS: 8, 61.5% vs. OB: 15, 12.8%, p = 0.008). The presence of methicillin-resistant Staphylococcus aureus (MRSA) prolonged hospital stay by 56 [24-58] days and ICU stay by 16 [1-44] days, whereas patients with Pseudomonas aeruginosa spent only 20 [18-29] days in the hospital and no day in the ICU 0 [0-5] days. CONCLUSIONS Our retrospective cohort study identified distinct bacterial-specific manifestations in pyogenic SD and ISEE regarding clinical course, neuroanatomic targets, method of pathogen detection, and sources of infection. The clinico-microbiological patterns varied depending on the specific pathogens.
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Affiliation(s)
- Mido Max Hijazi
- Department of Neurosurgery, Division of Spine Surgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Timo Siepmann
- Department of Neurology, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology, Bergmannsheil University Hospital, Ruhr University Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany
| | - Percy Schröttner
- Institute for Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
- Institute for Microbiology and Virology, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Dino Podlesek
- Department of Neurosurgery, Division of Spine Surgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, Division of Spine Surgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Tareq A Juratli
- Department of Neurosurgery, Division of Spine Surgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Ilker Y Eyüpoglu
- Department of Neurosurgery, Division of Spine Surgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Andreas Filis
- Department of Neurosurgery, Division of Spine Surgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
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Lafford HW, Stewart EE, Koslowsky IL, Rabin HR, Kloiber R. The routine clinical use of fluorodeoxyglucose PET/CT to confirm treatment response in pyogenic spine infection. Skeletal Radiol 2024; 53:161-170. [PMID: 37393203 DOI: 10.1007/s00256-023-04393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE Response of pyogenic spine infection to antibiotic therapy is usually based on nonspecific symptoms and inflammation markers. Abnormalities on MRI persist too long to influence therapy. Is FDG-PET/CT a timely and robust predictor of successful therapy? MATERIALS AND METHODS Retrospective study. Sequential FDG-PET/CTs done to assess treatment response over a 4-year period. Recurrence of infection after stopping treatment was the endpoint. RESULTS One hundred seven patients enrolled. First treatment response scan showed no signs of infection in 69 patients (low risk). Twenty-four additional patients underwent additional treatment after an initial positive scan with low-risk pattern on follow-up imaging. After stopping antibiotics, none had clinical recurrence of infection. One had positive cultures at surgery for negative predictive value of 0.99. Thirty-eight patients had evidence of residual infection. Abnormalities in 28 were comparable to what is seen with untreated infection (high-risk). Twenty-seven received additional treatment until resolution. Antibiotics were stopped in 1 who suffered recurrence. Ten had low-grade/localized abnormalities consistent with infection (intermediate-risk). Signs of infection resolved in 3 after additional treatment. Of the remaining 7 patients who had minor residual abnormalities when antibiotics were stopped, 1 had recurrent infection for a positive predictive value of 0.14. CONCLUSION Risk stratification proposed: A low-risk scan with only inflammation at a destroyed joint indicates negligible risk of recurrence. Unexplained activity in bone, soft tissue or spinal canal indicates high risk with further antibiotics recommended. Most patients with subtle or localized findings (intermediate risk) did not experience recurrence. Stopping therapy could be considered under careful observation.
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Affiliation(s)
- Hans W Lafford
- Department of Radiology, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
- Diagnostic Radiology Residency Program, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
| | - Errol E Stewart
- Department of Radiology, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada
| | - Ingrid L Koslowsky
- Department of Radiology, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada
| | - Harvey R Rabin
- Department of Medicine, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Canada
| | - Reinhard Kloiber
- Department of Radiology, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
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Suresh V, H S S, Raju B, Jindal H, Ozair A. Management of Postoperative Discitis with Debridement and Novel Technique of Local Antibiotic Instillation: Functional Outcomes from a Resource-Limited Setting. World Neurosurg 2024; 181:52-58. [PMID: 37839576 DOI: 10.1016/j.wneu.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Patients in low- and middle-income countries (LMICs) have substantial treatment abandonment and non-adherence with outpatient oral medications. This work sought to investigate outcomes of postoperative discitis treated with debridement and a novel technique focused on reducing outpatient antibiotic requirement in an LMIC setting. METHODS This study, conducted and reported following STROBE guidelines, reviewed outcomes of all patients with postoperative discitis who had been debrided by 1 neurosurgeon in a resource-limited setting during 2008-2020. Patients had undergone single-level L4-L5 or L5-S1 discectomy elsewhere, later developing magnetic resonance imaging-confirmed discitis. After non-response or deterioration following intravenous antibiotics, patients underwent early debridement, followed by in-patient antibiotic instillation into disc space for 2 weeks via drain. Study outcomes were modified Kirkaldy-Willis Grade, Japan Orthopaedic Association (JOA) score, and visual analog scale (VAS) score, all assessed at 1 year. RESULTS Twelve patients were included, 10 male and 2 female, with median age of 46 (IQR 3.5) years. Debridement was done after median 82.5 (IQR 35) days and took median time of 105 (IQR 17.5) minutes. VAS scores (mean ± SD) decreased from 9.25 ± 0.75 preoperatively to 0.67 ± 0.89 1 year postoperatively (mean difference 8.58, 95% CI 8.01-9.15, P < 0.001). JOA scores (mean ± SD) improved from 4.5 ± 2.94 to 26.42 ± 1.31 1 year postoperatively (mean difference 21.92, 95% CI 20.57-23.26, P < 0.001). Kirkaldy-Willis grade was excellent in 6 (50%) patients, good in 5 (41.7%), and fair in 1 (8.3%). Patients became ambulatory within 2 weeks, with no major complications during 4.15 (IQR 3.45) years of median follow-up. CONCLUSIONS In LMICs, patients with medically refractory postoperative discitis potentially have good outcomes after debridement plus 2-week local antibiotic instillation.
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Affiliation(s)
- Vinay Suresh
- Department of Neurosurgery, King George's Medical University, Lucknow, India
| | - Suresh H S
- Division of Neurosurgery, Premier Neuro and Eye Care Centre, Bengaluru, India
| | - Bharath Raju
- Department of Neurosurgery, McGovern Medical School, University of Texas Health, Houston, Texas, USA
| | | | - Ahmad Ozair
- Department of Neurosurgery, King George's Medical University, Lucknow, India; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
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Pessoa D, Vicente I, Pereira C, Pina A, Freitas P, Borges A, Sargento I. Patients with Spondylodiscitis following Chemoradiotherapy for Head and Neck Cancer in a Portuguese Cancer Hospital: A Case Report. Case Rep Oncol 2024; 17:556-563. [PMID: 38638599 PMCID: PMC11026072 DOI: 10.1159/000535712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 11/22/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction Head and neck cancer is an umbrella term for tumor manifestations across the head and neck regions, including the oral cavity, pharynx (including the naso, oro, and hypopharynx), larynx, and sinuses. Treatment options for head and neck cancer include surgery, radiation therapy, chemotherapy, and immunotherapy, with specific treatment plans depending upon individual tumor location and staging, together with overall patient health status. Furthermore, definitive chemoradiotherapy (CRT) has emerged as a highly effective therapeutic option for locoregional advanced head and neck squamous cell cancer. However, such therapy has also been linked to the development of spondylodiscitis. Spondylodiscitis consists of an infection starting at the vertebral endplates and spreading into the intervertebral discs, typically manifesting in adults. Case Presentation and Conclusion This case report describes our clinical team's experience in managing three separate cases of spondylodiscitis following CRT for head and neck tumors that presented at our clinic for diagnosis and treatment in order to identify predisposing factors that underlie the link between CRT and spondylodiscitis.
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Affiliation(s)
- Diana Pessoa
- Department of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Inês Vicente
- Department of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Carolina Pereira
- Department of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Ana Pina
- Department of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Pedro Freitas
- Department of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Alexandra Borges
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Isabel Sargento
- Department of Medical Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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Maddy KS, Tigre JY, Lu VM, Costello MC, Errante EL, Levi AD, Burks SS. Influence of instrumentation type on outcomes after surgical management of spondylodiscitis: a systematic review and meta-analysis. Eur Spine J 2023:10.1007/s00586-023-08065-w. [PMID: 38148366 DOI: 10.1007/s00586-023-08065-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Spondylodiscitis refers to infection of the intervertebral disk and neighboring structures. Outcomes based on instrumentation type are not well reported in the literature, but are important in establishing guidelines for surgical management of spondylodiscitis. This study aims to clarify the effect of instrumentation material selection on clinical and radiographic outcomes in patients with spondylodiscitis. METHODS Studies that evaluated the use of polyetheretherketone (PEEK), titanium, allograft, and/or autologous bone grafts for spondylodiscitis were identified in the literature. Radiographic and clinical data were analyzed using a meta-analysis of proportions, with estimated risk and confidence intervals reported for our primary study outcomes. RESULTS Thirty-two retrospective studies totaling 1088 patients undergoing surgical management of spondylodiscitis with PEEK, TTN, allograft, and autologous bone graft instrumentation were included. There were no differences in fusion rates (p-interaction = 0.55) with rates of fusion of 93.4% with TTN, 98.6% with allograft, 84.2% with autologous bone graft, and 93.9% with PEEK. There were no differences in screw loosening (p-interaction = 0.52) with rates of 0.33% with TTN, 0% with allograft, 1.3% with autologous bone graft, and 8.2% with PEEK. There were no differences in reoperation (p-interaction = 0.59) with rates of 2.64% with TTN, 0% with allograft, 1.69% with autologous bone graft, and 3.3% with PEEK. CONCLUSIONS This meta-analysis demonstrates that the choice of instrumentation type in the surgical management of spondylodiscitis resulted in no significant differences in rate of radiographic fusion, screw loosening, or reoperation. Future comparative studies to optimize guidelines for the management of spondylodiscitis are needed.
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Affiliation(s)
- Krisna S Maddy
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA.
| | - Joseph Yunga Tigre
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA
| | - Meredith C Costello
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA
| | - Emily L Errante
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA
| | - Allan D Levi
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - S Shelby Burks
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
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Al-Afif S, Atallah O, Scheinichen D, Palmaers T, Cinibulak Z, Rollnik JD, Krauss JK. Surgical treatment of spondylodiscitis in critically ill septic patients. Acta Neurochir (Wien) 2023; 165:3601-3612. [PMID: 37587320 PMCID: PMC10739300 DOI: 10.1007/s00701-023-05748-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE Surgical procedures in critically ill patients with spondylodiscitis are challenging and there are several controversies. Here, we present our experience with offering surgical intervention early in critically ill septic patients with spondylodiscitis. METHOD After we introduced a new treatment paradigm offering early but limited surgery, eight patients with spondylodiscitis complicated by severe sepsis and multiple organ failure underwent urgent surgical treatment over a 10-year period. Outcome was assessed according to the Barthel index at 12-month follow-up and at the last available follow-up (mean 89 months). RESULTS There were 7 men and 1 woman, with a mean age of 62 years. The preoperative ASA score was 5 in 2 patients, and 4 in 6 patients. Six of them presented with high-grade paresis, and in all of them, spondylodiscitis with intraspinal and/or paravertebral abscesses was evident in MR imaging studies. All patients underwent early surgery (within 24 h after admission). The median time in intensive care was 21 days. Out of the eight patients, seven survived. One year after surgery, five patients had a good outcome (Barthel index: 100 (1); 80 (3); and 70 (1)). At the last follow-up (mean 89 months), 4 patients had a good functional outcome (Barthel index between 60 and 80). CONCLUSION Early surgical treatment in critically ill patients with spondylodiscitis and sepsis may result in rapid control of infection and can provide favorable long-term outcome. A general strategy of performing only limited surgery is a valid option in such patients who have a relatively high risk for surgery.
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Affiliation(s)
- Shadi Al-Afif
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
| | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Dirk Scheinichen
- Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Thomas Palmaers
- Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Zafer Cinibulak
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Jens D Rollnik
- Institute for Neurorehabilitation Research (InFo), BDH-Clinic Hessisch Oldendorf, Affiliated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
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Shanmuganathan R, Ramachandran K, Shetty AP, Kanna RM. Active tuberculosis of spine: Current updates. N Am Spine Soc J 2023; 16:100267. [PMID: 37736557 PMCID: PMC10510092 DOI: 10.1016/j.xnsj.2023.100267] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
Background Spinal tuberculosis (TB) is the most common extrapulmonary form of tuberculosis. In both developing and developed countries, TB has been on the rising trend due to factors such as increasing HIV coinfection, multidrug resistance of the organism, and global migration. Spinal TB, which most often affects the lower thoracic and thoracolumbar area, accounts for 50% of all musculoskeletal tuberculosis. Methods Using the Cochrane Database of Systematic Reviews, EMBASE, and PubMed, a systematic computerized literature search was performed. Analyses of studies published within the past 10 years were conducted. The searches were performed using Medical Subject Headings terms, with "spinal tuberculosis," "diagnosis," "epidemiology," and "etiology","management," "surgery," and "therapy" as subheadings. Results Progressive collapse, kyphosis, and neurological deficiency are hallmarks of the disease because of its destructive effect on the intervertebral disc and adjacent vertebral bodies. The condition may be identified using laboratory testing and distinctive imaging features, but the gold standard for diagnosis is tissue diagnosis using cultures, histology, and polymerase chain reaction. Uncomplicated spinal TB is today a medical condition that can be adequately treated by multidrug ambulatory chemotherapy. Surgery is reserved for individuals who have instability, neurological impairment, and deformity correction. Debridement, deformity correction, and stable fusion are the cornerstones of surgical treatment. Conclusions Clinical results for the treatment of spinal TB are generally satisfactory when the disease is identified and treated early. However, the major health issue and the biggest obstacle in achieving the goals of the "End TB strategy" is the recent rise in the emergence of drug resistance. Hence strict vigilance and patient perseverance in the completion of the treatment is the main need of the hour.
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Affiliation(s)
- Rajasekaran Shanmuganathan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
| | - Karthik Ramachandran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
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Sanz Pablos J, Cabezas Lopez E, Miró Matos M, López Carrasco I, Montero Pastor N, Moratalla Bartolome E. Mesh excision secondary to spondylodiscitis after colposacropexy graft rejection: a step by step video. Tech Coloproctol 2023; 27:1401-1403. [PMID: 37815639 DOI: 10.1007/s10151-023-02867-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Spondylodiscitis secondary to colposacropexy is an extremely rare entity. Infection and mesh rejection are the main causes. Removal of the mesh is essential for patient's recovery and it can be a very challenging surgical procedure. CASE A 72-year-old woman presented with severe low back pain in the context of a recent colposacropexy. Magnetic resonance imaging was performed and spondylodiscitis secondary to prolapse correction surgery with mesh was suspected. In order to ensure an adequate recovery, removal of the mesh was required. CONCLUSIONS Spondylodiscitis secondary to colposacropexy should be suspected when the patient starts with moderate lumbar pain and is not correctly controlled with first-level analgesia. Infection or mesh rejection should be considered. Mesh rejection should be suspected when the patient does not improve after antibiotics. Complete removal of the mesh is needed in order to ensure the patient's recovery.
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Affiliation(s)
- J Sanz Pablos
- Division of female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Hospitales Madrid (HM), Boadilla del Monte, Madrid, Spain.
| | - E Cabezas Lopez
- Division of female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Hospitales Madrid (HM), Boadilla del Monte, Madrid, Spain
- Department of Gynecology, Division of Endoscopic Gynecology, Hospital Ramón y Cajal, Madrid, Spain
| | - M Miró Matos
- Division of female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Hospitales Madrid (HM), Boadilla del Monte, Madrid, Spain
| | - I López Carrasco
- Division of female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Hospitales Madrid (HM), Boadilla del Monte, Madrid, Spain
| | - N Montero Pastor
- Division of female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Hospitales Madrid (HM), Boadilla del Monte, Madrid, Spain
| | - E Moratalla Bartolome
- Division of female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Hospitales Madrid (HM), Boadilla del Monte, Madrid, Spain
- Department of Gynecology, Division of Endoscopic Gynecology, Hospital Ramón y Cajal, Madrid, Spain
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21
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Garg B, Mehta N, Mukherjee RN, Aryal A, Kandasamy D, Sharma R. Unmasking the great imitators-noninfectious conditions masquerading as spinal tuberculosis in a developing country: A single-center case series analysis. N Am Spine Soc J 2023; 16:100245. [PMID: 37664824 PMCID: PMC10472297 DOI: 10.1016/j.xnsj.2023.100245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/06/2023] [Accepted: 07/23/2023] [Indexed: 09/05/2023]
Abstract
Background The diagnosis of spinal tuberculosis often relies on clinical, radiological, and laboratory findings, particularly in resource-constrained settings. However, numerous noninfectious conditions exhibit similar clinical and radiological features to spinal tuberculosis, leading to potential misdiagnosis in the absence of microbiological or histopathological confirmation. This study aims to present a case series from a developing country, highlighting noninfectious conditions that mimic spinal tuberculosis. Methods A retrospective analysis was conducted on hospital records and imaging of patients diagnosed with spinal tuberculosis, lacking microbiological or histopathological evidence, and unresponsive to empirical antitubercular treatment. Patients displaying noninfectious conditions resembling spinal tuberculosis upon further investigation were included. Clinical and radiological findings of these patients were thoroughly analyzed. Results Among a total of 23 patients observed over a 6-year period (2015-2020), various noninfectious conditions were identified as mimickers of spinal tuberculosis. These conditions included vertebral body haemangioma, ankylosing spondylitis (with or without Andersson lesion), rheumatoid pannus, osteoid osteoma, cystic hygroma, multiple myeloma, vertebral metastasis, malignant small round-cell tumor, pancreatic pseudocyst, esophageal duplication cyst, Modic changes in degenerative disc disease, Paget's disease, and psoas hematoma. Conclusion Noninfectious spinal conditions can masquerade as spinal tuberculosis, underscoring the importance of obtaining a definitive tissue diagnosis before initiating antitubercular treatment. Particular attention should be given to features such as central lesions and the absence of soft tissue involvement in suspected cases of spinal tuberculosis, warranting a careful reconsideration of the diagnosis.
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Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Nishank Mehta
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rudra Narayan Mukherjee
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Aayush Aryal
- Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Devasenathipathy Kandasamy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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22
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Chevalerias M, Coiffier G, Darrieutort-Laffite C, Godot S, Ottaviani S, Henry J, Brochard J, Cormier G, Couderc M, Hoppe E, Mulleman D, Khatchatourian L, Le Thuaut A, Bart G, Le Goff B. Association between radiographic and functional outcome in vertebral osteomyelitis SPONDIMMO, a 6-month prospective multicenter cohort. Joint Bone Spine 2023; 90:105600. [PMID: 37330001 DOI: 10.1016/j.jbspin.2023.105600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES This study aimed to describe radiographic and functional evolution over 6 months in a large cohort of VO patients. METHODS We prospectively recruited patients with VO from 2016 to 2019 in 11 French centers. X-rays were performed at baseline, 3 months, and 6 months to assess progression using structural and static criteria. Functional impairment was evaluated using the Oswestry Disability Index (ODI) at 3 months and 6 months. RESULTS Two hundred and twenty-two patients were included. Mean age was 67.8±14 years, mostly men (67.6%). After 3 months, there was a significant increase in vertebral fusion (16.4% vs 52.7%), destruction of vertebral bodies (10.1% vs 22.8%), and of all the static features (frontal angulation (15.2% vs 24.4%), segmental (34.6% vs 56%) and regional (24.5% vs 41%) kyphosis). From 3 to 6 months, among the different X-ray abnormalities, only the complete fusion progressed significantly (16.6% vs 27.2%). Median ODI showed significant improvement from 3 to 6 months (24, IQR [11.5-38] vs 16, IQR [6-34]). At 6 months, 14.1% of the patients had a severe disability, 2% a major disability. The persistence of vertebral destruction at 6 months was associated with a higher ODI (16, IQR [7.5-30.5] vs 27, IQR [11.5-44.5]). No differences in radiological progression were observed with immobilization using a rigid brace. CONCLUSION Our study demonstrates structural and static radiographic progression after 3 months. Only the complete fusion progressed over the long-term. Functional impairment was associated with persistence of vertebral destruction.
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Affiliation(s)
| | | | | | - Sophie Godot
- Department of Rheumatology, AP-HP DCSS, Paris, France
| | | | - Julien Henry
- Department of Rheumatology, AP-HP Bicêtre, Paris, France
| | - Julia Brochard
- Department of Infectious Diseases, CH de Saint-Nazaire, Saint-Nazaire, France
| | - Grégoire Cormier
- Department of Rheumatology, CHD de Vendée, La Roche-sur-Yon, France
| | - Marion Couderc
- Department of Rheumatology, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Hoppe
- Department of Rheumatology, CHU d'Angers, Angers, France
| | | | - Lydie Khatchatourian
- Department of Internal Medicine and Infectious Disease, CH de Cornouaille, Quimper, France
| | - Aurélie Le Thuaut
- Direction of Research, Methodology and Biostatistics Platform, CHU de Nantes, Nantes, France
| | - Géraldine Bart
- Department of Rheumatology and Internal Medicine, Percy Military Training Hospital, Paris, France
| | - Benoit Le Goff
- Department of Rheumatology, CHU de Nantes, Nantes, France
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Campbell DH, Dowling TJ, Hah R, Alluri RK, Wang JC. Surgical strategies for spinal infections: A narrative review. N Am Spine Soc J 2023; 16:100293. [PMID: 38162170 PMCID: PMC10757275 DOI: 10.1016/j.xnsj.2023.100293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024]
Abstract
The successful operative management of spinal infections necessitates a thoughtful approach. Ideal treatment combines the universal goals of any spine operation, which are decompression of the neural elements and stabilization of instability, with source control and eradication of infection. Techniques to treat infection have evolved independently and alongside advances in implant technology and surgical techniques. This review will seek to outline current thinking on approaches to both primary and secondary spinal infections.
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Affiliation(s)
- David H. Campbell
- Department of Orthopedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, 1450 San Pablo St #5400, Los Angeles, CA 90033, United States
| | - Thomas J. Dowling
- Department of Orthopedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, 1450 San Pablo St #5400, Los Angeles, CA 90033, United States
| | - Raymond Hah
- Department of Orthopedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, 1450 San Pablo St #5400, Los Angeles, CA 90033, United States
| | - R. Kiran Alluri
- Department of Orthopedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, 1450 San Pablo St #5400, Los Angeles, CA 90033, United States
| | - Jeffrey C. Wang
- Department of Orthopedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, 1450 San Pablo St #5400, Los Angeles, CA 90033, United States
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Neuhoff J, Berkulian O, Kramer A, Thavarajasingam S, Wengert A, Schleicher P, Pingel A, Kandziora F. Single- and Multilevel Corpectomy and Vertebral body replacement for treatment of spinal infections. A retrospective single-center study of 100 cases. Brain Spine 2023; 4:102721. [PMID: 38510622 PMCID: PMC10951701 DOI: 10.1016/j.bas.2023.102721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/25/2023] [Indexed: 03/22/2024]
Abstract
Background The optimal operative approach for treating spinal infections remains a subject of debate. Corpectomy and Vertebral Body Replacement (VBR) have emerged as common modalities, yet data on their feasibility and complication profiles are limited. Methods This retrospective single-center study examined 100 consecutive cases (2015-2022) that underwent VBR for spinal infection treatment. A comparison between Single-level-VBR and Multi-level-VBR was performed, evaluating patient profiles, revision rates, and outcomes. Results Among 360 cases treated for spinal infections, 100 underwent VBR, located in all spinal regions. Average clinical and radiologic follow-up spanned 1.5 years. Single-level-VBR was performed in 60 cases, Two-level-VBR in 37, Three-level-VBR in 2, and Four-level-VBR in one case.Mean overall sagittal correction reached 10° (range 0-54°), varying by region. Revision surgery was required in 31 cases. Aseptic mechanical complications (8% pedicle screw loosening, 3% cage subsidence, 6% aseptic adjacent disc disease) were prominent reasons for revision. Longer posterior constructs (>4 levels) had significantly higher revision rates (p < 0.01). General complications (wound healing, hematoma) followed, along with infection relapse and adjacent disc infection (9%) and neurologic impairment (1%).Multilevel-VBR (≥2 levels) displayed no elevated cage subsidence rate compared to Single-level-VBR. Three deaths occurred (43-86 days post-op), all in the Multi-level-VBR group. Conclusion This study, reporting the largest number of VBR cases for spinal infection treatment, affirmed VBR's effectiveness in sagittal imbalance correction. The overall survival was high, while reinfection rates matched other surgical studies. Anterior procedures have minimal implant related risks, but extended dorsal instrumentation elevates revision surgery likelihood.
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Affiliation(s)
- J. Neuhoff
- BG Unfallklinik, Center for Spinal Surgery and Neurotraumatology, Frankfurt Am Main, Germany
| | - O. Berkulian
- BG Unfallklinik, Center for Spinal Surgery and Neurotraumatology, Frankfurt Am Main, Germany
| | - A. Kramer
- Department of Neurosurgery, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
| | - S. Thavarajasingam
- Department of Neurosurgery, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany
- Imperial Brain & Spine Initiative, Imperial College London, London, United Kingdom
| | - A. Wengert
- BG Unfallklinik, Center for Spinal Surgery and Neurotraumatology, Frankfurt Am Main, Germany
| | - P. Schleicher
- BG Unfallklinik, Center for Spinal Surgery and Neurotraumatology, Frankfurt Am Main, Germany
| | - A. Pingel
- BG Unfallklinik, Center for Spinal Surgery and Neurotraumatology, Frankfurt Am Main, Germany
| | - F. Kandziora
- BG Unfallklinik, Center for Spinal Surgery and Neurotraumatology, Frankfurt Am Main, Germany
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Kirk KF, Boel J, Nielsen HL. Vertebral osteomyelitis caused by Campylobacter jejuni in an immunocompetent patient. Gut Pathog 2023; 15:61. [PMID: 38037181 PMCID: PMC10688457 DOI: 10.1186/s13099-023-00589-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Campylobacter jejuni is the leading cause of human bacterial gastroenteritis worldwide. However, systemic infection with C. jejuni is uncommon, and osteomyelitis caused by C. jejuni is extremely rare. Cultivation from spinal bone biopsies has not previously been reported in the literature. CASE PRESENTATION A 79-year-old immunocompetent male was admitted to the emergency department at Aalborg University Hospital in Denmark with lower back pain, fever and diarrhoea. A FecalSwab obtained upon admission was PCR-positive for Campylobacter spp, while an aerobic blood culture bottle was positive for C. jejuni (Time to detection: 70.4 h). A MRI of columna totalis showed osteomyelitis at L1/L2 with an epidural abscess from L1 to L2 with compression of the dura sack. The patient underwent spinal surgery with spondylodesis and decompression of L1/L2. The surgery was uncomplicated and the discus material was also culture positive for C. jejuni. The patient was treated with meropenem for a total duration of four weeks, followed by four weeks of oral treatment with clindamycin in tapered dosage. The patient recovered quickly following surgery and targeted antibiotic treatment with decreasing lumbar pain and biochemical response and was fully recovered at follow-up three months after end of treatment. CONCLUSIONS While C. jejuni osteomyelitis is rare, it should still be suspected as a possible causative bacterial aetiology in patients with vertebral osteomyelitis, in particular when symptoms of diarrhoea is involved in the clinical presentation. Susceptibility testing is crucial due to emerging resistance, and targeted treatment strategies should rely upon such tests.
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Affiliation(s)
- Karina Frahm Kirk
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, 9000, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jeppe Boel
- Department for Bacteria, Parasites & Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Hans Linde Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
- Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18, Aalborg, 9000, Denmark.
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Lashkarbolouk N, Mazandarani M, Ilharreborde B, Nabian MH. Understanding the management of pediatric spondylodiscitis based on existing literature; a systematic review. BMC Pediatr 2023; 23:578. [PMID: 37980513 PMCID: PMC10656982 DOI: 10.1186/s12887-023-04395-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/28/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Spondylodiscitis (SD), a rare disease in children, poses diagnostic challenges due to non-specific presenting symptoms, scarcity in incidence, and difficulty expressing pain in non-verbal children. METHOD A comprehensive search was conducted on three databases, including PubMed/Medline, Web of Science, and Scopus until March 2023. The inclusion criteria were studies that investigated the clinical characteristics, treatment, and complications of children's spondylodiscitis. Full text of cross-sectional and cohort studies were added. The quality assessment of cohort studies was conducted using the Newcastle-Ottawa Quality Assessment Scale. The search, screening, and data extraction were performed by two researchers independently. RESULT Clinical manifestations of discitis in children are nonspecific, such as back pain, fever, reduced ability or inability to walk or sit, limping, and reduced range of movements. The mean delay in the time of diagnosis was 4.8 weeks. The most affected site of all the studies was the lumbar spine. 94% of studies reported increased inflammatory markers such as white blood cell count, C-reactive protein, and erythrocyte sedimentation rate. Less than 30% of patients had positive blood cultures and biopsy findings. The most common microbiological results (64%) were Staphylococcus Aureus and Kingella kingae. In radiographic evaluation, intervertebral disk narrowing, lumbar lordosis reduction, loss of disk height, and destruction of the vertebral body have been reported. In all studies, antibiotic therapy was initiated; in 52% immobilization was employed, and 29% of studies reported surgery was performed, and the follow-up period differed from 1.5 months to 156 months. 94% of studies reported complications such as vertebral body destruction, back pain, kyphosis, reduced range of movement, scoliosis, and neurological complications. CONCLUSION Spondylodiscitis is an uncommon, heterogeneous, multifactorial disease with resulting difficult and delayed diagnosis. Due to its morbidity, it is essential to investigate children with refusal to walk, gait disturbances, or back pain, particularly when associated with elevated inflammatory markers.
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Affiliation(s)
- Narges Lashkarbolouk
- Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahdi Mazandarani
- Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Golestan University of Medical Sciences, Gorgan, Iran
| | - Brice Ilharreborde
- Department of Pediatric Orthopedic Surgery, Robert Debré Hospital, AP-HP, Paris Diderot University, Paris, France
| | - Mohammad Hossein Nabian
- Department of Pediatric Orthopedic Surgery, Robert Debré Hospital, AP-HP, Paris Diderot University, Paris, France.
- Center for Orthopedic Trans- Disciplinary Applied Research (COTAR) Institute, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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27
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Kouadio AF, Bravo-Tsri AEB, Tanoh KE, Kouassi KPB, Yao BL, Kouakou BDM, Sanogo SC, Soro M, Konate I. Incidental finding of Pott's disease with abscesses of the psoas simulating an appendicular syndrome. Radiol Case Rep 2023; 18:4115-4118. [PMID: 37720919 PMCID: PMC10504458 DOI: 10.1016/j.radcr.2023.08.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Pott's disease or tuberculous spondylodiscitis is the disco-vertebral localization of Koch's bacillus. It causes progressive spinal lesions, with abscesses forming in the perivertebral soft tissues and epidural spaces. Medical imaging plays an indisputable role in the diagnosis and management of Pott's disease. Magnetic resonance imaging (MRI) enables early positive diagnosis and assessment of spinal damage. Computed tomography (CT) is currently the best interventional imaging method for the drainage of soft tissue abscesses and disco-vertebral biopsies for bacteriological and histological purposes. We report a case of accidental discovery of Pott's disease with abscesses of the psoas simulating an appendicular syndrome and describe its epidemiological, clinical, and radiological aspects through a review of the literature.
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Affiliation(s)
- Allou Florent Kouadio
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
| | - Akoli Eklou Baudoin Bravo-Tsri
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
| | - Kesse Emile Tanoh
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
| | - Kouamé Paul Bonfils Kouassi
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
| | - Brou Lambert Yao
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
| | | | - Sara Carole Sanogo
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
| | - Malick Soro
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
| | - Issa Konate
- Radiology Department of Bouaké University Hospital, 01 BP 1174, Bouaké, Ivory Coast
- Alassane Ouattara University of Bouaké, Bouaké, Ivory Coast
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Paul V, Kling K, Santoiemma PP. A rare anaerobic cause of vertebral osteomyelitis and psoas abscess: A case study. IDCases 2023; 34:e01900. [PMID: 37790216 PMCID: PMC10542417 DOI: 10.1016/j.idcr.2023.e01900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/19/2023] [Accepted: 09/27/2023] [Indexed: 10/05/2023] Open
Abstract
Parvimonas micra is an obligate anaerobe that forms part of the normal gastrointestinal flora. The advent of matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF) and 16s ribosomal RNA gene sequencing has led to increased detection of many rare anaerobic isolates, including Parvimonas micra. Typical risk factors for Parvimonas micra bacteremia include dental procedures or spinal instrumentation. Here, we report a case of Parvimonas micra spondylodiscitis and psoas abscess in a patient with no obvious antecedent risk factors and explore the challenges in isolation of the organism from tissue samples.
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Affiliation(s)
- Vivek Paul
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kendall Kling
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Phillip P. Santoiemma
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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29
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Janssen IK, Ryang YM, Wostrack M, Shiban E, Meyer B. Incidence and outcome of patients suffering from meningitis due to spondylodiscitis. Brain Spine 2023; 3:101781. [PMID: 38020984 PMCID: PMC10668068 DOI: 10.1016/j.bas.2023.101781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 05/23/2023] [Accepted: 07/10/2023] [Indexed: 12/01/2023]
Abstract
Introduction Meningitis is a rare but severe complication in patients with spondylodiscitis. Data about the incidence and clinical management are rare. Research question Aim of this study was to assess the incidence, clinical course and outcome of patients suffering from meningitis due to spondylodiscitis. Material and methods We performed a retrospective analysis of our prospective clinical database that included all patients suffering from spondylodiscitis between January 2010 and December 2019 were included. We assessed clinical findings, laboratory tests, treatment and outcome comparing patients with and without meningitis. Results Out of 469 patients suffering from spondylodiscitis, 30 patients (14 female) were diagnosed with an associated meningitis (6.4%). The mean CSF cell count was 3375.85 ± 8486.78/μl (range 32-41500/μl). The mean age at presentation was 70.87 ± 8.84 yrs (range 48-88 yrs). Mean C-reactive protein (CRP) and white blood cell (WBC) counts at time of admission were statistically higher in patients with associated meningitis (CRP: 19.81 ± 12.56 mg/dl vs. 11.63 ± 11.08 mg/dl, p = 0.001; WBC: 14.67 ± 7.76 g/l vs. 10.88 ± 05.11 g/l, p = 0.005. Mortality was also higher, as 13.3% and 7.1% of patients with and without concomitant meningitis died, respectively. Conclusion Bacterial meningitis due to spondylodiscitis is a rare but severe condition and is associated with higher morbidity and mortality rates. In patients with spondylodiscitis presenting with an altered state of consciousness an associated meningitis should be ruled out.
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Affiliation(s)
- Insa K. Janssen
- Department of Neurosurgery, Hôpitaux Universitaires Genève, Rue Gabrielle-Perret Gentil 4, 1205, Geneva, Switzerland
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Yu-Mi Ryang
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany
- Department of Neurosurgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | - Maria Wostrack
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Ehab Shiban
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany
- Department of Neurosurgery, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675, Munich, Germany
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Beucler N, Tine I, Dagain A. Single midline skin incision for long segment posterior percutaneous pedicle screw fixation. Neurochirurgie 2023; 69:101457. [PMID: 37236538 DOI: 10.1016/j.neuchi.2023.101457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Nathan Beucler
- Neurosurgery Department, Sainte-Anne Military Teaching Hospital, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France; École du Val-de-Grâce, French Military Health Service Academy, 1, place Alphonse-Laveran, 75230 Paris cedex 5, France.
| | - Ibrahima Tine
- Neurosurgery Department, Hôpital principal de Dakar, avenue Nelson-Mandela, BP 3006, Dakar, Senegal
| | - Arnaud Dagain
- Neurosurgery Department, Sainte-Anne Military Teaching Hospital, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France; Val-de-Grâce Military Academy, 1, place Alphonse-Laveran, 75230 Paris cedex 5, France
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Jeyaraman N, Jeyaraman M, Nallakumarasamy A, K S, Adhikari S, Rijal R, Asija A, Sedhai YR, Sah S, Mohanty A, Bonilla-Aldana DK, Sah R. A proposed management classification for spinal brucellosis from India. Travel Med Infect Dis 2023; 54:102614. [PMID: 37392982 DOI: 10.1016/j.tmaid.2023.102614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION The myriad presentation of osteoarticular brucellosis make the patient seek the help of general practitioners, orthopaedic and rheumatology specialists. Moreover, the lack of disease-specific symptomatology is the leading cause of the delay in diagnosing osteoarticular brucellosis. Given the increasing number of spinal brucellosis cases across the country, no literature is presented on the systematic management of spinal brucellosis. However, with our experience, we formulated a classification for managing spinal brucellosis. METHODS A single-centred prospective observational study was conducted with 25 confirmed cases of spinal brucellosis. Patients were analysed and graded clinically, serologically, and radiologically and were managed with antibiotics for 10-12 weeks, and if necessary, stabilisation and fusion were done based on the treatment classification devised. All patients were followed up to ensure disease clearance at serial follow-up with relevant investigations. RESULTS The mean age of the study participants was 52.16 ± 12.53 years. According to spondylodiscitis severity code (SSC) grading, four patients belong to grades 1, 12 to grade 2 and 9 to grade 3 at presentation. Erythrocyte sedimentation rate (p = 0.02), c-reactive protein (p < 0.001), Brucella agglutination titers (p < 0.001), and radiological outcomes improved statistically by six months. The treatment duration was individualised according to the patient's response to the treatment, with a mean time of 11.42 ± 2.66 weeks. The mean follow-up period was 14.42 ± 8 months. CONCLUSION High index of suspicion of patients from endemic regions, proper clinical assessment, serological evaluation, radiological assessment, appropriate decision-making (medical/surgical) in treatment, and regular follow-up were the key to successful comprehensive management of spinal brucellosis.
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Affiliation(s)
- Naveen Jeyaraman
- Department of Orthopaedics, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth, Chengalpet, 603108, Tamil Nadu, India
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600056, Tamil Nadu, India
| | - Arulkumar Nallakumarasamy
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India
| | - Shanmugapriya K
- Department of Respiratory Medicine, Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600095, Tamil Nadu, India
| | | | - Rishikesh Rijal
- Department of Gastroenterology, University of Louisville, Kentucky, USA
| | | | - Yub Raj Sedhai
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, USA
| | - Sanjit Sah
- Research Scientist, Global Consortium for Public Health and Research, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, 442001, India; SR Sanjeevani Hospital Kalyanpur-10, Siraha, Nepal
| | - Aroop Mohanty
- Department of Clinical Microbiology, All India Institute of Medical Sciences, Gorakhpur, 273008, Uttar Pradesh, India
| | | | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Kathmandu, 46000, Nepal; Department of Clinical Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, 411000, Maharashtra, India; Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, 411018, Maharashtra, India
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Maamari J, Grach SL, Passerini M, Kinzelman-Vesely EA, Nassr A, Carr C, Diehn FE, Tande AJ, Murad MH, Berbari EF. The use of MRI, PET/CT, and nuclear scintigraphy in the imaging of pyogenic native vertebral osteomyelitis: a systematic review and meta-analysis. Spine J 2023; 23:868-876. [PMID: 36754150 DOI: 10.1016/j.spinee.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/11/2023] [Accepted: 01/26/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND CONTEXT Native vertebral osteomyelitis (NVO) is a severe infection with an increasing incidence globally. Although there is no widely agreed upon reference standard for diagnosis of the disease, imaging plays a crucial role. Magnetic resonance imaging (MRI) is currently the imaging modality of choice. In recent years, advances in imaging have allowed for a larger role for alternative imaging techniques in the setting of NVO. PURPOSE Our aim was to evaluate the diagnostic accuracy of MRI, PET/CT, and nuclear imaging, namely 67Gallium and 99mTechnetium scintigraphy, in the diagnosis of pyogenic NVO. STUDY DESIGN/SETTING We conducted a systematic review of five medical databases and included all studies from 1970 to September 2021 that compared imaging techniques and provided sufficient data for diagnostic test accuracy meta-analysis. METHODS Abstract screening, full text review, and data extraction were done by a pair of independent reviewers. Nonnative and nonpyogenic patients were excluded. A bivariate random effect model was used for meta-analysis. RESULTS Twenty studies were included in the meta-analysis, encompassing a total of 1,123 imaging studies. The meta-analysis sensitivity and specificity of MRI were 90% and 72% respectively; those of PET/CT were 93% and 80%; those of 67Ga were 95% and 88%; those of 99mTc were 86% and 39%; and the sensitivity and specificity of combined Ga and Tc were 91% and 92% respectively in the setting of suspected NVO. CONCLUSIONS 67Ga has the highest sensitivity for NVO, and its specificity is augmented when combined with 99mTc. MRI and PET/CT are both highly sensitive modalities, although the specificity of PET/CT is slightly better. MRI remains an appropriate initial test depending on the availability of other modalities.
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Affiliation(s)
- Julian Maamari
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | - Stephanie L Grach
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | - Matteo Passerini
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | | | - Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
| | - Carrie Carr
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Felix E Diehn
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Aaron J Tande
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | - Mohammad H Murad
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | - Elie F Berbari
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Thavarajasingam SG, Subbiah Ponniah H, Philipps R, Neuhoff J, Kramer A, Demetriades AK, Shiban E, Ringel F, Davies B. Increasing incidence of spondylodiscitis in England: An analysis of the national health service (NHS) hospital episode statistics from 2012 to 2021. Brain Spine 2023; 3:101733. [PMID: 37383429 PMCID: PMC10293225 DOI: 10.1016/j.bas.2023.101733] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/14/2023] [Accepted: 03/29/2023] [Indexed: 06/30/2023]
Abstract
Background Spondylodiscitis is a potentially life-threatening infection of the intervertebral disk and adjacent vertebral bodies, with a mortality rate of 2-20%. Given the aging population, the increase in immunosuppression, and intravenous drug use in England, the incidence of spondylodiscitis is postulated to be increasing; however, the exact epidemiological trend in England remains unknown. Objective The Hospital Episode Statistics (HES) database contains details of all secondary care admissions across NHS hospitals in England. This study aimed to use HES data to characterise the annual activity and longitudinal change of spondylodiscitis in England. Methods The HES database was interrogated for all cases of spondylodiscitis between 2012 and 2019. Data for the length of stay, waiting time, age-stratified admissions, and 'Finished Consultant Episodes' (FCEs), which correspond to a patient's hospital care under a lead clinician, were analysed. Results In total, 43135 FCEs for spondylodiscitis were identified between 2012 and 2022, of which 97.1% were adults. Overall admissions for spondylodiscitis have risen from 3 per 100,000 population in 2012/13 to 4.4 per 100,000 population in 2020/21. Similarly, FCEs have increased from 5.8 to 10.3 per 100,000 population, in 2012-2013 and 2020/21 respectively. The highest increase in admissions from 2012 to 2021 was recorded for those aged 70-74 (117% increase) and aged 75-59 (133% increase), among those of working age for those aged 60-64 years (91% increase). Conclusion Population-adjusted admissions for spondylodiscitis in England have risen by 44% between 2012 and 2021. Healthcare policymakers and providers must acknowledge the increasing burden of spondylodiscitis and make spondylodiscitis a research priority.
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Affiliation(s)
- Santhosh G. Thavarajasingam
- Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Academic Neurosurgery, Addenbroke's Hospital, Cambridge University Hospital NHS Healthcare Trust, United Kingdom
- Imperial Brain & Spine Initiative, London, United Kingdom
- Spondylodiscitis Study Group, EANS Spine Section, European Association of Neurolosurgical Societies (EANS), Germany
| | - Hariharan Subbiah Ponniah
- Faculty of Medicine, Imperial College London, London, United Kingdom
- Imperial Brain & Spine Initiative, London, United Kingdom
| | | | - Jonathan Neuhoff
- Center for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik Frankfurt Am Main, Germany
- Spondylodiscitis Study Group, EANS Spine Section, European Association of Neurolosurgical Societies (EANS), Germany
| | - Andreas Kramer
- Department of Neurosurgery, Universitätsmedizin Mainz, Mainz, Germany
- Spondylodiscitis Study Group, EANS Spine Section, European Association of Neurolosurgical Societies (EANS), Germany
| | - Andreas K. Demetriades
- Edinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Division of Clinical Neurosciences, NHS Lothian, Edinburgh University Hospitals, Edinburgh, United Kingdom
- Spondylodiscitis Study Group, EANS Spine Section, European Association of Neurolosurgical Societies (EANS), Germany
| | - Ehab Shiban
- Department of Neurosurgery, Universitätsklinikum Augsburg, Augsburg, Germany
- Spondylodiscitis Study Group, EANS Spine Section, European Association of Neurolosurgical Societies (EANS), Germany
| | - Florian Ringel
- Department of Neurosurgery, Universitätsmedizin Mainz, Mainz, Germany
- Spondylodiscitis Study Group, EANS Spine Section, European Association of Neurolosurgical Societies (EANS), Germany
| | - Benjamin Davies
- Department of Academic Neurosurgery, Addenbroke's Hospital, Cambridge University Hospital NHS Healthcare Trust, United Kingdom
- Spondylodiscitis Study Group, EANS Spine Section, European Association of Neurolosurgical Societies (EANS), Germany
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Banz M, Memisevic N, Diab M, Malouhi A, Hagel S. [Recurrent Serratia marcescens bacteremia: seek and you shall find]. Inn Med (Heidelb) 2023:10.1007/s00108-023-01508-y. [PMID: 37138097 DOI: 10.1007/s00108-023-01508-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 05/05/2023]
Abstract
A 79-year-old patient was hospitalized due to recurrent Serratia marcescens bacteremia. An implantable cardioverter-defibrillator (ICD) electrode infection with septic pulmonary emboli and vertebral osteomyelitis were diagnosed. In addition to antibiotic therapy, the ICD system was completely extracted. In patients with cardiac implantable electronic devices (CIED) and bacteremia that cannot be adequately explained or recurs, regardless of the pathogen involved, a CIED-associated infection always needs to be ruled out.
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Affiliation(s)
- Micha Banz
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - Nedim Memisevic
- Klinik für Innere Medizin I, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Deutschland
| | - Mahmoud Diab
- Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Deutschland
| | - Amer Malouhi
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Deutschland
| | - Stefan Hagel
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland
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Kim J, Oh SH, Kim SW, Kim TH. The epidemiology of concurrent infection in patients with pyogenic spine infection and its association with early mortality: A nationwide cohort study based on 10,695 patients. J Infect Public Health 2023; 16:981-988. [PMID: 37148755 DOI: 10.1016/j.jiph.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Generally, a sufficient duration of relevant antibiotics based on an appropriate culture combined with proper surgical treatment guarantees a favorable clinical outcome in patients with pyogenic spine infections. However, a patient's condition often deteriorates as concurrent infections occur in other organs, leading to mortality. Therefore, this study aimed to investigate the epidemiology of concurrent infections in patients with a pyogenic spine infection and estimate the rates and risks of early mortality. METHODS Patients with a pyogenic spine infection were identified using a national claims database that includes the entire population. The epidemiology of the six types of concurrent infections was investigated, and the corresponding early mortality rates and risks were estimated. The results were validated internally by bootstrapping and externally by defining two additional cohorts for sensitivity analysis. RESULTS Among 10,695 patients with a pyogenic spine infection, the prevalence of the six types of concurrent infections was 11.3 % for urinary tract infections, 9.4 % for intra-abdominal infections, 8.5 % for pneumonia, 4.6 % for septic arthritis or osteomyelitis of the extremities, 0.7 % for central nervous system infections, and 0.5 % for cardiac infections. Patients with a concurrent infection had approximately 4-fold greater mortality than those without (3.3 % vs. 0.8 %). The early mortality rates were particularly higher in patients with multiple or specific types of concurrent infections, including central nervous system infections, cardiac infections, and pneumonia. In addition, the mortality trends differed significantly according to the number and type of concurrent infections. CONCLUSIONS These data on six types of concurrent infection among patients with pyogenic spinal infection can be used as a source of reference by clinicians.
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Affiliation(s)
- Jihye Kim
- Division of Infection, Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, the Republic of Korea
| | - Seung Ho Oh
- Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, the Republic of Korea
| | - Seok Woo Kim
- Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, the Republic of Korea
| | - Tae-Hwan Kim
- Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, the Republic of Korea.
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Afshari FT, Gee O, Lo WB. Spondylodiscitis following ingestion of button battery in an infant-a case-based update. Childs Nerv Syst 2023:10.1007/s00381-023-05949-6. [PMID: 37055484 DOI: 10.1007/s00381-023-05949-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/05/2023] [Indexed: 04/15/2023]
Abstract
Button battery ingestion in infants is an increasingly common surgical emergency which can lead to oesophageal perforation, mediastinitis, trachea-oesophageal fistulation, airway compromise and death. One exceedingly rare complication of battery ingestion is discitis and osteomyelitis in the cervical and upper thoracic spine. Diagnosis is normally delayed due to the non-specific presentation, delayed imaging findings and the initial clinical focus on dealing with the immediate, and potentially life-threatening, complications. We describe a case of a 1-year-old girl who presented with haematemesis and an oesophageal injury, secondary to button battery ingestion. Sagittal reconstruction of the CT chest demonstrated a suspicious area of vertebral erosion in the cervicothoracic spine which prompted a further evaluation with MRI demonstrating spondylodiscitis of C7-T2 with vertebral erosion and collapse. The child was successfully treated with long course of antibiotics. We wish to highlight the importance of clinical and radiological spinal assessment in children with button battery ingestion to avoid delayed diagnosis and complications of spinal osteomyelitis.
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Affiliation(s)
- Fardad T Afshari
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Oliver Gee
- Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - William B Lo
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
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Lacasse M, Derolez S, Bonnet E, Amelot A, Bouyer B, Carlier R, Coiffier G, Cottier JP, Dinh A, Maldonado I, Paycha F, Ziza JM, Bemer P, Bernard L. 2022 SPILF - Clinical Practice guidelines for the diagnosis and treatment of disco-vertebral infection in adults. Infect Dis Now 2023; 53:104647. [PMID: 36690329 DOI: 10.1016/j.idnow.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/12/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
These guidelines are an update of those made in 2007 at the request of the French Society of Infectious Diseases (SPILF, Société de Pathologie Infectieuse de Langue Française). They are intended for use by all healthcare professionals caring for patients with disco-vertebral infection (DVI) on spine, whether native or instrumented. They include evidence and opinion-based recommendations for the diagnosis and management of patients with DVI. ESR, PCT and scintigraphy, antibiotic therapy without microorganism identification (except for emergency situations), therapy longer than 6 weeks if the DVI is not complicated, contraindication for spinal osteosynthesis in a septic context, and prolonged dorsal decubitus are no longer to be done in DVI management. MRI study must include exploration of the entire spine with at least 2 orthogonal planes for the affected level(s). Several disco-vertebral samples must be performed if blood cultures are negative. Short, adapted treatment and directly oral antibiotherapy or early switch from intravenous to oral antibiotherapy are recommended. Consultation of a spine specialist should be requested to evaluate spinal stability. Early lifting of patients is recommended.
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Affiliation(s)
- M Lacasse
- Medecine Interne et Maladies Infectieuses, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - S Derolez
- Rhumatologie, 125 rue de Stalingrad, CHU Avicenne, 93000 Bobigny, France
| | - E Bonnet
- Maladies Infectieuses, Pl. Dr Baylac, CHU Purpan, 31000 Toulouse, France.
| | - A Amelot
- Neurochirurgie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - B Bouyer
- Chirurgie orthopédique et traumatologique, CHU de Bordeaux, Place Amélie Raba-léon, 33076 Bordeaux, France
| | - R Carlier
- Imagerie, Hôpital Raymond Poincaré, 104 Bd R Poincaré, 92380 Garches, France
| | - G Coiffier
- Rhumatologie, GH Rance-Emeraude, Hôpital de Dinan, 22100 Dinan, France
| | - J P Cottier
- Radiologie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - A Dinh
- Maladies Infecteiuses, CHU Raymond Poicaré, 92380 Garches, France
| | - I Maldonado
- Radiologie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - F Paycha
- Médecine Nucléaire, Hôpital Lariboisière, 2 rue Ambroise Paré 75010 Paris, France
| | - J M Ziza
- Rhumatologie et Médecine Interne. GH Diaconesses Croix Saint Simon, 75020 Paris, France
| | - P Bemer
- Microbiologie, CHU de Nantes, 1 Place A. Ricordeau, Nantes 44000 Cedex 1, France
| | - L Bernard
- Medecine Interne et Maladies Infectieuses, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
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Mazarakis NK, Baren J, Loughenbury PR, Koutsarnakis C, Gupta H, Fawcett RW. Site matters: Image-guided percutaneous sampling of intervertebral disc results in increased positive diagnostic yield in spondylodiscitis. Br J Neurosurg 2023; 37:177-181. [PMID: 34904496 DOI: 10.1080/02688697.2021.2013438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Spondylodiscitis is a common referral to spinal on call services. Identification of the causative organism is vital in order to dictate the appropriate antibiotic treatment. In this context, the surgical and interventional radiology team is often asked to perform a diagnostic biopsy. The aim of the present study was to assess whether the sampling location affects the diagnostic yield. Our results suggest that the overall positive diagnostic yield was 35%. When disc material was included in the sample the diagnostic yield significantly improved to 47%. Bone sampling alone had a positive yield of 15%. Age, pre-biopsy CRP, pre-biopsy use of antibiotics did not seem to affect the likelihood of obtaining a positive yield. These results suggests that when performing image guided biopsies for suspected cases of spondylodiscitis the inclusion of disc material is important.
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Affiliation(s)
- Nektarios K Mazarakis
- Department of Spinal Surgery, Division of Neurosciences, Leeds General Infirmary, Leeds, UK
| | - James Baren
- Department of Interventional Radiology, Leeds General Infirmary, Leeds, UK
| | - Peter R Loughenbury
- Department of Spinal Surgery, Division of Neurosciences, Leeds General Infirmary, Leeds, UK
| | | | - Harun Gupta
- Department of Interventional Radiology, Leeds General Infirmary, Leeds, UK
| | - Richard W Fawcett
- Department of Interventional Radiology, Leeds General Infirmary, Leeds, UK
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Lawson McLean A, Senft C, Schwarz F. Management of lumbar pyogenic spondylodiscitis in Germany: a cross-sectional analysis of spine specialists. World Neurosurg 2023; 173:e663-e668. [PMID: 36894008 DOI: 10.1016/j.wneu.2023.02.128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 02/26/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE The incidence of pyogenic spondylodiscitis (PS) is increasing, and the disease is associated with considerable morbidity, mortality, long-term healthcare utilisation and societal costs. Disease-specific treatment guidelines are lacking and there is little consensus regarding optimal conservative and surgical management. This cross-sectional survey of German specialist spinal surgeons sought to determine practice patterns and degree of consensus regarding the management of lumbar PS (LPS). METHODS An electronic survey covering provider information, diagnostic approaches, treatment algorithms and follow-up care of patients with lumbar PS was distributed to members of the German Spine Society. RESULTS 79 survey responses were included in the analysis. MRI is the diagnostic imaging modality of choice for 87% of respondents. 100% routinely measure C-reactive protein in suspected LPS and 70% routinely take blood cultures before therapy initiation. 41% believe that surgical biopsy to obtain microbiological diagnosis should be carried out in all cases of suspected LPS, whereas 23% believe that surgical biopsy should only be carried out when empirical antibiotic therapy proves ineffective. 38% believe an intraspinal empyema should always be surgically evacuated, regardless of spinal cord compression. The median intravenous antibiotic duration is two weeks. The median total duration of the antibiotic therapy (intravenous and oral) is eight weeks. MRI is the preferred imaging modality for follow-up of both conservatively and operatively treated LPS. CONCLUSION There exists considerable variation of care in the diagnosis, management and follow-up of LPS among German spine specialists with little agreement on key aspects of care. Further research is required to understand this variation in clinical practice and to enhance the evidence base in LPS.
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Affiliation(s)
- Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany.
| | - Christian Senft
- Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany
| | - Falko Schwarz
- Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany
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Dholoo F, Sriramanarayanan A, Prasad SPK, Livingstone J, Lewis N, Prasad V, Unnithan A. Spondylodiscitis-a cohort analysis of its identification and management. Int Orthop 2023; 47:813-818. [PMID: 36539530 DOI: 10.1007/s00264-022-05662-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Discitis represents infection of the intervertebral disc and osteomyelitis of the adjacent end plates. Classically, patients present with fever and back pain. Varied presentations and lack of adherence to guidelines lead to great variation in its identification and management. The primary objective of this study was to conduct a cohort analysis, assessing the identification and management of discitis, in a busy secondary orthopaedic centre. METHODS A retrospective study was conducted, of cases diagnosed and treated for discitis, in a secondary orthopaedic department, within the UK from January 2017 to October 2019. During this time period, all patients who underwent magnetic resonance imaging (MRI) spine were identified. Patients with MRI-proven discitis were then added into the study. RESULTS A total of 152 MRIs showed radiographic features of discitis. Of these, only 38 had a clear clinical correlation. Back pain was the most common presenting complaint followed by fever. The commonest site of involvement was vertebral levels L5 and S1. All patients had baseline bloods, and most, but not all, had blood cultures taken. Staphylococcus aureus was the most frequently isolated, causative organism. The mainstay of treatment was intravenous flucloxacillin, with most patients requiring a minimum of six weeks. CONCLUSION Our study has helped define the population of patients presenting with discitis, in a busy secondary orthopedic center. Analyzing over two years of data has provided us with valuable insight into the most appropriate diagnostics and management for discitis.
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Affiliation(s)
- Farzan Dholoo
- Ashford and St. Peter's Hospitals NHS Foundation Trust, St. Peter's Hospital, Guildford Road, Lyne, KT16 0PZ, Chertsey, UK
| | - Anjali Sriramanarayanan
- Ashford and St. Peter's Hospitals NHS Foundation Trust, St. Peter's Hospital, Guildford Road, Lyne, KT16 0PZ, Chertsey, UK
| | - Savi Prabha Krishna Prasad
- Ashford and St. Peter's Hospitals NHS Foundation Trust, St. Peter's Hospital, Guildford Road, Lyne, KT16 0PZ, Chertsey, UK
| | - James Livingstone
- Ashford and St. Peter's Hospitals NHS Foundation Trust, St. Peter's Hospital, Guildford Road, Lyne, KT16 0PZ, Chertsey, UK.
| | - Nicki Lewis
- Ashford and St. Peter's Hospitals NHS Foundation Trust, St. Peter's Hospital, Guildford Road, Lyne, KT16 0PZ, Chertsey, UK
| | - Vishal Prasad
- Ashford and St. Peter's Hospitals NHS Foundation Trust, St. Peter's Hospital, Guildford Road, Lyne, KT16 0PZ, Chertsey, UK
| | - Ashwin Unnithan
- Ashford and St. Peter's Hospitals NHS Foundation Trust, St. Peter's Hospital, Guildford Road, Lyne, KT16 0PZ, Chertsey, UK
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Zhong D, Ke Z, Wang L, Liu Y, Lin L, Zeng W, Zhou W, Wang Y. Comparative Clinical Efficacy and Safety of Sacral-2-Alar Iliac Screw Versus Iliac Screw in the Lumbosacral Reconstruction of Spondylodiscitis. World Neurosurg 2023; 171:e237-e244. [PMID: 36496146 DOI: 10.1016/j.wneu.2022.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study aimed to evaluate the clinical efficacy and safety of S2-alar-iliac (S2AI) and iliac screw (IS) techniques in treating lumbosacral spondylodiscitis. METHODS Between January 2020 and January 2022, 28 patients suffering from lumbosacral spondylodiscitis underwent lumbosacral fixation and were divided into the IS group (14 patients) and the S2AI group (14 patients). Surgical details, demographic characteristics, preoperative and postoperative Oswestry Disability Index, visual analog scale, and complications were analyzed. RESULTS Twenty-eight patients were included in this study, including 14 patients treated with IS and 14 patients treated with S2AI. The 2 groups were similar in sex, age, follow-up period, total drainage volume, hospitalization stay, and fusion time. (P > 0.05) The estimated blood loss and surgical time of S2AI during surgery were significantly lower than those of IS. (P < 0.05) The visual analog scale and Oswestry Disability Index scores significantly improved in both groups from preoperative to the last follow-up. Sacroiliac joint pain was found in both groups in the follow-up period, but the incidence was not significantly different (P = 0.663). Compared with the IS approach, the incidence of symptomatic screw prominence was lower in the S2AI group, but the difference was not significant. (P = 0.088). CONCLUSIONS S2AI, as well as IS techniques, can achieve promising results for reconstructing lumbosacral stability in spondylodiscitis. In addition, the S2AI technique can also reduce surgical trauma and operation time.
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Affiliation(s)
- Dian Zhong
- Department of Orthopedic Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - ZhenYong Ke
- Department of Orthopedic Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - LiYuan Wang
- Department of Orthopedic Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Liu
- Department of Orthopedic Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lu Lin
- Department of Orthopedic Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Zeng
- Department of Orthopedic Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - WenYi Zhou
- Department of Orthopedic Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Wang
- Department of Orthopedic Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Both A, Christner M, Berinson B, Dreimann M, Viezens L, Lütgehetmann M, Aepfelbacher M, Rohde H, Stangenberg M. The added value of a commercial 16S/18S-PCR assay (UMD-SelectNA, Molzym) for microbiological diagnosis of spondylodiscitis: an observational study. Diagn Microbiol Infect Dis 2023; 106:115926. [PMID: 36963329 DOI: 10.1016/j.diagmicrobio.2023.115926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/14/2023] [Accepted: 02/19/2023] [Indexed: 03/26/2023]
Abstract
In spondylodiscitis, pathogen identification is important to guide therapy strategies. Here the use of an rDNA PCR assay (Molzym UMDSelectNA) for pathogen detection in spondylodiscitis was evaluated in 182 specimens from 124 spondylodiscitis patients. In 81% of specimens rDNA PCR and conventional culture produced concordant results. Compared to conventional culture, sensitivity and specificity of rDNA PCR were 75% and 83.9%, respectively. The rDNA PCR performed better than conventional culture in identification of Streptococcus spp.. However, overall sensitivity was suboptimal, e.g., in cases with low bacterial burden, and only 5 of 124 patients (4%) received a microbiological diagnosis by employing rDNA PCR. Thus, the added value of routine use of rDNA PCR on spondylodiscitis specimens is limited. Targeted use of the assay in culture-negative cases may be efficient and moderately increase diagnostic yield. The need for susceptibility information implies that 16S rDNA PCR may only be used as an add-on tool to culture.
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Affiliation(s)
- Anna Both
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Christner
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Berinson
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Dreimann
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Lennart Viezens
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Marc Lütgehetmann
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Aepfelbacher
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Rohde
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
| | - Martin Stangenberg
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
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Lestin-Bernstein F, Tietke M, Schmiedel S, Dreimann M, Heese O. Meningitis and spondylodiscitis due to Nocardia nova in an immunocompetent patient. BMC Infect Dis 2023; 23:112. [PMID: 36823551 PMCID: PMC9951400 DOI: 10.1186/s12879-023-08067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Disseminated nocardiosis is a very rare disease. By now only few cases of meningitis and spondylodiscitis have been reported. To our knowledge, this is the first case of meningitis caused by Nocardia nova. CASE PRESENTATION We report on a case of bacteraemia, meningitis and spondylodiscitis caused by N. nova in an immunocompetent patient. We describe the long, difficult path to diagnosis, which took two months, including all diagnostic pitfalls. After nocardiosis was diagnosed, intravenous antibiotic therapy with ceftriaxone, later switched to imipenem/cilastatin and amikacin, led to rapid clinical improvement. Intravenous therapy was followed by oral consolidation with co-trimoxazole for 9 months without any relapse within 4 years. CONCLUSIONS Establishing a diagnosis of nocardiosis is a precondition for successful antibiotic therapy. This requires close communication between clinicians and laboratory staff about the suspicion of nocardiosis, than leading to prolonged cultures and specific laboratory methods, e.g. identification by 16S rDNA PCR.
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Affiliation(s)
- F. Lestin-Bernstein
- grid.461732.5Clinical Hygiene and Infectiology, Helios Clinics of Schwerin - University Campus of Medical School Hamburg (MSH - University of Applied Sciences and Medical University), Wismarsche Str. 393-397, 19049 Schwerin, Germany
| | - M. Tietke
- grid.461732.5Radiology and Neuroradiology, Helios Clinics of Schwerin - University Campus of Medical School Hamburg (MSH - University of Applied Sciences and Medical University), Schwerin, Germany
| | - S. Schmiedel
- grid.13648.380000 0001 2180 3484Infectiology and Tropical Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M. Dreimann
- grid.13648.380000 0001 2180 3484Trauma Surgery and Orthopaedics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - O. Heese
- grid.461732.5Neurosurgery and Spinal Surgery, Helios Clinics of Schwerin - University Campus of Medical School Hamburg (MSH - University of Applied Sciences and Medical University), Schwerin, Germany
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Pfausler B, Rass V, Lindner A. [Infections of the spinal cord and adjacent structures]. Nervenarzt 2023; 94:287-295. [PMID: 36820856 PMCID: PMC9948794 DOI: 10.1007/s00115-023-01439-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 02/24/2023]
Abstract
Inflammation of the spinal cord and the adjacent structures can be caused by viruses, bacteria, fungi and parasites. Viruses predominantly infect the spinal cord and the nerve roots directly or trigger a secondary immune response, whereas bacteria, fungi and parasites tend to form abscesses, granulomas and cysts and can lead to a secondary compression of the spinal cord, similar to a destructive osteomyelitis. The etiological clarification of an acute or subacute spinal process is carried out based on the clinical presentation, the time course of the development of symptoms, the immune status, neuroimaging and microbial and/or molecular biological examinations of cerebrospinal fluid and serum. The tropism of individual pathogens to certain fiber structures and cellular clusters in the spinal cord in synopsis with the clinical presentation, neuroimaging and a history of exposure, can often quickly lead to a focused clarification and diagnosis. This article deals with important pathogens of spinal and paraspinal infections, the geographical distribution, the clinical and neuroimaging presentation with special consideration of the anatomical and topographical localization and recent epidemiological developments. Particular attention is paid to the outbreak of poliomyelitis due to circulating vaccine-derived poliovirus (cVDPV).
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Affiliation(s)
- Bettina Pfausler
- Universitätsklinik für Neurologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
| | - Verena Rass
- Universitätsklinik für Neurologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Anna Lindner
- Universitätsklinik für Neurologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
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Koike Y, Kai R, Abe R, Munechika J, Ohgiya Y. Outcomes of C-arm cone-beam CT-guided percutaneous procedures for thoracolumbar spondylodiscitis: a comparison between with and without intradiscal drainage. MINIM INVASIV THER 2023; 32:81-89. [PMID: 36780294 DOI: 10.1080/13645706.2023.2174806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
INTRODUCTION Percutaneous intradiscal drainage had little established evidence to date. We assessed the outcomes of C-arm cone-beam CT-guided (CBCT-guided) procedures for spondylodiscitis and compare procedures with and without intradiscal drainage. MATERIAL AND METHODS A retrospective review was conducted on patients who underwent CBCT-guided procedures for spondylodiscitis with fluid collection in the intradiscal space between January 2010 and September 2021. Included patients were divided into two groups: with and without 'intradiscal drainage' (ID and non-ID, respectively). RESULTS A total of 87 patients with thoracolumbar discitis (mean age 73.4 ± 12.3 years, 35 females) were included. There was no significant difference in clinical outcomes between groups. Although insignificant, a subgroup analysis of patients with discitis and psoas abscess showed a higher infection control success rate (81% (17/21) vs 58% (7/12), p = .23) and faster median C-reactive protein improvement (CRP <3 mg/dL: 12 vs 42 days, p = .11, CRP <1 mg/dL: 27 vs 45 days, p = .097) of ID than of non-ID. CONCLUSIONS Findings did not clarify the role of intradiscal drainage when it was indicated in all cases of spondylodiscitis with fluid collection. Future studies with larger sample sizes of selected discitis cases are expected to demonstrate the superiority of intradiscal drainage.
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Affiliation(s)
- Yuya Koike
- Division of Radiology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan.,Department of Interventional Radiology, Saiseikai Yokohamashi Nanbu Hospital, Kanagawa, Japan
| | - Ryozo Kai
- Division of Radiology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Ryosuke Abe
- Division of Radiology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Jiro Munechika
- Division of Radiology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Yoshimitsu Ohgiya
- Division of Radiology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan
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Raymaekers V, Roosen G, Put E, Vanvolsem S, Achahbar SE, Meeuws S, Plazier M, Wissels M, Bamps S. Extreme Lateral Interbody Fusion as a Feasible Treatment for Thoracolumbar Spondylodiscitis: A Multicenter Belgian Case-Series. World Neurosurg 2023; 172:e299-e303. [PMID: 36623724 DOI: 10.1016/j.wneu.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Spondylodiscitis is, after tissue sampling, initially managed with intravenous antibiotics. In patients with treatment failure, surgical debridement and stabilization is considered. An anterior or posterior approach has already been reported as a successful surgical access, but is associated with a large exposure and a significant morbidity. METHODS We present a multicenter Belgian case-series on the use of a minimally invasive extreme lateral interbody fusion procedure with add-on percutaneous pedicle screw fixation for patients with a need for surgical debridement and tissue samples or intractable back pain due to spondylodiscitis. Patient characteristics, microbiology results, antibiotic treatment, pre- and postoperative Visual Analogue Pain Score (VAS) scores, time to bony consolidation, complications and duration of the hospital stay were collected. RESULTS Seven patients with one level spondylodiscitis were included. The mean age 64 years with a mean preoperative VAS score of 8.86 ( ± 0.90). Postoperative VAS score significantly decreased to 2.57 (-70.3%, P < 0.001). Mean antibiotic treatment duration was 8 weeks. Median duration of the hospital stay was 14 days. Patients were followed for 1 year. Complete bony consolidation was observed in 6 out of 7 patients after 1 year. One patient had a stable pseudarthrosis. CONCLUSIONS These results indicate that extreme lateral interbody fusion topped off with a percutaneous pedicle screw fixation might be a feasible, safe and valuable choice to surgically treat patients with spondylodiscitis with fast and important improvement in VAS. Further prospective research might strengthen the sparsely existing literature of minimally invasive surgery for spondylodiscitis to provide the best possible care.
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Affiliation(s)
- Vincent Raymaekers
- Department of Neurosurgery, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
| | - Gert Roosen
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Studie- & Opleidingcentrum Neurochirurgie Virga Jesse, Hasselt, Belgium
| | - Eric Put
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Studie- & Opleidingcentrum Neurochirurgie Virga Jesse, Hasselt, Belgium
| | - Steven Vanvolsem
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Studie- & Opleidingcentrum Neurochirurgie Virga Jesse, Hasselt, Belgium
| | - Salah-Eddine Achahbar
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Studie- & Opleidingcentrum Neurochirurgie Virga Jesse, Hasselt, Belgium
| | - Sacha Meeuws
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Studie- & Opleidingcentrum Neurochirurgie Virga Jesse, Hasselt, Belgium
| | - Mark Plazier
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium; Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Studie- & Opleidingcentrum Neurochirurgie Virga Jesse, Hasselt, Belgium
| | - Maarten Wissels
- Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Studie- & Opleidingcentrum Neurochirurgie Virga Jesse, Hasselt, Belgium
| | - Sven Bamps
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium; Department of Neurosurgery, Jessa Hospital, Hasselt, Belgium; Department of Neurosurgery, St. Trudo Hospital, Sint-Truiden, Belgium; Department of Neurosurgery, St. Franciscus Hospital, Heusden-Zolder, Belgium; Studie- & Opleidingcentrum Neurochirurgie Virga Jesse, Hasselt, Belgium.
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Kim WJ, Park C, Sarraf K. Management of vertebral osteomyelitis in adults. Br J Hosp Med (Lond) 2023; 84:1-5. [PMID: 36708343 DOI: 10.12968/hmed.2022.0362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Vertebral osteomyelitis is a condition that predominantly affects older men with chronic comorbidities, such as diabetes, renal and hepatic failure, or immunosuppression. Symptoms develop insidiously and a high index of suspicion is required to diagnose the condition; this is achieved through serological testing and imaging. The mainstay of treatment is long-term antibiotic therapy, lasting a minimum of 6 weeks; however, surgical debridement with stabilisation is required when conservative treatment is proving ineffective and infection progresses. It is critically important that sufficient treatment is provided for those experiencing vertebral osteomyelitis, as not doing so could lead to severe neurological compromise and death.
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Affiliation(s)
- Woo Jae Kim
- Department of Trauma and Orthopaedics, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Chang Park
- Department of Trauma and Orthopaedics, Northwest Thames Rotation, London, UK
| | - Khaled Sarraf
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
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Marruzzo D, Mancini F, Ricciuti V, Barbieri FR, Preziosi R, Pagano S, Ricciuti RA. Modified percutaneous biopsy of the spine: improvement of the technique. Eur Spine J 2023; 32:221-227. [PMID: 36477894 DOI: 10.1007/s00586-022-07384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 09/04/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Biopsy of the spine can be performed by open surgery or percutaneous needle sampling. The first has the highest diagnostic yield while the second is a less invasive procedure with lower rate of complications and shorter hospitalization time. We described a modified technique of percutaneous biopsy using semi-rigid grasping forceps that may offer the advantages of both, open and minimally invasive surgery. METHODS Thirty consecutive patients with spinal lesions requiring biopsy were admitted to Neurosurgical Unit of Belcolle Hospital (Viterbo, Italy) from January 2017 to September 2021. There was a suspicion of spondylodiscitis in 25 cases and of tumor in 5 cases. Percutanous trans-pedicular spine biopsy has been performed using this new semi-rigid grasping forceps. Combining the opening width, jaw length and full 360° rotation, the device allows a wide and precise sampling. RESULTS Sampling was sufficient in all cases (100%); tumors was observed in 5 cases (16.7%%) with a percentage of definitive histopathologic diagnosis of 100% (n = 5); among the remaining patients histological examination yielded a diagnosis of spinal infection in 25 cases (100%), and microbiologic culture provided an aetiologic diagnosis in 23 cases (92%). All procedures were well tolerated, and no postoperative complications were observed. Levels involved included: thoracic (T5-T9) in 8 cases, thoracolumbar junction (T10-L2) in 12 cases and lumbar (L3-L5) in 10 cases. CONCLUSIONS Percutaneous biopsy with the semi-rigid grasping forceps is a safe and effective procedure that can be used for diagnosis of both infectious and tumor lesions of the spine. It allows to obtain a larger specimen volume and to use a multidirectional trajectory for sampling, resulting in a minimally invasive technique with strong ability to yield etiologic diagnosis.
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Candura D, Perna A, Calori S, Tamburrelli FC, Proietti L, Meluzio MC, Velluto C, Smakaj A, Santagada DA. Vertebral Candidiasis, the State of the Art: A Systematic Literature Review. Acta Neurochir Suppl 2023; 135:231-240. [PMID: 38153475 DOI: 10.1007/978-3-031-36084-8_36] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE In recent years, Candida spondylodiscitis has represented an increasingly emerging disease in clinical practice. This condition requires long-term antibiotic therapy and sometimes surgical treatments. The main purpose of this study is to investigate the epidemiology, clinical and radiological aspects, treatment protocols, and outcomes of Candida-mediated vertebral osteomyelitis. METHODS A systematic review of the English literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.The research was conducted on Medline, Cochrane library, PubMed, and Scopus using as search terms "vertebral"; "spinal"; "infection"; "spondylodiscitis"; "discitis"; "osteomyelitis"; "Candida"; and "Candidosis." A case of vertebral candidiasis that was surgically managed was also reported. RESULTS In total, 88 articles were included in our systematic review. Including the reported case, our analysis covered 113 cases of vertebral candidiasis. Candida albicans was isolated in 64 cases (56.1%), Candida tropicalis in 21 (18.4%), Candida glabrata in 14 (12.3%), and Candida parapsilosis in five (4.4%). The mean duration of the follow-up was 395 days. Finally, 87 (82%) patients completely recovered, ten (9.4%) died, and nine (8.5%) reported sequelae. CONCLUSION This systematic review summarized the state of the art on vertebral candidiasis, describing data on its clinical features, diagnostic criteria and current limitations, and treatment alternatives and their outcomes.
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Affiliation(s)
- Dario Candura
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Andrea Perna
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Orthopedics and Traumatology, Fondazione Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Rome, Italy
| | - Sara Calori
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Geriatrics and Orthopedics, Sacred Heart Catholic University, Rome, Italy
| | - Luca Proietti
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Geriatrics and Orthopedics, Sacred Heart Catholic University, Rome, Italy
| | - Maria Concetta Meluzio
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Calogero Velluto
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Amarildo Smakaj
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Domenico Alessandro Santagada
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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Umana GE, Scalia G, Spitaleri A, Passanisi M, Crea A, Tomasi OS, Cicero S, Maugeri R, Iacopino DG, Visocchi M. Multilevel Corpectomy for Subaxial Cervical Spondylodiscitis: Literature Review and Role of Navigation, Intraoperative Imaging and Augmented Reality. Acta Neurochir Suppl 2023; 135:331-338. [PMID: 38153489 DOI: 10.1007/978-3-031-36084-8_50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
BACKGROUND Subaxial cervical spine spondylodiscitis represents a real challenge in spine surgery. In later stages multiple spinal metamers can the interested by the pathological infection and the alteration of the spinal stability leading to spinal deformity. There is scant literature on subaxial cervical spondylodiscitis management and especially on ≥three-level cervical corpectomies. The authors conducted a literature search on this specific topic and presented an emblematic case of a patient treated with circumferential cervical fixation and four-level cervicothoracic corpectomy. MATERIALS AND METHODS A comprehensive literature review was performed using the combined Medical Subject Headings (MeSH) terms (multilevel) AND (sub axial spine OR cervical spine) AND (spine osteomyelitis OR spinal osteomyelitis), to search in the PubMed and Scopus databases. Our case was also included in this literature review. From our literature search the authors selected 13 papers, eight were excluded because they did not match our inclusion criteria (the involvement of only one or two levels, or did not perform corpectomy, discectomy, or cervical spine localization). The authors also presented a 71-year-old patient, in poor general clinical status who underwent several cage repositioning, with a final four-level corpectomy (C5, C6, C7, and T1), expandable C5-T1 cage positioning and C4-T2 anterior plating performed merging augmented reality, neuronavigation and intraoperative imaging. RESULTS This systematic review included 28 patients treated with ≥ three-level corpectomy (11 patients with three-level corpectomy, 15 patients with four-level corpectomy, and 2 patients with six-level corpectomy), 6 women, 5 men, and 17 not reported specifically, with a mean age of 55.9 years (range: 44-72 years). The combined anterior and posterior approach was taken in all but one case, which was treated with the anterior approach only. In one case of six-level cervicothoracic corpectomy, sternotomy was necessary. All reported patients recovered after surgery, except one who died after nosocomial pneumonia. No major intraoperative complications were reported. Usual postoperative complications include wound hematoma, pneumonia, subsidence, epidural hematoma, dural leakage, dysphagia, soft tissue swelling. The mean follow-up time was 31.9 months (range: 8-110 months). CONCLUSION According to the literature search performed by the authors, multilevel corpectomies for cervical spinal osteomyelitis is a safe and effective complex surgical procedure, even in extended procedures involving up to six levels or those at the cervicothoracic junction. The use multimodal navigation merging intraoperative imaging acquisition, navigation, and augmented reality may provide useful information during implant positioning in complex and altered anatomy and for assessing the best final result.
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Affiliation(s)
- Giuseppe Emmanuele Umana
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
| | - Angelo Spitaleri
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | - Maurizio Passanisi
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | - Antonio Crea
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | - Ottavio S Tomasi
- Department of Neurosurgery, Christian-Doppler-Klinik, Paracelsus Private Medical University, Salzburg, Austria
| | - Salvatore Cicero
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | - Rosario Maugeri
- Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
| | - Domenico Gerardo Iacopino
- Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone", Palermo, Italy
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