1
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Li J, Chang Z. Case Report: A spinal infection with bilateral psoas abscesses was treated with NPWT to enhance the local infection by increasing the infiltration of neutrophil cells and draining the pus. Front Cell Infect Microbiol 2023; 13:1228376. [PMID: 37600941 PMCID: PMC10436603 DOI: 10.3389/fcimb.2023.1228376] [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] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
Treatment of spinal brucellosis with bilateral psoas abscess is a challenging clinical endeavor. We retrospectively evaluated a case of lumbar infection and bilateral psoas abscess, and was effectively managed through a unilateral extreme lateral approach with the aid of NPWT for bilateral drainage. We hypothesize that NPWT can influence the Piezo1 receptor of neutrophils and further influence the interaction between neutrophils and endothelial cells to promote the clearance of infected lesions, and this phenomenon is also observed in pathological slides. This proves that NPWT can rapidly enhance the recruitment of neutrophils in the infected area and improve the local immune response, and after a year of reassessment and tracking, Bilateral drainage using NPWT via a unilateral Extreme Lateral Approach could acquire satisfactory surgical outcomes, can be used as a treatment modality for lumbar infection with bilateral psoas abscesses.
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Affiliation(s)
| | - Zhengqi Chang
- Department of Orthopedics, 960th Hospital of PLA, Jinan, China
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2
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Panigrahi S, Acharya A, Otta S, Puppala S. Spinal fungal abscess mimicking as potts spine. Int J Mycobacteriol 2023; 12:364-366. [PMID: 37721246 DOI: 10.4103/ijmy.ijmy_115_23] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Spinal epidural abscess (SEA) is a rarest form of spinal infections and is characterized by the presence of pus in the space between the dura mater, and the osseoligamentous confines of the vertebral canal. This can cause spinal injury due to direct compression or local ischemia. The major etiology of SEA is bacterial and tuberculous in endemic regions. The incidence of fungal spinal abscess is relatively low and <5% of SEA is attributable to fungi. We, here, report a case of 77-year-old known patient of chronic renal disease on hemodialysis that presented with low-back pain for 15 days and was subsequently diagnosed with SEA by magnetic resonance imaging, and causative organism was identified as Candida by culture. The abscess was surgically drained after laminectomy. The patient improved with surgery and antifungal treatment.
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Affiliation(s)
- Souvagya Panigrahi
- Department of Neurosurgery, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Abhijit Acharya
- Department of Neurosurgery, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Sarita Otta
- Department of Microbiology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Sumirini Puppala
- Department of Neurology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
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3
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Pola E, Nasto LA, Cipolloni V, Colangelo D, Leone A, Schiavone Panni A. 10-Year Clinical, Functional, and X-ray Follow-Up Evaluation of a Novel Posterior Percutaneous Screw-Rod Instrumentation Technique for Single-Level Pyogenic Spondylodiscitis. Trop Med Infect Dis 2021; 6:tropicalmed6030159. [PMID: 34564543 PMCID: PMC8482233 DOI: 10.3390/tropicalmed6030159] [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: 08/01/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
Medical treatment with antibiotic therapy remains the mainstay of treatment for pyogenic spondylodiscitis (PS). Nevertheless, orthopaedic treatment is also very important in relieving pain, preventing neurological damage, and avoiding development of spinal deformities (e.g., scoliosis, kyphosis) due to spinal instability. Rigid thoracolumbosacral orthosis (TLSO) bracing is often needed in patients with PS, and average duration of treatment of 3 to 4 months. However, TLSO bracing can be poorly tolerated and limit ability of the patient to go back to a normal life. In 2004 our group developed an alternative surgical treatment to TLSO bracing by percutaneous posterior screw-rod bridge instrumentation of the infected level. This treatment allows early and free mobilization of the patients and is associated with faster recovery, lower pain scores and improved quality of life as previously reported. Herein, we report the clinical outcome of the first 3 patients who have completed the 10 years follow-up mark after the procedure. A case report is also described and details of the procedure are provided.
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Affiliation(s)
- Enrico Pola
- Department of Orthopaedics, A.O.U. “Vanvitelli” University Hospital, “Luigi Vanvitelli” University, Via del Sole 10, 80138 Naples, Italy; (V.C.); (D.C.); (A.S.P.)
- Correspondence:
| | - Luigi Aurelio Nasto
- Department of Paediatric Orthopaedics, IRCCS Istituto “G. Gaslini”, Via G. Gaslini 5, 16147 Genova, Italy;
| | - Valerio Cipolloni
- Department of Orthopaedics, A.O.U. “Vanvitelli” University Hospital, “Luigi Vanvitelli” University, Via del Sole 10, 80138 Naples, Italy; (V.C.); (D.C.); (A.S.P.)
| | - Debora Colangelo
- Department of Orthopaedics, A.O.U. “Vanvitelli” University Hospital, “Luigi Vanvitelli” University, Via del Sole 10, 80138 Naples, Italy; (V.C.); (D.C.); (A.S.P.)
| | - Antonio Leone
- Department of Medical Imaging, Radiotherapy and Haematology, Università Cattolica del Sacro Cuore di Roma, “A. Gemelli” University Hospital, l.go A. Gemelli 1, 00168 Roma, Italy;
| | - Alfredo Schiavone Panni
- Department of Orthopaedics, A.O.U. “Vanvitelli” University Hospital, “Luigi Vanvitelli” University, Via del Sole 10, 80138 Naples, Italy; (V.C.); (D.C.); (A.S.P.)
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4
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Hasan GA, Raheem HQ, Qutub A, Wais YB, Katran MH, Shetty GM. Management of Pyogenic Spondylodiscitis Following Nonspinal Surgeries: A Tertiary Care Center Experience. Int J Spine Surg 2021; 15:591-599. [PMID: 33985997 DOI: 10.14444/8080] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The literature is lacking on the incidence and management of pyogenic spondylodiscitis (PS) following routine elective surgical procedures. This study aimed to analyze the presentation and treatment outcome in patients with PS following nonspinal surgeries at a tertiary care center with a minimum follow-up of 12 months. METHODS The demographic, clinical-radiologic features, and treatment outcomes in 40 patients with a diagnosis of PS following nonspinal surgical procedures were retrospectively reviewed and analyzed. RESULTS The mean age at presentation was 36.4 ± 11.8 years, with 80% of patients being female. The common surgical procedures associated with PS were cesarean delivery (30%), gastric sleeve surgery (12.5%), and dilatation and curettage (12.5%). The tissue biopsy culture was positive in 82.5% of patients. A total of 26 patients (65%) were treated with conservative management and 14 patients (35%) were treated surgically. The mean pretreatment Core Outcome Measure Index score significantly decreased at 12 months (P < .0001) after treatment. The mean pretreatment erythrocyte sedimentation rate (P < .0001) and C-reactive protein (P < .0001) levels significantly decreased at 12 months after treatment. CONCLUSIONS With most patients with PS following nonspinal surgeries treated with conservative management, excellent clinical outcomes were achieved in all patients at 12 months after treatment. The diagnosis of PS should be considered in patients presenting with low back pain (LBP) with a recent history of undergoing a nonspinal surgical procedure. Patients who undergo surgical procedures are an important "at-risk" patient population, and early diagnosis and treatment can help achieve excellent clinical outcomes. Further studies are required to determine risk factors and possible perioperative precautions that can be taken to prevent PS in patients who undergo nonspine surgeries. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE Pyogenic spondylodiscitis should be suspected in patients presenting with LBP after a recent non-spinal surgical procedure. Early diagnosis and treatment can help achieve excellent clinical outcomes in these patients.
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Affiliation(s)
- Ghazwan A Hasan
- Department of Orthopaedic Surgery, Al-Kindi Teaching Hospital, Baghdad, Iraq
| | | | | | | | | | - Gautam M Shetty
- Orthopaedic & Knee Clinic, Mumbai, India.,AIMD Research, Mumbai, India
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5
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Nasto LA, Fantoni M, Cipolloni V, Piccone L, Pola E, Schiavone Panni A. A Detailed Analysis of Clinical Features and Outcomes of Patients with Pyogenic Spondylodiscitis Presenting without Axial Back Pain. Trop Med Infect Dis 2021; 6:54. [PMID: 33923885 DOI: 10.3390/tropicalmed6020054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/14/2021] [Accepted: 04/18/2021] [Indexed: 12/19/2022] Open
Abstract
Study design: Retrospective analysis of a single institution prospective, longitudinal database of spinal pyogenic infections. Diagnosis of pyogenic spondylodiscitis (PS) can be challenging. Although presenting symptoms are often non-specific, acute non-remitting axial back pain is the most striking feature. Nevertheless, several authors have reported on the uncommon occurrence of patients with PS without axial back pain. The aim of this study was to characterize presenting symptoms, causative agents, comorbidities, and treatment outcomes of patients presenting with painless pyogenic spondylodiscitis. A total of 214 patients diagnosed with PS were reviewed; patients were divided into two groups: patients presenting with no axial back pain (no pain group, n = 16), and patients presenting with axial back pain (control group, n = 198). Analyzed data comprised general demographics, presenting symptoms, comorbidities, spinal infection location, and amount of spinal involvement. While average age (62.4 vs. 65.0) and sex distribution was similar between the two groups, a significant diagnostic delay was noted in the control group (53 vs. 17 days, p < 0.001). Patients in the no pain group were more likely IV drug abusers or have had liver failure/cirrhosis. Anatomic distribution (i.e., cervical vs thoracolumbar) of the infection did not differ between the two groups, but a higher number of post-surgical infections was noted in the no pain group (37.5 vs. 15.6%, p = 0.026). E. coli and Pseudomonas spp. were more commonly seen in no pain group patients, and mortality was also higher in this group (12.5 vs. 6.0%, p = 0.004).
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Beydoun N, Tandon S, Krengel S, Johnson E, Palacio Bedoya F, Moore M, Refai D, Rouphael N. A Retrospective Chart Review on the Role of Suppressive Therapy in the Management of Spinal Infections Involving Hardware. Open Forum Infect Dis 2020; 7:ofaa253. [PMID: 32715019 PMCID: PMC7372706 DOI: 10.1093/ofid/ofaa253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/19/2020] [Indexed: 11/22/2022] Open
Abstract
Background One percent to 8% of patients undergoing spinal instrumentation surgeries develop infections. There is no consensus on the medical and surgical management of these infections. Methods We conducted a retrospective chart review based on International Classification of Diseases, Ninth Revision, and Common Procedural Terminology codes relevant to spinal infections with hardware within Emory Healthcare over a 10-year period. Extracted data included patient demographics, clinical presentation, laboratory and microbiologic results, and surgical and medical management including choice and duration of suppressive therapy. Multivariable logistic regression was used to assess the association of length of use of suppressive antibiotics with treatment success and to identify predictors of use of suppressive antibiotics. Results Of 869 records, 124 met inclusion criteria. Fifty patients (40.3%) had an infection that occurred after hardware placement, mostly within 3 months postsurgery, while the remainder had vertebral osteomyelitis that required hardware placement. After initial intravenous antibiotic treatment for ≥4 weeks, 72 patients (64.5%) were given suppressive antibiotics. The overall treatment success rate was 78.2%. In spinal infections involving hardware with gram-negative rods, patients were less likely to receive suppressive antibiotics, less likely to have hardware removed, and less likely to have treatment success compared with patients with infections with Staphylococcus species. Conclusions Management of spinal infections involving hardware should be tailored to the timing of onset of infection and causative organism. Further studies are needed to determine best management practices, particularly for gram-negative rod infections where the role of further suppressive antibiotics and hardware removal may be warranted.
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Affiliation(s)
- Nour Beydoun
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,The Hope Clinic, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sonia Tandon
- The Hope Clinic, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sonia Krengel
- The Hope Clinic, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Eric Johnson
- The Hope Clinic, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Federico Palacio Bedoya
- Division of Infectious Diseases, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael Moore
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel Refai
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nadine Rouphael
- The Hope Clinic, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Division of Infectious Diseases, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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7
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Mohammed R, Panikkar S, Elmalky M. Drug Reaction, Eosinophilia, and Systemic Symptoms (DRESS) Syndrome As a Mimicker of Spinal Infection: Awareness for Spinal Surgeons. Cureus 2020; 12:e7503. [PMID: 32373407 PMCID: PMC7195205 DOI: 10.7759/cureus.7503] [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] [Indexed: 11/23/2022] Open
Abstract
Drug reaction, eosinophilia, and systemic symptoms (DRESS) syndrome is a delayed severe drug hypersensitivity (type IVb) syndrome with cutaneous eruption, hematological abnormalities, and multi-organ involvement. The wide spectrum of the disease manifestations, long-term sequelae, and high mortality rates are a clinical concern. Though not commonly reported in spinal surgery patients, the use of long-term antibiotics is a potential causative agent in spinal infections. DRESS syndrome can mimic systemic spinal infections, and clinical diagnosis requires high awareness and extreme vigilance. Prompt recognition and appropriate action can mitigate the potential poor outcomes and improve patient prognosis.
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Affiliation(s)
- Riaz Mohammed
- Spine Surgery & Orthopedics, Cardiff & Vale University Health Board, Cardiff, GBR
| | | | - Mahmoud Elmalky
- Spine Surgery, Salford Royal Hospital NHS Foundation Trust, Salford, GBR.,Orthopedics, Menoufia University, Shebin Alkom, EGY
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8
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Milosevic B, Cevik M, Urosevic A, Nikolic N, Poluga J, Jovanovic M, Milosevic I, Micic J, Paglietti B, Barac A. Risk factors associated with poor clinical outcome in pyogenic spinal infections: 5-years' intensive care experience. J Infect Dev Ctries 2020; 14:36-41. [PMID: 32088682 DOI: 10.3855/jidc.12260] [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: 11/26/2019] [Accepted: 01/08/2020] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Management of pyogenic spinal infections (PSI) after the development of neurological deficit has not been specifically addressed in the literature. We aimed to describe real-life clinical outcomes of PSI in patients admitted to an intensive care unit with neurological deficit and identify factors associated with good prognosis. METHODOLOGY Consecutive patients admitted to ICU with a possible diagnosis of spinal infection over five years' period were included. Descriptive statistics were performed to examine the demographics and clinical parameters. RESULTS The majority (71%) of patients were male. The mean age was 57.4 years (27-79), and 71% were > 50 years old. At least one underlying risk factor was identified in 68% of the patients; the most common comorbidity was diabetes mellitus (DM). All patients have presented with fever accompanied by a neurological deficit (86%) and back pain (79%). A complete recovery was achieved in 25% of patients. However, the majority of patients had adverse outcomes with 21.4% mortality, and 43% remaining neurological sequelae. Increased age with a cut-off of 65 years and pre-existing DM were identified as being associated with poor outcome. CONCLUSION Mortality among patients admitted to ICU with PSI was significantly higher than reported in the literature. The residual neurological deficit was common, one-third of patients had remaining neurological sequelae, and only one-fourth had complete recovery. Increased age and background DM were the most important determinants of poor clinical outcome. The impact of DM appears to be much more important than currently recognised in this population.
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Affiliation(s)
- Branko Milosevic
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia.
| | - Muge Cevik
- School of Medicine, University of St. Andrews, St Andrews, United Kingdom.
| | - Aleksandar Urosevic
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia.
| | - Natasa Nikolic
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia.
| | - Jasmina Poluga
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia.
| | - Milica Jovanovic
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia.
| | - Ivana Milosevic
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia.
| | - Jelena Micic
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia.
| | - Bianca Paglietti
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
| | - Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia.
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9
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Sheoran L, Goel N, Acharya S, Adsul N, Wattal C. A rare aetiology of spinal epidural abscess. Indian J Med Microbiol 2019; 37:590-592. [PMID: 32436886 DOI: 10.4103/ijmm.ijmm_19_493] [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: 11/04/2022]
Abstract
Spinal epidural abscess (SEA) due to Streptococcus pneumoniae is a rare entity, but it is associated with high mortality. Here, we describe a rare case of pneumococcal SEA in an immunocompetent adult who presented with fever, lower back pain and paresis. Central nervous system examination revealed a decreased power in bilateral lower limbs. Magnetic resonance imaging of the lumbosacral spine showed loculated pus collection in the epidural space at the level of L4-L5 vertebrae. Pus obtained following L4-L5 decompression along with blood cultures grew S. pneumoniae. The patient was treated with clindamycin and cefoperazone-sulbactam for 6 weeks, and no relapse was noted on 11 months follow-up.
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Affiliation(s)
- Lata Sheoran
- Department of Clinical Microbiology and Immunology, Sir Gangaram Hospital, New Delhi, India
| | - Neeraj Goel
- Department of Clinical Microbiology and Immunology, Sir Gangaram Hospital, New Delhi, India
| | - Shankar Acharya
- Department of Spinal Surgery, Sir Gangaram Hospital, New Delhi, India
| | - Nitin Adsul
- Department of Spinal Surgery, Sir Gangaram Hospital, New Delhi, India
| | - Chand Wattal
- Department of Clinical Microbiology and Immunology, Sir Gangaram Hospital, New Delhi, India
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10
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Keser N, Is M, Ceman D, Somay A. Locally Used Antibiotics for Spinal Infection Prophylaxis and Their Effects on Epidural Fibrosis: an Experimental Laminectomy Study in Rats Using Rifamycin and Gentamycin. Inflammation 2018; 42:714-720. [PMID: 30413905 DOI: 10.1007/s10753-018-0929-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The study aims to assess the effects of antibiotics (ABs), which are typically used in spinal infection prophylaxis, on the formation of epidural fibrosis (EF). Specifically, we investigated the effect of rifamycin and gentamycin on EF formation in laminectomized rats. Thirty-two rats were randomly and equally divided into four groups as follows: laminectomy and physiological saline (0.9% NaCl) solution (control); laminectomy and rifamycin; laminectomy and gentamicin; and laminectomy and a mixture of rifamycin and gentamicin. Laminectomy was performed on L1 and L2 vertebrae in all rats. One month after spinal surgery, spinal tissue samples surrounding the laminectomy were cut with a microtome and stained with hematoxylin-eosin and Masson's trichrome. The histopathological analysis included examining the extent of EF, fibroblast cell density, and cartilage and bone regeneration. Statistical analysis was performed using the IBM SPSS Statistics 22 program (SPSS IBM, Turkey). A value of p < 0.05 was considered statistically significant. EF value differences between the AB treatment groups and the control group were statistically significant (p = 0.030). Specifically, binary comparisons indicated that the EF value was significantly higher in the rifamycin group than that in the control group (p = 0.003; p < 0.05). Our study suggests that locally applied ABs, especially rifamycin, should be diluted before administration to the epidural space.
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Affiliation(s)
- Nese Keser
- Department of Neurological Surgery, Istanbul Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, E-5 Karayolu Uzeri, 34752, İcerenkoy-Atasehir, Istanbul, Turkey.
| | - Merih Is
- Department of Neurological Surgery, Istanbul Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, E-5 Karayolu Uzeri, 34752, İcerenkoy-Atasehir, Istanbul, Turkey
| | - Duygu Ceman
- Department of Neurological Surgery, Haydarpasa Numune Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Adnan Somay
- Department of Pathology, Istanbul Fatih Sultan Mehmet Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Abstract
BACKGROUND The aim of the study was to retrospectively evaluate the outcome of medical management of postoperative discitis (POD). MATERIALS AND METHODS A total of 31 patients treated for POD were included in the study. Clinical, radiological, and laboratory data of all patients were collected and evaluated. All patients were treated initially with bed rest and antibiotic therapy after radiological diagnosis. Surgical management was undertaken after failure of 4 weeks of conservative management. All cases were followed clinically with laboratory and radiological investigations. RESULTS Five cases failed to respond to medical management and were treated surgically with debridement and transpedicular fixation. All patients showed clinical recovery till the last follow-up. CONCLUSION Early diagnosis and proper management are the keys to successful outcome of postoperative spndylodiscitis. Surgical debridement and fusion are required when conservative treatment fails.
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Affiliation(s)
- Deepak Kumar Singh
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Neha Singh
- Departement of Radiodiagnosis and Imaging, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Praveen Kumar Das
- Department of Anesthesiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Deepak Malviya
- Department of Anesthesiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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12
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Amadoru S, Lim K, Tacey M, Aboltins C. Spinal infections in older people: an analysis of demographics, presenting features, microbiology and outcomes. Intern Med J 2017; 47:182-188. [PMID: 27753184 DOI: 10.1111/imj.13300] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 08/01/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Clinical features of infection can become more atypical as we age. Spinal infections can be insidious, and timely diagnosis and treatment are essential to prevent adverse outcomes. AIMS To explore differences in presentation and outcomes between younger and older patients with bacterial spinal infections. METHODS Clinical, microbiological and radiological information was collected for patients with spinal infections (spondylodiscitis, vertebral osteomyelitis, septic discitis, facet joint septic arthritis and spinal epidural abscess) at a single metropolitan hospital between January 2008 and January 2015. Patients were excluded if they were under 18 years of age or if clinical and imaging findings were inconsistent with the diagnosis. Presenting features, investigations and outcomes were compared for patients ≥65 (older) or <65 (younger) years old. RESULTS Of 53 identified patients, 34 (64%) were classified as older, with more males in both older (65%) and younger (79%) groups. Older patients presented later (median symptom duration 13 vs 4 days, P = 0.016). Back pain was nearly ubiquitous. Older patients presented less commonly with fevers (38 vs 63%) and rigors (24 vs 42%) but more commonly with hypotension (18 vs 5%), delirium (24 vs 11%), higher median inflammatory marker levels and variable microbiological findings, although these differences were not statistically significant. They had longer median lengths of stay (24 vs 14 days) and a higher likelihood of death or failure of medical treatment (HR 9.34, P = 0.031). Radicular pain was associated with poor outcome (HR 3.29, P = 0.046). CONCLUSION Older patients with spinal infections present later, with higher inflammatory markers and fewer typical infective symptoms and signs; these may contribute to poorer outcomes. A low threshold for promptly investigating older patients with new or worsening back pain should be set.
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Affiliation(s)
- S Amadoru
- Department of Geriatric Medicine, Northern Health, Melbourne, Victoria, Australia.,Department of Geriatric Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - K Lim
- Department of Geriatric Medicine, Northern Health, Melbourne, Victoria, Australia.,Department of Geriatric Medicine, Melbourne Health, Melbourne, Victoria, Australia
| | - M Tacey
- Northern Centre for Health Education and Research (NCHER), Northern Health, Melbourne, Victoria, Australia.,Melbourne EpiCentre, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - C Aboltins
- Department of Infectious Diseases, Northern Health, Melbourne, Victoria, Australia.,North West Academic Centre, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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13
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Dobran M, Marini A, Nasi D, Gladi M, Liverotti V, Costanza MD, Mancini F, Scerrati M. Risk factors of surgical site infections in instrumented spine surgery. Surg Neurol Int 2017; 8:212. [PMID: 28970960 PMCID: PMC5613592 DOI: 10.4103/sni.sni_222_17] [Citation(s) in RCA: 21] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/06/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The incidence of wound infections associated with instrumented spine surgery ranges from 2 to 20%. These complications may lead to poor outcomes. Knowing the risk factors associated with surgical site infections (SSI) after utilizing spinal implants is essential to avoid these complications, including hardware removal. METHODS We reviewed retrospectively 550 patients who underwent spinal fusion surgery from 2011 to 2015; 16 developed SSI after spinal instrumentation. The diagnosis of SSI was established based on positive wound swab or blood cultures, and various clinical, laboratory, and radiological findings. Additional preoperative and intraoperative risk factors were analyzed. RESULTS The incidence of SSI after spinal instrumentation surgery was 2.9%. Obesity was a statistically significant parameter (P = 0.013) that contributed to SSI along with the alcoholism and/or drug abuse (P = 0.034); use of a Foley catheter nearly reached significance levels. CONCLUSIONS There is an increased risk of SSI in patients who are obese or use drugs and/or alcohol. Clear preoperative identification of these risk factors prior to implanting spinal instrumentation should help prevent SSI in the future.
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Affiliation(s)
- M. Dobran
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - A. Marini
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - D. Nasi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - M. Gladi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - V. Liverotti
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - M. Della Costanza
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - F. Mancini
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - M. Scerrati
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
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14
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DOBRAN M, MARINI A, GLADI M, NASI D, COLASANTI R, BENIGNI R, MANCINI F, IACOANGELI M, SCERRATI M. Deep spinal infection in instrumented spinal surgery: diagnostic factors and therapy. G Chir 2017; 38:124-129. [PMID: 29205141 PMCID: PMC5726498 DOI: 10.11138/gchir/2017.38.3.124] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 11/17/2022]
Abstract
AIM Postoperative surgical site infections (SSI) are complication of spinal surgery. These complications may lead to a poor outcome with neurological deficits, spinal deformity and chronic pain. The purpose of this study is to explore the statistical value of diagnostic parameters and the proper therapy. METHOD We retrospectively reviewed 550 patients who underwent spinal instrumentation at our department from January 2011 to December 2015. The SSI was present in 16 patients out of 550 operated. Diagnostic criteria of SSI were the positivity of the surgical wound swab or blood culture, the clinical findings, positivity of laboratory tests and radiological elements. All patients had peri-operative antibiotic prophylaxis. Diagnostic laboratory findings were compared with a homogeneous control group of 16 patients and analyzed by univariate statistical analysis with Chi-square test for the discrete variables. P<0,05 was considered statistically significant. RESULTS Matching the SSI patients with a group of control, fever was not statistically significant for diagnosis as number of leukocytes, neutrophils and lymphocytes. On the contrary values of ESR and CRP were statistically significant with p <0, 01. The hardware was removed only in 3 patients (18%) out of 16 SSI patients. CONCLUSION In this study the statistically significant parameters to diagnose SSI are ESR and CRP values. The leucocytes count, number of lymphocytes and presence of fever integrates the data of ESR and CRP with no statistical significance. Most patients with SSI reach clinical healing with favorable outcome by means of target antibiotic therapy without hardware removal.
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Affiliation(s)
- M. DOBRAN
- Neurosurgery Clinic, “Università Politecnica delle Marche”, Ancona, Italy
| | - A. MARINI
- Neurosurgery Clinic, “Università Politecnica delle Marche”, Ancona, Italy
| | - M. GLADI
- Neurosurgery Clinic, “Università Politecnica delle Marche”, Ancona, Italy
| | - D. NASI
- Neurosurgery Clinic, “Università Politecnica delle Marche”, Ancona, Italy
| | - R. COLASANTI
- Neurosurgery Clinic, “Università Politecnica delle Marche”, Ancona, Italy
| | - R. BENIGNI
- Neurosurgery Clinic, “Università Politecnica delle Marche”, Ancona, Italy
| | - F. MANCINI
- Neurosurgery Clinic, “Università Politecnica delle Marche”, Ancona, Italy
| | - M. IACOANGELI
- Neurosurgery Clinic, “Università Politecnica delle Marche”, Ancona, Italy
| | - M. SCERRATI
- Neurosurgery Clinic, “Università Politecnica delle Marche”, Ancona, Italy
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15
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Zwolak P, König MA, Osterhoff G, Wilzeck V, Simmen HP, Jukema GN. Therapy of acute and delayed spinal infections after spinal surgery treated with negative pressure wound therapy in adult patients. Orthop Rev (Pavia) 2013; 5:e30. [PMID: 24416474 PMCID: PMC3883071 DOI: 10.4081/or.2013.e30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 05/29/2013] [Accepted: 08/20/2013] [Indexed: 11/23/2022] Open
Abstract
We present the results of the treatment of infected primary or delayed spine wounds after spinal surgery using negative pressure wound therapy. In our institution (University Hospital Zurich, Switzerland) nine patients (three women and six men; mean age 68.6, range 43-87 years) were treated in the period between January to December 2011 for non-healing spinal wounds. The treatment consisted of repeated debridements, irrigation and temporary closure with negative pressure wound therapy system. Three patients were admitted with a spinal epidural abscess; two with osteoporotic lumbar fracture; two with pathologic vertebra fracture and spinal cord compression, and two with vertebra fracture after trauma. All nine patients have been treated with antibiotic therapy. In one case the hardware has been removed, in three patients laminectomy was performed without instrumentation, in five patients there was no need to remove the hardware. The average hospital stay was 16.6 days (range 11-30). The average follow-up was 3.8, range 0.5-14 months. The average number of negative pressure wound therapy procedures was three, with the range 1-11. Our retrospective study focuses on the clinical problems faced by the spinal surgeon, clinical outcomes after spinal surgery followed by wound infection, and negative pressure wound therapy. Moreover, we would like to emphasize the importance for the patients and their relatives to be fully informed about the increased complications of surgery and about the limitations of treatment of these wounds with negative pressure wound therapy.
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Affiliation(s)
- Pawel Zwolak
- Department of Trauma Surgery, University Hospital Zurich , Switzerland
| | | | - Georg Osterhoff
- Department of Trauma Surgery, University Hospital Zurich , Switzerland
| | - Verena Wilzeck
- Department of Trauma Surgery, University Hospital Zurich , Switzerland
| | - Hans-Peter Simmen
- Department of Trauma Surgery, University Hospital Zurich , Switzerland
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16
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Baxi S, Malani PN, Gomez-Hassan D, Cinti SK. Association Between Follow-Up Magnetic Resonance Imaging and Clinical Status Among Patients With Spinal Infections. Infect Dis Clin Pract (Baltim Md) 2012; 20:326-329. [PMID: 24748760 PMCID: PMC3989101 DOI: 10.1097/ipc.0b013e3182639f6a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spinal infections, including paraspinal and/or epidural abscesses and vertebral discitis and osteomyelitis, can have devastating consequences. The diagnostic imaging modality of choice has traditionally been magnetic resonance imaging (MRI) given the very high sensitivity and specificity, although the role of MRI in follow-up of spinal infections and how this relates to follow-up clinical status is poorly understood. We sought to understand the relationship between follow-up MRI and clinical status. METHODS We conducted a retrospective review of adults with spinal infection to assess the relationship between follow-up MRI and clinical course. The degree of agreement between MRI and clinical follow-up was assessed using the Cohen kappa coefficient. A multinomial logistic regression model was applied to assess the impact of covariates in affecting the clinical outcome and MRI at follow-up independently. RESULTS Ninety-eight patients met inclusion criteria during a 13-year period. We observed a lack of correlation between clinical follow-up status and MRI (κ = 0.065, P = 0.322). The McNemar-Bowker test for symmetry revealed that this disagreement was asymmetric (P < 0.001). Notably, clinical worsening was never associated with an improved MRI, and clinical improvement was overall not predictive of MRI result and vice versa. CONCLUSIONS Routine follow-up MRI does not seem to correlate with clinical follow-up among patients with spinal infections. The use of MRI without new clinical indications in routine follow-up testing should be interpreted with caution.
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Affiliation(s)
- Sanjiv Baxi
- Department of Internal Medicine, University of California San Francisco, San Francisco, CA
| | - Preeti N. Malani
- Division of Geriatric Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI
- Geriatric Research, Education, and Clinical Center (GRECC), Ann Arbor, MI
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Diana Gomez-Hassan
- Division of Neuroradiology, Department of Radiology, University of Michigan Health System, Ann Arbor, MI
| | - Sandro K. Cinti
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
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