ABSTRACT
Resumen: Objetivo: Determinar la asociación entre las características clínicas y estudios de laboratorio con el tipo de microorganismo aislado en hemocultivos de pacientes con espondilodiscitis piógena. Material y métodos: Es un estudio transversal analítico, se revisaron expedientes clínicos de pacientes con espondilodiscitis piógena desde Enero de 2013 hasta Enero de 2017. Se realizó análisis descriptivo univariado usando frecuencias y porcentajes para variables cualitativas, medidas de tendencia central y dispersión para las cuantitativas. Análisis bivariado mediante prueba de χ2 o test exacto de Fisher. Análisis de variables cuantitativas mediante t Student o U de Mann-Whitney. Se usó coeficiente de correlación de Spearman. Considerando significancia estadística p < 0.05. Resultados: Se obtuvo una muestra de 34 pacientes, 20 (58%) fueron mujeres, mediana (Me) de edad 60 años (52-66). Se aisló en hemocultivos, bacterias Gram positivas 11 (32.4%) y Gram negativas 23 (67.6%). El microorganismo aislado más frecuente fue Escherichia coli 12 (35.3%). Los pacientes con espondilodiscitis por Gram negativas presentaron dolor leve y velocidad de sedimentación globular (VSG) Me 26 mm/hra P (18-36), los pacientes con espondilodiscitis por Gram positivas presentaron dolor severo y VSG Me 38 mm/h P (34-40) (p = 0.000 y 0.028, respectivamente). La VSG y dolor en el grupo de pacientes con espondilodiscitis por bacterias Gram negativas tuvo un coeficiente de correlación de Spearman moderado 0.418, (p = 0.047); en el grupo de Gram positivas, un coeficiente de correlación de Spearman bajo 0.228, (p = 0.507). Conclusión: Existe una asociación clínica y estadística de manera significativa entre los tipos de microorganismo aislado en hemocultivo, la intensidad del dolor valorado en escala visual análoga (EVA) y los niveles de VSG.
Abstract: Objective: Determine the association between clinical characteristics and laboratory studies with the type of isolated microorganism in blood cultures of patients with Pyogenic Spondylodiscitis. Material and methods: It is a cross-analytical study, clinical records of patients with Pyogenic Spondylodiscitis were reviewed from January 2013 to January 2017. Univariate descriptive analysis was performed using frequencies and percentages for qualitative variables, central trend measures and dispersion for quantitative ones. Bivariate analysis by testing of χ2 or Fisher's exact test. Analysis of quantitative variables using T Student or Mann-Whitney U. Spearman's correlation coefficient was used. Considering statistical significance p < 0.05. Results: A sample of 34 patients was obtained, 20 (58%) were women, median (Me) of age 60 years (52-66). Was isolated into blood cultures, Gram-positive bacteria 11 (32.4%) gram negatives 23 (67.6%). The microorganism most common isolate was Escherichia coli 12 (35.3%). Patients with Gram-negative spondylodiscitis had mild pain and globular sedimentation rate (VSG) Me 26 mm/hra P (18-36), patients with Gram-positive spondylodyscitis had severe pain and VSG Me 38 mm/h P (34-40) (p= 0.000 and 0.028, respectively). VSG and pain in the group of patients with gram-negative bacteria spondylodiscitis had a moderate Spearman correlation coefficient of 0.418, (p = 0.047); in the Gram positives group, a low correlation coefficient of Spearman 0.228, (p = 0.507). Conclusion: There is a clinical and statistical association significant between types of isolated microorganism in blood culture, pain intensity valued on analog visual scale (EVA) and VSG levels.
Subject(s)
Humans , Female , Pain , Discitis/complications , Discitis/etiology , Discitis/therapy , Retrospective Studies , Treatment OutcomeABSTRACT
STUDY DESIGN: Retrospective clinical study. OBJECTIVES: To assess the efficacy of a cortical bone trajectory pedicle screw (CBT-PS) for the treatment of lumbar pyogenic spondylodiscitis. SUMMARY OF LITERATURE REVIEW: Pedicle screws were used for surgical treatment of pyogenic spondylodiscitis to prevent instability and deformity. CTB-PS are typically inserted from the inferomedial to superolateral direction of the pedicle and have yielded satisfactory results in degenerative or osteoporotic spinal disorders. MATERIALS AND METHODS: Eight patients with single segment lumbar pyogenic spondylodiscitis were analyzed. At first, anterior debridements and interbody fusions were perfomed with autogenous strut bone grafts, followed by posterior fixations and fusions with CBT-PS. The lordotic angles of operated levels were checked at the preoperative, postoperative, and final follow-ups. Visual analogue scales (VAS) were checked at the preoperative and final follow-ups. RESULTS: Lesion sites were found at four L3-4, three L4-5, and one L2-3. Follow-ups were held at 26.13±8.23 months. The lordotic angles at preoperative, postoperative, and final follow-ups were 12.13±3.09°, 14.63±3.16°, and 12.75±3.99°, retrospectively. There were significant differences between results from the preoperative-postoperative and postoperative-final follow ups. There was no difference in the preoperative-final follow up. There was a significant difference between the VAS at the preoperative and final follow-ups (8.13±0.83 and 2.38±0.92, retrospectively). Complete bony unions of were observed at the final follow-up in all cases. CONCLUSIONS: The advantages of using a CBT-PS for lumbar pyogenic spondylodiscitis included the ability to minimize damage from the screw for both the posterior structure damage and the operated anterior area to prevent instability and deformity, and to achieve rigid bone union. CBT-PS is a potential surgical option for pyogenic spondylodiscitis.
Subject(s)
Humans , Clinical Study , Congenital Abnormalities , Debridement , Discitis , Follow-Up Studies , Pedicle Screws , Retrospective Studies , Transplants , Weights and MeasuresABSTRACT
La espondilodiscitis infecciosa es una entidad poco frecuente que afecta el disco intervertebral y las vértebras adyacentes. Su importancia clínica radica en la morbilidad que determina. En este caso nos centraremos en la espondilodiscitis piógena (EP) y, dentro de ella, en la estreptocócica. Se presenta el caso clínico de un paciente con espondilodiscitis por Streptoccocus intermedius perteneciente al grupo viridans, se analizan las características clínicas, y se realiza una breve revisión bibliográfica.
Infectious spondylodiscitis is a rare condition that affects the intervertebral disc and adjacent vertebrae. Its clinical relevance is related with its morbidity. In this case we will focus on the pyogenous spondylodiscitis (PS), and more specifically, streptococcal. Clinical case report of a patient with spondylodiscitis caused by Streptoccocus intermedius of the viridans group, with a description of the clinical features and a brief literature review.
ABSTRACT
STUDY DESIGN: Case report. OBJECTIVES: To report a case of extensive spinal epidural abscess and bilateral psoas abscesses combined with pyogenic spondylodiscitis after a L3 vertebroplasty. SUMMARY OF LITERATURE REVIEW: Infection after vertebroplasty or kyphoplasty is a rare medical complication. Few reports on spinal epidural abscess and bilateral psoas abscesses, coupled with pyogenic spondylodiscitis after vertebroplasty, are available in the English medical literature. MATERIALS AND METHODS: The authors performed a clinical and radiographic case review. RESULTS: A 74-year-old woman, without any existing medical illness, presented with a history of three weeks of lower back pain, fever, and neurologic deficits of both legs after vertebroplasty performed in another hospital. Magnetic resonance imaging demonstrated an extensive spinal epidural abscess from T10 to S1 and huge bilateral psoas abscesses combined with spondylodiscitis at L3-4. Urgent limited laminectomies and abscess drainage were performed from L1 to S1. The day after the operation, ultrasound-guided percutaneous drainage was performed to manage bilateral psoas abscesses. Methicillin-resistant Staphylococcus aureus was identified by intraoperative culture. Antibiotic therapy during hospitalization was maintained for six weeks with vancomycin and rifampicin. The infection was successfully treated without any neurologic deficit and spinal deformity. CONCLUSIONS: Vertebroplasty is relative safe and simple procedure; however, the procedure also may cause severe spinal infection. Aseptic techniques under sterile environment was required during surgery. It is important that early diagnosis and prompt surgical decompression in spinal epidural abscess with neurologic deficit. Limited surgery and antibiotic therapy could be a good treatment option in spinal epidural abscess combined with pyogenic spondylodiscitis.
Subject(s)
Aged , Female , Humans , Abscess , Congenital Abnormalities , Decompression, Surgical , Discitis , Drainage , Early Diagnosis , Epidural Abscess , Fever , Hospitalization , Kyphoplasty , Laminectomy , Leg , Low Back Pain , Magnetic Resonance Imaging , Methicillin-Resistant Staphylococcus aureus , Neurologic Manifestations , Psoas Abscess , Rifampin , Vancomycin , VertebroplastyABSTRACT
We reviewed 9 cases of pyogenic spondylodiscitis following percutaneous endoscopic lumbar discectomy (PELD). Microbiologic cultures revealed 6 causative organisms. Five patients were managed conservatively and four were treated surgically. The mean follow-up period was 20.6 months and the average length of hospitalization was 24 days. Radiological evidence of spinal fusion was noted and infection was resolved in all patients. Although PELD is a safe and effective procedure, the possibility of pyogenic spondylodiscitis should always be considered.
Subject(s)
Humans , Discitis , Diskectomy , Follow-Up Studies , Hospitalization , Spinal FusionABSTRACT
Deep wound infection is a serious surgical complication. The majority of patients with pyogenic spondylodiscitis can be treated non-surgically with antibiotics and immobilization. However, although surgical management of pyogenic spondylodiscitis continues to evolve, no consensus has yet been reached regarding the best surgical approaches and techniques. Anterior lumbar interbody fusion (ALIF) followed by percutaneous pedicle screw fixation (PPF) is an effective surgical option for treating postoperative pyogenic spondylodiscitis (PPS). In this report, we describe a case of PPS in a 64-year-old man who underwent ALIF with PPF.
Subject(s)
Humans , Middle Aged , Anti-Bacterial Agents , Consensus , Discitis , Immobilization , Wound InfectionABSTRACT
OBJECTIVE: This study is performed to compare the clinical courses (feature, treatment and outcomes) in patients with negative versus positive culture result in pyogenic spondylodiscitis. METHODS: From January 2001 to December 2006, we reviewed clinical data in 26 consecutive patients with pyogenic spondylodiscitis retrospectively. We exclude patients that underwent surgical irrigation or debridement with biopsy. We measured clinical outcomes, length of antibiotic administration, recurrence rate, laboratory studies (CRP, ESR and leukocyte counts) and complications between two groups. Clinical outcomes were rated with Macnab's criteria. RESULTS: Causative organisms were confirmed in 6 cases and the other 20 cases had negative culture result. Mean follow-up duration was 13 months. Mean intravenous antibiotics administration duration of patients having negative culture result was 8.4 weeks and oral was 5 months. On the other hand, in cases of positive culture result, mean intravenous duration was 8.7 weeks and oral was 5.2 months. Initial mean ESR and CRP were elevated, and decreased in both groups according to antibiotics medication (p<0.001 and p=0.001). But initial mean WBC count was normal range. There was no difference in tendencies of decrement of ESR and CRP between two groups (p=0.61 and p=0.571). Clinical outcomes (p=0.231) and complications (p=0.558) were not significantly different. There were no recurrence case for followup period. CONCLUSION: Negative culture results did not significantly affect the clinical course of pyogenic spondylodiscitis when we compared the clinical courses of both groups.