The Safety and Decision Making of Instrumented Surgery in Infectious Spondylitis

OBJECTIVE: Infectious spondylitis is mostly managed by appropriate antibiotic treatment options, and some patients may require surgical interventions. However, surgical interventions that use spinal instrumentation to correct the mechanical instability may be associated with the risk of an increase in the recurrence rate. In this study, we investigated whether spinal instrumentation effects on recurrence of infectious spondylitis. METHODS: The study was conducted as a retrospective study by dividing the subjects into the noninstrumentation surgery and instrumentation surgery groups among a total of 95 patients who had received surgical interventions in infectious spondylitis from 2009 to 2014. The study investigated patient variables such as underlying illness, presumed source of infection, clinical data, laboratory and radiological data, and ultimate outcome, and compared them between the 2 groups. RESULTS: In the 95 patients, instrumentation was not used in 21 patients but it was used in 74 patients. When the disease involved ≥3 vertebral bodies, lumbosacral level and epidural part, noninstrumentation surgery was mainly conducted, but when the disease involved the thoracic level and psoas muscle part, instrumentation surgery was mainly conducted. However, there were no differences between the 2 groups in terms of the recurrence rate and the incidence of primary failure. CONCLUSION: The use of instrumentation in treating infectious spondylitis was determined by the level of involvement and part of the infection, but the use of instrumentation did not cause any increases in the recurrence rate and the incidence of primary failure.

Infectious Spondylitis Mimicking Osteoporotic Vertebral Compression Fractures: Report of Two Cases

STUDY DESIGN: Case study of two cases. OBJECTIVES: The aim of our study is to describe the rare MR imaging patterns of infectious spondylitis. SUMMARY OF LITERATURE REVIEW: It is generally accepted that the intravertebral cleft sign is not shown in cases of infection or malignancy, and thus, its recognition can obviate unnecessary imaging or biopsy because of its benign significance. MATERIALS AND METHODS: Two patients are presented who developed worsening back pain after a minor trauma. Preoperative MR images of these patients showed intravertebral fluid and benign vertebral compression fractures. Anterior decompression and fusion were done and the bacteria isolated from the intraoperative cultures were Listeria monocytogenes and Mycobacterium tuberculosis, respectively. RESULTS: After 2 years of follow-up, the patients were free of pain, without signs of infection, and showed correct fusion. CONCLUSIONS: MR findings in infectious spondylitis may simulate the patterns of osteoporotic VCFs.

Espondilodiscitis tuberculosa / Tuberculous Spondylodiscitis

La afectación por la tuberculosis de la columna vertebral se denomina espondilodiscitis tuberculosa y es una enfermedad poco frecuente en nuestros días. Objetivo: presentar un paciente con diagnóstico de espondilodiscitis tuberculosa y manifestaciones clínicas de dolor lumbar y fiebre. Presentación del caso: describimos el caso de un paciente masculino de 46 años de edad, que ingresó con dolor lumbar y fiebre de un mes de evolución. Al examen físico se detectaron manifestaciones de compresión radicular L5-S1, prueba de tuberculina con induración de 22 mm, y en la Resonancia Magnética Nuclear se observaron imágenes compatibles con complejo discótico osteomielítico L5-S1. Presentó una evolución favorable con tratamiento médico. Conclusión: la espondilodiscitis debe ser diagnóstico diferencial en todo paciente con dolor lumbar y fiebre...

Tuberculous spondylodiscitis is the condition of tuberculosis in the spine and it is a rare disease today. Objective: to present a patient with a diagnosis of tuberculous spondylodiscitis and clinical manifestations of lumbar pain and fever. Case presentation : a case of a male patient aged 46 is described here. This patient was admitted due to back pain and fever during a month. At physical examination manifestations of L5-S1 nerve root compression were observed. This patient underwent the tuberculin test with induration of 22 mm, and NMR showed images compatible with L5-S1 discotic osteomyelitis complex. He presented a favorable outcome with medical treatment. Conclusions: the differential diagnosis must be spondylodiscitis in all patients with back pain and fever...

Streptococcus Spondylitis Concomitant Infectious Endocarditis: A Case Report / 대한정형외과연구학회지

It is known that most common causative pathway of pyogenic spondylitis is bacterial transmission through blood and pyogenic spondylitis rarely accompanies infectious endocarditis. We experienced 1 case of pyogenic spondylitis concomitant infectious endocarditis. So, we report this case with a review of literature.

Espondilodiscitis infecciosa / Infectious spondylodiscitis

Introducción: la osteomielitis vertebral o espondilodiscitis es una enfermedad poco frecuente. Su incidencia ha aumentado en los últimos años debido a una mayor cantidad de procedimientos quirúrgicos espinales, de bacteriemia nosocomial, el envejecimiento de la población y la adicción a drogas intravenosas. La infección hematógena es la causa más común de espondilitis. El tratamiento antimicrobiano prolongado y la cirugía son esenciales para controlar la infección y prevenir la aparición de secuelas. Objetivos: señalar la importancia del diagnóstico y la terapéutica correcta, así como profundizar en el conocimiento de esta entidad. Descripción: se presentó un paciente masculino de 58 años de edad, que después de realizar un esfuerzo físico intenso comenzó con dolor en la columna lumbosacra; tuvo febrículas en 2 ocasiones, que se correspondió con un hematoma del psoas infectado secundariamente y una presentación clínica solapada, donde la resonancia magnética nuclear resultó la técnica de imagen que permitió arribar al diagnóstico. Su tratamiento definitivo fue la antibioticoterapia prolongada por más de 8 semanas con protección de la columna vertebral mediante una ortesis (corsé de Taylor). Se hizo un diagnóstico precoz y se impuso un tratamiento adecuado. Conclusiones: con un diagnóstico oportuno y apropiado se evitan otras complicaciones y mejoran las expectativas de vida del paciente. Se debe hacer la mayor divulgación científica posible sobre esta enfermedad poco común, que adolece de escases de pensamiento clínico en el medio cubano y, por lo tanto, no se sospecha ni se diagnostica precozmente

Introduction: the vertebral osteomyelitis or spondylodiscitis is an uncommon disease. Its incidence has increased in past years due to a significant quantity of spinal surgical procedures, to nosocomial bacteremia, aging of population and the addiction to intravenous drugs. The hematogenic infection is the commonest cause of spondylitis. The lengthy antimicrobial treatment and surgery are essential to control infection and to prevent appearance of sequelae. Objectives: to emphasize the significance of diagnosis and appropriate therapeutics, as well as to deepen in the knowledge of this entity. Description: this is the case of a male case aged 58 who after perform an intensive physical effort had an spinal low back pain, he had febricula in two occasions corresponding with a hematoma of the secondarily infected psoas and an overlapped clinical presentation where the nuclear magnetic resonance was the imaging technique allowed to made diagnosis. Its definitive treatment was the lengthy antibiotic therapy for more than 8 weeks with protection of the spinal column by means of orthesis (Taylor'corset). An early diagnosis was made imposing an appropriate treatment. Conclusions: with an appropriate and timely diagnosis it is possible to avoid complications and to improve the patient's life expectancies. It is necessary the great possible scientific popularization on this uncommon disease with a lack of clinical thought in the Cuban environment and thus, it is neither early suspected or diagnosed

Espondilodiscitis causada por Kingella kingae en pediatría: reporte de un caso / Espondilodiskitis caused by Kingella kingae in children: a case report

During the last years, spondilodiskitis due to Kingella kingae has been a new target of interest, since it is the second agent that causes non tuberculous espondilodiskitis in children, after Staphylococcus aureus. Its clinical presentation is very inespecific, sometimes with fever, abdominal or lumbar disconfort, nocturnal pain, altered walking and sedestation. Images, culture methods and PCR (polymerase chain reaction) can be helpful for diagnosis, although in an important percent of the cases, etiology cannot be determined. Although there are no established guidelines for treatment, before the suspicion, empiric antibiotic treatment should be started for good prognosis. We describe a case of a 3 year old boy, who had this disease and then a review about spondilodiskitis in childhood and microbiological aspects of Kingella kingae.

La espondilodiscitis por Kingella kingae ha sido blanco de mayor interés en los últimos años, dado que constituye el segundo agente etiológico, luego de Staphylococcus aureus en espondilodiscitis no tuberculosa en niños. Clínicamente presenta sintomatología inespecífica, a veces acompañada de fiebre y de molestias abdominales o lumbares, con dolor de predominio nocturno y con alteraciones en la marcha y en la sedestación. El diagnóstico se puede ayudar con imágenes y métodos de cultivo o RPC (reacción polimerasa en cadena), aunque en un gran porcentaje de los casos no se logra determinar la etiología. Sin embargo, pese a que no exista un protocolo establecido para el tratamiento, ante la sospecha se debe iniciar tratamiento empírico, con buen pronóstico. Describimos un caso de un paciente de tres años que cursó con esta patología y posteriormente se expone una revisión sobre espondilodiscitis en la infancia y los aspectos microbiológicos de K. kingae.

A Case of Salmonella Psoas Abscess Presenting as Low Back Pain and Subacute Renal Failure / 대한내과학회지

Salmonella is a rare cause of psoas abscess and infectious spondylitis. We report a case of a 62-year-old male patient with Salmonella group D psoas abscess and infectious spondylitis as low back pain and subacute renal failure. The patient who had a previous operation history of abdominal aortic aneurysm rupture was admitted to evaluate low back pain and abnormal renal function. Bilateral psoas abscess and infectious spondylitis of lumbar vertebrae was detected by spine MRI and Salmonella group D was isolated in aspirated fluid of psoas abscess. After long term antibiotics treatment (ceftriazxone and ciprofloxacin), psoas abscess and spondylitis was markedly improved, however, his renal function was not recovered to progress to end stage renal disease.

Differential Diagnosis between Tuberculous Spondylitis and Pyogenic Spondylitis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study OBJECTIVES: We wanted to make the early differential diagnosis between tuberculous spondylitis and pyogenic spondylitis according to the clinical and MRI findings. SUMMARY OF THE LITERATURE REVIEW: Making an early differential diagnosis between tuberculous spondylitis and pyogenic spondylitis is essential to start prompt and proper treatment. However, the clinical symptoms and MRI findings of both these illnesses can vary considerably. MATERIAL AND METHOD: Ninety-five patients (49 men and 46 women, mean age: 54.5) who were treated from January 2001 to February 2007 and whose diagnosis was confirmed by laboratory or pathological studies were retrospectively reviewed. 50 patients with tuberculous spondylitis and 45 patients with primary pyogenic spondylitis were included. The patients with combined infection or an uncertain diagnosis were excluded. We compared the medical records and MRI findings between the different groups of patients. RESULTS: The patients with tuberculous spondylitis were younger (48.2 years vs. 61.5 years, respectively) and they had a longer symptom duration (4.3 months vs 1.8 months, respectively). The erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) level were significantly higher in the patients with pyogenic spondylitis (71.3/49.6 mm/hr and5.74/2.98 mg/dl, respectively). A high fever above 38 degree was more frequent in the patients with pyogenic spondylitis. Intraosseous abscess, epidural abscess, a well-definded paraspinal abscess, focal enhancement and severe destruction of the vertebral body on MRI were more frequent in the patients with tuberculous spondylitis. Four parameters such as a symptom duration longer than 3 months, no fever higher than 38 degree, a well-defined paravertebral abscess and an intraosseous abscess were selected. 42 patients in the tuberculous group had 3 or more of these four parameters. The sensitivity and specificity of these combined 4 parameters were 84% and 97.8%, respectively, for making the differential diagnosis between these 2 maladies. CONCLUSION: These diagnostic criteria might be useful to discriminate between tuberculous spondylitis and pyogenic spondylitis even without definite laboratory or pathological results.

Infectious Spondylitis following Kyphoplasty: A case report / 대한통증학회지

Vertebroplasty and kyphoplasty are well-known, useful techniques for the treatment of painful vertebral compression fractures. Although the risk associated with these procedures is low, serious complications can occur. Of these complications, infection is even rarer, however, when it does occur, it is difficult to manage and can become life-threatening. We describe here a case of infectious spondylitis with epidural inflammation that occurred after performing kyphoplasty in a patient who had a thoracic vertebra compression fracture. We reviewed other case and literatures. Extreme asepsis of the operating theater, screening and treatment for systemic infection prior to the procedure, as well as the use of appropriate antibiotic prophylaxis are strongly recommended when conducting kyphoplasty to prevent infection.

Preoperative Gadolinium-enhanced Magnetic Resonance Images on Infectious Spondylitis

OBJECTIVE: The purpose of this study is to analyze the patterns of intervertebral disc enhancement seen in infectious spondylitis, differentiate between two groups(tuberculous vs pyogenic spondylitis). METHODS: Between January 1994 and December 2002, 83patients underwent operative procedure with confirmed to histopathologic evaluation. Magnetic resonance(MR) images were obtained in all patients and were analyzed retrospectively. 57patients had tuberculosis and 26patients were infected by pyogens. The patterns of gadolinium enhancement of disc were classified into 4 types(post's classification): Type I, non-enhancing; Type II, enhancement of the peripheral rim; Type III, Type II with central area and partial endplate; Type IV, general enhancement. RESULTS: The enhancement patterns observed were as follows: Common pattern of tuberculous spondylitis was Type II, and pyogenic spondylitis was Type III.(p<0.01) This difference may result from pathophysiologic varieties of organisms. CONCLUSION: Careful preoperative MR analysis of the patterns of disc enhancement occuring in infectious spondylitis can be useful for differentiating between the tuberculous and pyogenic spondylitis.