Surgical approach algorithm in the treatment of lumbar and thoracolumbar pyogenic spondylodiscitis (original) (raw)
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Introduction: Spondylodiscitis is a rare infection of the intervertebral disc and nearby bone structures, which incidence has been increasing in the past decades. Conservative treatment is the gold standard, but sometimes surgery is needed to relief the symptoms and eradicate the infection, preserve the neurological function, and restore structural alignment and stability. Case presentation: The authors present a clinical case of a 73-year-old-male with T11-12 and L4-L5 spondylodiscitis with an epidural collection at this last level, treated surgically with an interlaminar endoscopic debridement and posterior percutaneous instrumentation after failing of isolated medical treatment. Discussion: The diagnosis of spondylodiscitis may sometimes be difficult due to its non-specific symptoms and sometimes inconclusive blood tests. Endoscopic surgery along with posterior percutaneous instrumentation provides a minimally invasive surgical option in multimorbid patients and/or in early stages of the disease, reducing the surgical trauma, complications and fastening the recovery. Conclusion: Spondylodiscitis is a highly heterogeneous disease, remaining its diagnosis and treatment a J Spine Res Surg 2021; 3 (1): 001-009 Journal of Spine Research and Surgery 2 complex challenge. With this case report the authors expect to raise awareness to the use of minimally invasive techniques in treating diseases of this type.
Postoperative Lumbar Pyogenic Spondylodiscitis: An Institutional Review
2019
Background Postoperative discitis (POD) remains a dreaded complication in the present era of asepsis. The treatment has been traditionally conservative, but the safety of spinal implants in infective settings has prompted the surgeons to provide rigid immobilization for promoting healing. A major concern in a country like ours is huge patient inflow and long waiting list added to the woe of patient's refusal for a second operative intervention after a first undesirable outcome. Objectives The aim of the study was to evaluate the functional and radiological outcome of conservative management of POD and determine the methods of prevention. Settings and Design A retrospective case study series in a tertiary-level hospital. Materials and Methods Between January 2015 and 2017, 12 cases of POD (10 own and 2 referred) were managed and followed up clinically, radiologically, and with laboratory investigation. Two cases were managed surgically—one with kyphotic deformity and the o...
Medical and Surgical Management of Pyogenic and Nonpyogenic Spondylodiscitis
Contemporary Neurosurgery, 2004
The differential diagnosis for pyogenic spondylodiscitis includes inflammatory, neoplastic, degenerative, and granulomatous processes. Inflammatory diseases such as pyelonephritis, appendicitis, abdominal abscesses, and infarction may have a clinical presentation similar to that of spondylodiscitis. Tumors of the spine, whether primary or metastatic, sometimes simulate the radiologic picture of infection. In general, however, spinal infections involve the disc, whereas neoplasms involve the vertebrae and spare the disc. Degenerative diseases, including disc herniation and osteoporosis with vertebral collapse, also should be considered. Differentiating pyogenic spondylodiscitis from granulomatous spondylodiscitis can be difficult, especially if cultures are negative. Other nontuberculous granulomatous infections involving the spine have been reported and must be considered in the differential diagnosis, including brucellosis, aspergillosis, Candida tropicalis infection, blastomycosis, and coccidioidomycosis. Complications The complications associated with pyogenic spondylodiscitis vary with the level of the spine involved and are related to the extension of the process to the surrounding tissues. The cervical spine is involved in 6.5% of spinal infections, whereas thoracic involvement has been reported to occur in 35% of cases. These infections occasionally can lead to pharyngeal abscess and mediastinitis (Fig. 1A). Epidural abscess, subdural abscess, meningitis, loss of lordosis, segmental collapse with subsequent spinal instability, and progressive neurological impairment may occur at any level. Isolated posterior element involvement is rare. Management and Outcome Spondylodiscitis usually is not recognized at an early stage, when the treatment is simple and effective, due to the nonspecific nature of the symptoms at the onset of the disease. Early diagnosis is based on a high level of suspicion with emphasis on the following: existing infectious focus; the presence of risk factors such as increased age, diabetes mellitus, rheumatoid arthritis, corticosteroid use, ethanol abuse, immunosuppression, intravenous drug abuse, infectious endocarditis, and recent surgical or invasive diagnostic spinal procedure; localized spinal pain with paravertebral muscle spasm, limitation of movement, and evidence of neurological deficit; results of laboratory studies, including erythrocyte sedimentation rate (ESR), white blood cell count, blood cultures, purified protein derivative test, C-reactive protein, and direct cultures through fine needle or open biopsy; and imaging studies.
International Journal of Spine Surgery, 2021
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 6 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.
2016
Study design: A prospective study in single-institution, single-surgeon review. Objective: To analyze the outcome of posterior instrumentation and interbody debridement and fusion in managing lumbar pyogenic spondylodiscitis. Summary of Background Data: Several management methods for pyogenic spondylitis have been reported, of which posterior surgical treatment with pedicle screws and debridement and decompression is one of the common methods of management with short and long segment stabilization. There are limited reports regarding the efficacy of posterior only approach with pedicle screw instrumentation involving the inflamed segments. Methods: 32 patients with lumbar pyogenic spondylodiscitis who underwent posterior decompression and lumbar interbody fusion with bone graft and pedicle screw instrumentation including the affected segment and a level above and below were included. Postoperative recovery of neurology, ambulation and back ache score were examined for a period of 12 month. Serological infection control, radiological fusion and spinal alignment were investigated in the two monthly follow up. Results: In all 32 patients successful treatment was achieved without any recurrence or spread of infection. Erythrocyte sedimentation rate and C-reactive protein levels were seen normalized with an average of75 days and 30 days respectively. On an average ambulation with brace was started at 2.5 days following surgery. Radiological signs of interbody fusion were noted in all the cases at a mean of 5.2 months. Average of the spinal alignment of the fixed segments became 2 degree of preop lordosis was achieved to 10 degree of postop lordosis and was maintained in the 12 months follow up. None of the patients had any signs of implant loosening or failure. Conclusion: Debridement and interbody fusion with bone graft and posterior instrumentation of the affected segment and a level above and below is an effective method and achieves good clinical outcome and maintenance of radiological spinal alignment in lumbar pyogenic spondylodiscitis.
Pyogenic spondylodiscitis: An overview
Journal of Infection and Public Health, 2010
Although uncommon, spontaneous and postoperative pyogenic spondylodiscitis entail major morbidity and may be associated with serious long-term sequelae. A review of the literature was done to advance our understanding of the diagnosis, treatment, and outcome of these infections. The principles of conservative treatment are to establish an accurate microbiological diagnosis, treat with appropriate antibiotics, immobilize the spine, and closely monitor for spinal instability and neurological deterioration. The purpose of surgical treatment is to obtain multiple intraoperative cultures of bone and soft tissue, perform a thorough debridement of infected tissue and decompression of neural structures, and reconstruct the unstable spinal column with bone graft with or without concomitant instrumentation. Appropriate management requires aggressive medical treatment and, at times, surgical interventions. If recognized early and treated appropriately, a full recovery can often be expected. Therefore, clinicians should be aware of the clinical presentation of such infections to improve patient outcome.
Medicine, 2015
The aim of this study is to report our 39 patients treated with anterior debridement and autologous iliac bone grafting with or without anterior instrumentation, which is the presumed treatment of choice for thoracic or lumbar spondylodiscitis. Our patients underwent surgical treatment of spondylodiscitis using anterior debridement and autologous iliac bone grafting with or without anterior instrumentation and were analyzed with a mean follow-up of 8 years (range, 2-11 years). Kaneda 2-rod system instrumentation was used in 12 patients, in total. Clinical outcomes were assessed by the Frankel grade. Radiographic fusion was characterized based on 3dimensional computed tomography. Of the whole group, 20 patients suffered from tuberculous spondylodiscitis and 19 suffered from hematogenous spondylodiscitis. Pathogens responsible for pyogenic infection included Staphylococcus aureus (4 patients), Pseudomonas aeruginosa (3 patients), and Brucella melitensis (1 patient). Fifteen patients had thoracic involvement, 20 had lumbar involvement, and 4 had thoracolumbar junction involvement. Preoperative neurological deficits were noted in 13 of the 39 patients. In terms of Frankel grade, 8 patients have improved, 4 have remained the same, and 1 patient has worsened during the follow-up period. Imagingdocumented fusion was achieved in 23 of 27 patients in the graft group (85% fusion rate) and 11 of 12 patients in the graft þ Kaneda instrumentation group (91% fusion rate). There was no instrumentation failure, loosening, or graft-related complication such as slippage or fracture of the graft. This approach demonstrated a good recovery rate of neurological functions and a high fusion rate.
BMC musculoskeletal disorders, 2017
Pyogenic spondylodiscitis is a form of spinal infection that can result in severe back pain and even death. However, information is lacking on the relative effectiveness of various therapies. A retrospective chart review was conducted to investigate whether early surgical treatment of pyogenic spondylodiscitis coupled with intravenous antibiotics results in better patient prognoses than intravenous antibiotics therapy alone. All patients treated for pyogenic spondylodiscitis at a single medical center from July 2006 to July 2011 were retrospectively reviewed. The inclusion criteria consisted of diagnosis of an early stage infection without neurological deficit, and patients without severe sepsis who were suitable candidates for early surgery as determined by a Pittsburgh bacteremia score < 4, and patients with delayed diagnosis and lost to outpatient follow-up were excluded. Clinical outcomes included patient demographic data, kyphosis angle, length of treatment, Oswestry Disabil...
Neurosurgical Management and Outcome Parameters in 237 Patients with Spondylodiscitis
Brain Sciences
Surgical treatment of spondylodiscitis allows for rapid mobilization and shortens hospital stays, which makes surgical treatment the first-line therapy. We aim to describe our experiences with operative treatment on spondylodiscitis and to determine the parameters that are important in the prediction of outcomes. A retrospective review identified 237 patients who were operatively treated for spondylodiscitis in our institution between January 2010 and December 2018. Clinical data were collected through review of electronic records and relevant imaging. In all cases, contrast-enhancing MRI from the infected region of the spine was obtained. Leukocyte count and C-reactive protein concentrations (CRP) were determined in all the patients. We included 237 patients in the study, 87 female (36.7%) and 150 male (63.3%), with a mean age of 71.4 years. Mean follow-up was 31.6 months. Forty-five patients had spondylodiscitis of the cervical, 73 of the thoracic, and 119 of the lumbosacral spine...
EFORT open reviews, 2017
Spondylodiscitis may involve the vertebral bodies, intervertebral discs, paravertebral structures and spinal canal, with potentially high morbidity and mortality rates.A rise in the susceptible population and improved diagnosis have increased the reported incidence of the disease in recent years.Blood cultures, appropriate imaging and biopsy are essential for diagnosis and treatment.Most patients are successfully treated by conservative means; however, some patients may require surgical treatment.Surgical indications include doubtful diagnosis, progressive neurological deficits, progressive spinal deformity, failure to respond to treatment, and unresolved pain. Cite this article: 2017;2:447-461. DOI: 10.1302/2058-5241.2.160062.