Nonspecific Spondylodiscitis in Adults: Retrospective Study (original) (raw)
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Spondylodiscitis: evaluation of patients in a tertiary hospital
The Journal of Infection in Developing Countries, 2014
Introduction: Spondylodiscitis (SD) is an uncommon but important infection. The aim of this work was to study the risk factors, bacteriological features, clinical, laboratory and radiological findings of SD, and to shed light on the initial treatment. Methodology: A total of 107 patients who underwent treatment for SD were evaluated. The diagnosis of SD was defined by clinical findings, complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum tube agglutination (STA) test, Ziehl-Neelsen staining, culture, histopathology, and radiological methods such as magnetic resonance imaging (MRI) and computed tomography (CT) scans. Results: Of the 107 cases, ranging between 17 to 83 years of age, 64 (59.8%) were male. Twenty-seven (25.2%) patients had diabetes mellitus. Laboratory investigations revealed elevated CRP in 70 (65%) patients, elevated ESR in 65 (61%) patients, and elevated white blood cell (WBC) counts in 41 (38.3%) patients. Thirty-six (33.6%) patients were identified as having brucellar SD, and 5 (4.7%) patients were identified as having tuberculous SD. A total of 66 (61.6%) patients were determined to have pyogenic SD. The most frequently isolated microorganism was Staphylococcus aureus. Antibiotic therapy was given intravenously to all pyogenic SD patients. Conclusions: The incidence of SD has increased as a result of the higher life expectancy of older patients with chronic debilitating diseases and the increase of spinal surgical procedures. In patients with low back pain, SD should be considered as a diagnosis. For effective treatment, it is important to determine the etiology of the disease.
Spontaneous Spondylodiscitis - Epidemiology, Clinical Features, Diagnosis and Treatment
Folia Medica
Spontaneous spondylodiscitis is a rare but serious infectious disease which is a combination of an inflammatory process, involving one or more adjacent vertebral bodies (spondylitis), the intervertebral discs (discitis) and finally - the neighboring neural structures. In most cases the condition is due to a hematogenous infection and can affect all regions of the spinal cord, but it is usually localized in the lumbar area. The most common clinical symptom is a pronounced, constant and increasing nocturnal paravertebral pain, while consequently different degrees of residual neurological symptoms from nerve roots and/or spinal cord may appear. The disease course is chronic and the lack of specific symptoms often prolongs the time between its debut and the diagnosis. This delay in diagnosis determines its potentially high morbidity and mortality. Treatment is conservative in cases with no residual neurological symptoms and consists of antibiotic therapy and immobilization. Surgical tre...
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.
Spondylodiscitis: update on diagnosis and management
Journal of Antimicrobial Chemotherapy, 2010
Spondylodiscitis, a term encompassing vertebral osteomyelitis, spondylitis and discitis, is the main manifestation of haematogenous osteomyelitis in patients aged over 50 years. Staphylococcus aureus is the predominant pathogen, accounting for about half of non-tuberculous cases. Diagnosis is difficult and often delayed or missed due to the rarity of the disease and the high frequency of low back pain in the general population. In this review of the published literature, we found no randomized trials on treatment and studies were too heterogeneous to allow comparison. Improvements in surgical and radiological techniques and the discovery of antimicrobial therapy have transformed the outlook for patients with this condition, but morbidity remains significant. Randomized trials are needed to assess optimal treatment duration, route of administration, and the role of combination therapy and newer agents.
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.
Spondylodiscitis. A retrospective study of 163 patients
Acta Orthopaedica, 2008
Background and purpose Spondylodiscitis may be a serious disease due to diagnostic delay and inadequate treatment. There is no consensus on when and how to operate. We therefore retrospectively analyzed the outcome of a large series of patients treated either nonoperatively or surgically.
Infectious spondylodiscitis: has there been any evolution in the diagnostic and treatment outcomes?
Coluna/Columna, 2014
Objective: To evaluate the clinical and radiological results of treatment of patients with spondylodiscitis. Methods: Imaging exams used in this study were plain radiographs and magnetic resonance imaging of the spine. Results: Data from 33 patients, 10 (30.3%) females and 23 (69.7%) males were evaluated. The average time to diagnosis was four months and 28 days (SD ± 1 month and 28 days) and 19 patients (57.5%) presented neurological deficit. Surgical treatment was performed in 22 patients (66.6%) and three patients (9.1%) had complications from the surgery. Conclusions: Despite technological advances in complementary exams, early diagnosis of spondylodiscitis remains a challenge. However, drug treatment associated with surgery shows good results.
Spontaneous spondylodiscitis: presentation, risk factors, diagnosis, management, and outcome
International Journal of Infectious Diseases, 2009
Background: Spontaneous spondylodiscitis is an uncommon disease, which may result in serious complications with potentially high morbidity and mortality. We conducted a prospective case study over a 2-year period in order to analyze the clinical features, approaches to management, and outcome of spondylodiscitis. Methods: Eight consecutive patients (four men, four women; age range 53-82 years) suffering from spondylodiscitis were identified during the study period. Parameters recorded included: demographics, past medical history, predisposing factors, presenting signs and symptoms, spinal level and extension of the infection, laboratory indices of inflammation, microbiological testing, radiological assessment, kind and duration of treatment, follow-up magnetic resonance imaging (MRI) studies, and outcome. Results: Duration of symptoms varied from 14 to 90 days. All patients had back pain; fever !38 8C was present in 5/8 (62.5%) and neurological findings in 6/8 (75%). Diabetes mellitus was identified in six (75%). Most of the patients had elevated laboratory markers of inflammation. At the initial MRI, 12 anatomical levels were found. The microorganism was identified in 7/8 by blood or bone marrow cultures (50% Staphylococcus aureus). None of the patients underwent surgical intervention. Seven patients (87.5%) recovered to full activity; follow-up MRI study results were not always in parallel with the clinical improvement of patients. Conclusions: Spontaneous spondylodiscitis should be considered in every patient with back pain accompanied by fever and laboratory markers of inflammation. The major predisposing risk factor seems to be uncontrolled diabetes.
Management of Patients with Spondylodiscitis: An Overview
2021
Background:Spinal infections can be described etiologically as pyogenic, granulomatous (tuberculous, brucellar, fungal) and parasitic spondylodiscitis, a term encompassing vertebral osteomyelitis, spondylitis and discitis, which are considered different manifestations of the same pathological process; epidural abscess, which can be primary or secondary to spondylodiscitis and facet joint arthropathy.When infection affects the intervertebral disc, the term to describe this condition is usually spondylodiscitis. If invades the endplates or the vertebral body, the infection is more correctly designated for vertebral osteomyelitis or spondylitis. However, at the time of diagnosis in many cases, the infection has already compromised these two structures; therefore, both terms are frequently used.Conservative treatment is the standard of care for patients with spondylodiscitis, using multidisciplinary approaches involving microbiologists, infectious disease consultants, anaesthetists, int...