Management of Pyogenic Spondylodiscitis Following Nonspinal Surgeries: A Tertiary Care Center Experience (original) (raw)
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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.
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...
Epidemiological and clinical features of pyogenic spondylodiscitis
European review for medical and pharmacological sciences, 2012
Pyogenic spondylodiscitis (PS) is an uncommon but important infection, that represents 3-5% of all cases of osteomyelitis. The annual incidence in Europe has been estimated to be from 0.4 to 2.4/100,000. A has been reported, with peaks at age less than 20 years and in the group aged 50-70 years. The incidence of PS seems to be increasing in the last years as a result of the higher life expectancy of older patients with chronic debilitating diseases, the rise in the prevalence of immunosuppressed patients, intravenous drug abuse, and the increase in spinal instrumentation and surgery. PS is in most cases a hematogenous infection. Staphylococcus aureus is the most frequent causative microorganism, accounting for about one half of the cases of PS. Gram-negative rods are causative agents in 7-33% of PS cases. Coagulase-negative staphylococci (CoNS) have been reported in 5-16% of cases. Staphylococcus epidermidis is often related to post-operative infections and intracardiac device-relat...
Appropriate duration of post-surgical intravenous antibiotic therapy for pyogenic spondylodiscitis
BMC Infectious Diseases, 2018
Background: Most guidelines recommend 6 to 12 weeks of parenteral antibiotic treatment for pyogenic spondylodiscitis. When surgical debridement is adequately performed, further intravenous antibiotic treatment duration can be reduced than that of conservative treatment alone theoretically. However, the appropriate duration of post-surgical parenteral antibiotic treatment is still unknown. This study aimed to identify the risk factors of recurrence and evaluate the appropriate duration after surgical intervention. Methods: This 3-year retrospective review included 102 consecutive patients who were diagnosed with pyogenic spondylodiscitis and underwent surgical intervention. Recurrence was defined as recurrent signs and symptoms and the need for another unplanned parenteral antibiotic treatment or operation within one year. This study included two major portions. First, independent risk factors for recurrence were identified by multivariable analysis, using the database of demographic information, pre-operative clinical signs and symptoms, underlying illness, radiographic findings, laboratory tests, intraoperative culture results, and treatment. Patients with any one of the risk factors were considered high-risk; those with no risk factors were considered low-risk. Recurrence rates after short-term (≤3 weeks) and long-term (> 3 weeks) parenteral antibiotic treatment were compared between the groups. Results: Positive blood culture and paraspinal abscesses were identified as independent risk factors of recurrence. Accordingly, 59 (57.8%) patients were classified as low-risk and 43 (42.2%) as high-risk. Among the high-risk patients, a significantly higher recurrence rate occurred with short-term than with long-term antibiotic therapy (56.2% vs. 22. 2%, p = 0.027). For the low-risk patients, there was no significant difference between short-term and long-term antibiotic therapy (16.0% vs. 20.6%, p = 0.461). Conclusions: The appropriate duration of parenteral antibiotic treatment in patients with pyogenic spondylodiscitis after surgical intervention could be guided by the risk factors. The duration of postoperative intravenous antibiotic therapy could be reduced to 3 weeks for patients without positive blood culture or abscess formation.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 1999
We studied 31 cases of postoperative pyogenic spondylodiskitis (POS), comparing them with 72 cases of nonpostoperative pyogenic spondylodiskitis (NPOS). POS represents 30.1% of cases of pyogenic spondylodiskitis. The onset of symptoms occurred an average (+/-SD) of 27.7 (+/- 25.3) days following surgery. Predisposing factors were less frequent in POS than NPOS cases (P = .002). Neurological complications and inflammatory signs in the spine were more frequent with POS than with NPOS (P = .002 and P < .00001). Coagulase-negative Staphylococcus and anaerobic bacteria were more frequent in POS than in NPOS (P = .0001 and P = .05). Percutaneous bone biopsies yielded the etiology in 66.7% of cases, open bone biopsies in 100%, blood cultures in 55.6%, and cultures of adjacent foci in 94.4%. Eleven patients (35.5%) were cured with antimicrobial treatment, but surgical treatment was necessary in 64.5%. No relapses or deaths were recorded. Seventeen patients (54.8%) had severe functional s...
Surgical strategies in spondylodiscitis due to lumbar disc surgery
Turkish Neurosurgery, 2015
Whereas advanced age, immunosuppression, spinal trauma, chronic renal failure and diabetes mellitus are the individual risk factors that cannot be changed in infection pathogenesis, obesity, smoking, invasive catheters and prolonged hospital stay are among the factors that can be changed. Exposure of the surgical area to the radiation, malignancy and chemotherapy also increase the postoperative infection risk (9). █ INTRODUCTION T he complication rates of spinal surgery have increased in recent years together with the increase in spinal surgery (15). The number of postoperative spondylodiscitis cases has also increased due to the increase both in surgery for the aged population and in the number of immunosuppressed cases (4,6). AIm: Despite different surgical treatment protocols at different centers for spondylodiscitis due to lumbar surgery, there is no consensus on its surgical indications. In this study, we aimed to clarify the steps to be followed in the management and treatment of postoperative spondylodiscitis. mATERIAl and mEThODS: The data of 20 cases with postoperative spondylodiscitis were evaluated. C-reactive protein (CRP) was used for diagnosis and follow-up. According to culture results of the infected material obtained from the operated cases, appropriate antibiotic treatment was initiated. In non-operated cases, parenteral empirical antibiotic treatment was implemented. Surgical treatment was planned for cases with clinical and radiological instability, abscess on imaging and those who were nonrespondent to empirical antibiotic treatment. For the cases that clinically recovered and had normal CRP levels, oral antibiotic treatment was continued after parenteral antibiotic treatment. RESUlTS: Of the cases; 13 were male (65%) and 7 were femals (35%). The mean age was 56.3 years (32-74). The most prevalent complaints in referral were waist and leg pain. Except one, all cases had increased CRP levels. All patients had spondylodiscitis on magnetic resonance imaging. Seven had radiological and clinical instability and 3 had epidural abscess. The most commonly growing microorganism in culture was Staphylococcus aureus. Surgical treatment was applied to seven cases and medical treatment to 13 cases. CONClUSION: In cases with waist pain in the postoperative period, the first potential diagnosis to be considered is spondylodiscitis. Surgical treatment should be implemented for cases resistant to empirical antibiotic treatment, with abscess on imaging, or with lumbar instability.
Percutaneous endoscopic discectomy might be effective in selected cases of pyogenic spondylitis
Journal of Orthopaedic Surgery, 2019
Background: Percutaneous endoscopic discectomy (PED) has been reported to be an effective procedure and minimally invasive surgical therapy for various spinal pathologies. Objective: To evaluate the clinical outcome of patients with pyogenic spondylitis who were treated with PED. Methods: Twenty-four patients with pyogenic spondylitis who underwent PED were evaluated for medical history, level of the affected intervertebral space, mode of onset, plain radiographs, epidural or psoas abscesses on MRI, results of blood and intraoperative sample cultures, preoperative C-reactive protein (CRP) level, time until postoperative CRP normalization (CRP < 0.3), and any additional surgery. Patients who underwent additional surgery and showed uncontrollable inflammation were considered to have “failed” PED for pyogenic spondylitis. To elucidate the factors that were significantly associated with a failure of PED for pyogenic spondylitis, statistical analyses were conducted by univariate analy...
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.
Epidemiologic Features and Surgical Treatment of Spontaneous Pyogenic Spondylodiscitis in Bangladesh
Bangladesh Journal of Neurosurgery
Background: Spontaneous pyogenic spondylodiscitis is an uncommon clinical condition. But in our country it is not infrequent. High level of clinical suspicion is necessary for diagnoses of spontaneous pyogenic spondylodiscitis. There is no study regarding this issue in Bangladesh. Objective: The objective of this study was to see the epidemiological feature and types of surgical treatment of spontaneous pyogenic spondylodiscitis in Bangladesh Materials and Methods: This is a retrospective observational study. This study was done in the Department of Neurosurgery, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh. The study period was January, 2016 to July, 2021 for a period of 5.5 years. 17 patients who were undergone surgery included in the study. The data were collected from questionnaires and hospital records and analyzed. Results: In our study the highest incidence was found in 4th (23.52%) and 6th (29.42%) decade of life which was around 53%. The male to femal...