Advantages of IT-based clinical pathways in surgical treatment of non-specific spondylodiscitis

Homagk, N; Jarmuzek, T.; Meisel, Hans-Joerg; Hofmann, Gunther O.; Homagk, L.

doi:10.5430/jha.v5n6p19

Cited by 3 publications

(3 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In most cases, its use is rational to visualize bone destruction and verify abscesses using intravenous contrast. In addition, the combination of CT and MRI diagnostics enables the visualisation of vertebral bodies, spinal cord, ligaments in more detail [20][21][22].…”

Section: Methodsmentioning

confidence: 99%

Early Imaging and Course-of-Disease Control Markers of Pyogenic Vertebral Osteomyelitis

Bohdan¹,

Plakhtyr²,

Bohdan³

2021

PSSS MS

View full text Add to dashboard Cite

Background. The diagnosis of early pyogenic vertebral osteomyelitis is essential for prompt determination of treatment strategy and prevention of suppurative-destructive complications, although the nonspecifi c clinical manifestation obstructs timely disease detection. Aim. To analyse the clinical accuracy of various radiological imaging methods for early detection and control over vertebral osteomyelitis course Materials and methods. A retrospective study of standardized clinical data of patients (N = 54) who underwent treatment at the Neurosurgery Department of the MМCC WR between 2010 and 2020 was carried out. Patients were observed for 12–36 months. Study fi ndings and discussion. Our study revealed that during radiological imaging, infl ammatory changes in the vertebrae specifi c to osteomyelitis were not found in any case, which signifi cantly delays the diagnosis. The study analysed and grouped radiological signs of the infl ammatory process spread in the vertebrae in case of spondylodiscitis by CT and MR stages. Spondylodiscitis was diagnosed by CT of the spine in the late third stage only in 29.0 % of patients. Nonspecifi c destructive changes of vertebrae were detected in 51.6% of persons, which required additional MRI examination to establish the diagnosis. In 19.4% of those examined in the presence of the fi rst MR stage, no specifi c CT signs of osteomyelitis were found. MRI scan of the spine is the main specifi c (93 %), accurate (94 %) and sensitive (97 %) method for early detection of pyogenic osteomyelitis. Although according to the world literature, MRI is not sensitive enough to assess the dynamics of the infl ammatory process in the spine, the progressive increase in signal intensity of vertebral cortex on T1-weighted images within aff ected vertebrae correlates well with infl ammation resolving and C-reactive protein (CRP) level normalization. We described this radiological sign as a «vertebral rim» phenomenon (VRP). In our study, a reliable correlation was found between CRP level and the «vertebral rim» phenomenon on MRI. Conclusions. For early detection of pyogenic vertebral osteomyelitis, MRI examination is the main specifi c and sensitive method. We suggest combining the CRP level and «vertebral rim» sign in practice as dynamics of spondylodiscitis markers and justifi cation of antibacterial therapy strategy.

show abstract

Section: Methodsmentioning

confidence: 99%

Early Imaging and Course-of-Disease Control Markers of Pyogenic Vertebral Osteomyelitis

Bohdan¹,

Plakhtyr²,

Bohdan³

2021

PSSS MS

View full text Add to dashboard Cite

show abstract

“…Im Rahmen der Diskussionen um eine angemessene und sichere konservative und/oder chirurgische Behandlung von Patienten mit nicht spezifischer Spondylodiszitis wurden elektronisch dokumentierte klinische Behandlungspfade (Pathways) entwickelt, für die auch entsprechende "Severity Codes" definiert wurden [80,81]. In einer Untersuchung an 250 Patienten wurde sowohl für die konservative als auch für die operative Behandlung von Patienten mit unterschiedlichen Graden der Spondylodiszitis belegt, dass ein derartig standardisiertes Prinzip dazu beitragen kann, für die Betroffenen eine verbesserte Lebensqualität zu erreichen und eine übermäßig unnütze Behandlung zu vermeiden [82].…”

Section: Diagnostik Mit Bildgebenden Verfahrenunclassified

Spondylitis – Spondylodiscitis – an Update

et al. 2018

View full text Add to dashboard Cite

Spondylodiscitis is an infection of the intervertebral disc with subsequent infection of the adjacent vertebral bodies. The main causes are 3 pathogen groups: bacteria, particularly tuberculosis pathogens, fungi and parasites. In pyogenic spondylodiscitis, infections with Staphylococcus aureus are the most common, with an incidence of up to 80%. Mortality is around 2 - 3%. Infections with tuberculosis are often associated with psoas and paravertebral abscesses. Neurological deficits are registered in up to 50% of patients. For microbiological diagnostic testing, blood cultures are used for aerobic and anaerobic bacteria. However, histological examination leads significantly more frequently to positive pathogen detection. In tissue samples, results with 16S rRNA PCR results are clearly superior to results from microbiological examination. The MRI exhibits high sensitivity and specificity and is therefore superior to other radiological methods. Elimination of the infection, pain reduction and stabilisation of the spine are the main objectives of any treatment. A standardised antibiotic therapy for spondylodiscitis has not been clearly defined. Pathogen detection is important, with focused antibiotic therapy. Antibiotic therapy should initially be administered intravenously for 2 - 4 weeks. This should be followed by oral administration for 6 - 12 weeks. In the case of antibiotic-resistant infections with neurological deficiencies, it is recommended to perform a surgical procedure, with careful debridement and instrumentation as well as i. v. administered antibiotics for 3 weeks followed by three month oral antibiotic treatment. Surgical procedures are indicated with neurological deficits, progressive increase in spinal deformities, failure of conservative therapy with insufficient pain relief and unreliable pathogen identification. The selection of the surgical procedure should mainly be based on the extent and localisation of bone destruction and the individual circumstances of the patients. The prognosis is good if there is a clear reduction in CRP and ESR in the first few weeks.

show abstract

“…Gerade betriebswirtschaftliche Aspekte müssen in der Therapieplanung zunehmend Berücksichtigung finden. Daher sind elektronisch basierte Therapieplanungen, die zudem eine Therapiedauer und -kostenschätzung erlauben, zur Dezidierung betriebswirtschaftlicher Fragen vorteilhaft [43].…”

Section: Diskussionunclassified

Die schweregradorientierte Therapie der Spondylodiszitis – eine prospektive Betrachtung anhand von elektronisch basierten Behandlungspfaden

et al. 2017

View full text Add to dashboard Cite

Spondylodiscitis is a rare but serious infection of the spine. Recognised methods of treatment include immobilisation and systemic antibiotics. However, available data for specific and recommendations for continuing treatment are also rare. The aim of the present study is the optimisation of the therapy of spondylodiscitis using a clinical pathway that depends on a classification of spondylodiscitis. From 1 October 1998 to 31 December 2013, a classification of the severity of spondylodiscitis was established, including specific treatment recommendations. As part of the re-evaluation, the classification of severity was adapted. On this basis, electronically based clinical pathways were developed. A total of 296 cases were included. With a steadily increasing number of treatments, the mean age of the patients increased to 67.3 years. In 34.3% of these patients, spondylodiscitis developed spontaneously and 68.6% of patients did not receive treatment until the diagnosis. In the context of the specific treatment, pain intensity decreased from 6.0 to 3.1 NRS (numeric rating scale). The inflammatory values (CRP) decreased from 119.2 to 46.7 mg/dl. The time from the onset of symptoms to the surgical treatment was almost 65.6 days and has not changed significantly. Nevertheless, the time from admission to surgical treatment could be reduced to less than 3 days. The classification of patients into 3 degrees of severity of spondylodiscitis (SSC) depends on the SponDT: spondylodiscitis diagnosis and treatment. The SponDT describes vertebral destruction and the current neurological status. The severity-adapted therapy was mapped electronically and includes specific surgical care, systemic antibiotic therapy and physical therapy.

show abstract

Advantages of IT-based clinical pathways in surgical treatment of non-specific spondylodiscitis

Cited by 3 publications

References 26 publications

Early Imaging and Course-of-Disease Control Markers of Pyogenic Vertebral Osteomyelitis

Early Imaging and Course-of-Disease Control Markers of Pyogenic Vertebral Osteomyelitis

Spondylitis – Spondylodiscitis – an Update

Die schweregradorientierte Therapie der Spondylodiszitis – eine prospektive Betrachtung anhand von elektronisch basierten Behandlungspfaden

Contact Info

Product

Resources

About