Comparative study of postoperative and spontaneous pyogenic spondylodiscitis

Dufour, Véronique; Feydy, A.; Rillardon, L.; Redondo, A; Page, L. Le; Bert, Frédéric; Belmatoug, Nadia; Fantin, Bruno

doi:10.1016/j.semarthrit.2004.08.004

Cited by 91 publications

(74 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In most of the reports, the average incidence is 1% after simple discectomy [10]. The most common etiology of postoperative spondylodiscitis is bacterial infection [6,11], but responsible pathogens include bacteria and fungi [12].…”

Section: Incidencementioning

confidence: 99%

Postoperative spondilodiscitis

Gerometta

Bittan

Olaverri

2012

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Introduction Postoperative spondylodiscitis is a primary infection of the nucleus pulposus with secondary involvement of the cartilaginous endplate and vertebral bone. Although uncommon, postoperative spondylodiscitis causes major morbidity and may be associated with serious long-term sequelae. Several risk factors had been identified, including immunosuppression, obesity, alcohol, smoking, diabetes and malnutrition. Materials and methods A review of the literature was done to analyse the diagnosis, treatment and prevention of postoperative spondylodiscitis. Results We found that the principles of conservative treatment are to establish an accurate microbiological diagnosis, treat with appropriate antibiotics, immobilise the spine, and closely monitor for spinal instability and neurological deterioration. The purpose of surgical treatment is to obtain multiple cultures of bone and soft tissue, perform a thorough debridement of infected tissue, decompress neural structures, and reconstruct the unstable spinal column with bone graft with or without concomitant instrumentation. Conclusions Appropriate management requires aggressive medical treatment and, at times, surgical intervention. If recognised 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. A review of the literature was done to advance our understanding of the diagnosis, treatment, prevention and outcome of these infections.

show abstract

Section: Incidencementioning

confidence: 99%

Postoperative spondilodiscitis

Gerometta

Bittan

Olaverri

2012

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…These organisms generally account for over 80% of all positive cultures (6,8). Although gram-positive organisms account for the majority of cases and will be appropriately treated by standard antistaphylococcal therapy, our patient highlights the need for a definitive diagnosis, by either conventional or molecular methods, so that appropriate antimicrobial therapy can be administered.…”

mentioning

confidence: 90%

Veillonella parvula Discitis and Secondary Bacteremia: a Rare Infection Complicating Endoscopy and Colonoscopy?

2007

View full text Add to dashboard Cite

We report a case of Veillonella parvula lumbar discitis and secondary bacteremia confirmed by molecular characterization of the 16S rRNA genes. Identification of the organism was essential for an appropriate choice of antimicrobial therapy following the failure of empirical flucloxacillin. Veillonella spp. are normal flora of the gastrointestinal tract, raising the possibility that an endoscopy and colonoscopy performed 8 weeks prior to presentation, during which small intestinal and rectal biopsies were obtained, was the portal of entry. This case highlights the importance of obtaining a microbiologic diagnosis, particularly in patients who previously have had procedures involving instrumentation. CASE REPORTA 55-year-old school headmaster presented to the Emergency Department of St. Vincent's Hospital, Sydney, Australia, with a 48-h history beginning with the sudden onset of severe lower back pain. There was no history of injury or trauma. The pain was associated with night sweats, and he described an episode of shaking consistent with rigors. There was no significant past medical history and no recent dental procedure was reported. He had undergone a routine endoscopy and colonoscopy for a slight change in bowel habits 2 months prior to presentation. There were no abnormal findings, but a small bowel biopsy and a rectal biopsy were obtained to exclude celiac disease and histologic colitis.On examination, the patient was initially afebrile, although his temperature rose to 38°C that night. No heart murmurs were present, and there were no peripheral stigmata of infective endocarditis. Dentition was normal, and no gingivitis was noted. Severe back pain was precipitated by minimal movement of the legs and trunk.On examination, moderate tenderness was noted over the lumbar spine and left lumbar paravertebral region. The neurological examination was limited by pain but was considered to be normal. The neutrophil count was 4.6 ϫ 10 9 /liter, but the erythrocyte sedimentation rate was 68 mm/h and the C-reactive protein (CRP) level was 211 mg/liter. An X-ray examination of the lumbar spine revealed degenerative changes at L3, L4, and L5. During the next 12 h the pain worsened, requiring narcotic analgesia, and urinary retention developed, necessitating bladder catheterization and an indwelling catheter. Two sets of blood cultures were collected, and antimicrobial therapy was withheld pending a magnetic resonance imaging scan, which was performed 18 h after admission. The magnetic resonance imaging scan revealed multilevel disc destruction with posterior disc extrusions most severe at the L2/3 level, resulting in compression of the thecal sac and central canal stenosis at this level. No bony destruction was noted.Blood cultures remained negative 48 h after admission. A computed tomography-guided biopsy of the L2/3 disc was undertaken, with three fine-needle aspirate biopsies obtained using a 22-gauge needle. Following the biopsy, the patient was started on flucloxacillin and given a single 1-g dose of ceftriaxone. With...

show abstract

“…Because the choice of antibiotic depends on the etiologic microorganism, it is important to identify the pathogen. Most PVO patients have one or more of the following: fever, leukocytosis, and elevation of inflammatory markers, such as C-reactive protein and erythrocyte sedimentation rate (1,2,5,8,11). As a result, empirical antibiotics are frequently used before a specimen is obtained for culture (14).…”

mentioning

confidence: 99%