First report on treating spontaneous infectious spondylodiscitis of lumbar spine with posterior debridement, posterior instrumentation and an injectable calcium sulfate/hydroxyapatite composite eluting gentamicin: a case report

Bostelmann, Richard; Steiger, Hans Jakob; Scholz, A

doi:10.1186/s13256-016-1125-y

Cited by 9 publications

(4 citation statements)

References 22 publications

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“…Although a previous case series showed resolution of appendicular bacterial osteomyelitis in five of five canines treated with tobramycin‐impregnated beads, no known veterinary reports have described the successful use of debridement and local antimicrobial therapy alone in the treatment of pathologic vertebral fracture. A single case report in the human neurosurgical literature (published after presentation of the current case) supports the use of a combination approach, describing minimally invasive debridement, transpedicular screw‐rod fixation, and injection of a calcium sulfate hydroxyapatite composite designed to elute gentamicin for treatment of infectious spondylodiscitis.…”

Section: Discussionmentioning

confidence: 66%

Surgical intervention for vertebral osteomyelitis in a calf

et al. 2019

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Objective: To report the surgical treatment and outcome of a non-ambulatory calf with cervical vertebral ostoeomyelitis. Study design: Clinical report. Sample population: One 3.5-month-old female mixed-breed calf with tetraparesis of 3 months duration. Methods: After computed tomography-guided bone biopsy, a bacterial osteolytic lesion within the body of the fourth cervical vertebrae (C4) and resultant pathologic compression fracture clinically resulting in full tetraparesis was diagnosed in the calf. Culture results from the lesion within C4 confirmed a diagnosis of Trueperella pyogenes. Results: Poor response to medical management justified surgical debridment of the lesion in C4 and subsequent stabilization of the cervical vertebral column. A threepart procedure was performed including (1) debridement of the C4, (2) bilateral ventral vertebral stabilization from C3 to C5, and (3) placement of ampicillinimpregnated plaster of Paris beads within the body of C4. With postoperative physical rehabilitation, the calf regained full ambulatory function. At 1-month follow-up, the calf remained ambulatory with mild proprioceptive ataxia and no evidence of implant failure. At annual recheck, the calf had gained 208 kg and remained fully ambulatory with no residual neurologic deficits. Conclusion: Surgical intervention and use of antibiotic-impregnated implants offered a viable alternative to long-term medical management of vertebral osteomyelitis in the calf reported here. Clinical significance: This case identifies surgical intervention as a potential means for improving outcomes in a historically fatal condition of production animals.

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Section: Discussionmentioning

confidence: 66%

Surgical intervention for vertebral osteomyelitis in a calf

et al. 2019

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“…Daneben wurden Ciprofloxacin und Clindamycin intravenös verabreicht. Nach 1 Jahr konnte bei der Kontrolluntersuchung eine vollständige Beseitigung der Infektion bestätigt werden [113].…”

Section: Operative Behandlungenunclassified

Spondylitis – Spondylodiscitis – an Update

et al. 2018

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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.

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“…SPONTANEOUS spondylodiscitis, although rare, but carries the risk of developing neurological impairment [1] .…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, debridement of the posterior intervertebral space and the epidural abscess might be easier via the posterior approach [5] . Independent of the surgical approach, usually autogenous bone grafts are considered to be the "gold standard" in spine reconstruction [1,6] .…”

Section: Introductionmentioning

confidence: 99%