Infectious spondylodiscitis

Cottle, Lucy; Riordan, Terrance P.

doi:10.1016/j.jinf.2008.02.005

Cited by 337 publications

(409 citation statements)

References 62 publications

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“…Twelve patients needed surgery, and thus conservative treatment failed in 13.1 % of patients. Karadimas et al [12] noted 17.1 % failures among patients managed non-surgically; other authors have reported failure rates from 12 to 16 % [1,4,7]. We had three in-hospital deaths in this group.…”

Section: Discussionmentioning

confidence: 53%

Failure modes in conservative and surgical management of infectious spondylodiscitis

et al. 2012

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Purpose and methods We reviewed the management, failure modes, and outcomes of 196 patients treated for infectious spondylodiscitis between January 1, 2000 and December 31, 2010, at the Spinal Unit, Aarhus University Hospital, Aarhus, Denmark. Patients with infectious spondylodiscitis at the site of previous spinal instrumentation, spinal metastases, and tuberculous and fungal spondylodiscitis were excluded. Results Mean age at the time of treatment was 59 (range 1-89) years. The most frequently isolated microorganism was Staphylococcus aureus. The lumbosacral spine was affected in 64 % of patients and the thoracic in 21 %. In 24 % of patients, there were neurologic compromise, four had the cauda equina syndrome and ten patients were paraplegic. Ninety-one patients were managed conservatively. Treatment failed in 12 cases, 7 patients required re-admission, 3 in-hospital deaths occurred, and 5 patients died during follow-up. Posterior debridement with pedicle screw instrumentation was performed in 75, without instrumentation in 19 cases. Seven patients underwent anterior debridement alone, and in 16 cases, anterior debridement was combined with pedicle screw instrumentation, one of which was a two-stage procedure. Re-operation took place in 12 patients during the same hospitalization and in a further 12 during follow-up. Two in-hospital deaths occurred, and five patients died during follow-up. Patients were followed for 1 year after treatment. Eight (9 %) patients treated conservatively had a mild degree of back pain, and one (1 %) patient presented with mild muscular weakness. Among surgically treated patients, 12 (10 %) had only mild neurological impairment, one foot drop, one cauda equine dysfunction, but 4 were paraplegic. Twenty-seven (23 %) complained of varying degrees of back pain. Conclusions Conservative measures are safe and effective for carefully selected patients without spondylodiscitic complications. Failure of conservative therapy requires surgery that can guarantee thorough debridement, decompression, restoration of spinal alignment, and correction of instability. Surgeons should master various techniques to achieve adequate debridement, and pedicle screw instrumentation may safely be used if needed.

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Section: Discussionmentioning

confidence: 53%

Failure modes in conservative and surgical management of infectious spondylodiscitis

et al. 2012

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“…[8][9][10][11][12] In our study, the main complaint of pain coincided with actual location of infected level in only five (45%) of the patients with lumbar discitis, one (25%) of the patients with dorsal discitis, and two (40%) of the patients with thoracolumbar discitis.…”

Section: Discussionmentioning

confidence: 82%

Diagnostic Difficulties in Bacterial Spondylodiscitis

et al. 2015

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Objective: To analyze aspects related to the diagnostic difficulty in patients with bacterial spondylodiscitis. Methods: Cross-sectional observational study with retrospective data collected in the period from March 2004 to January 2014.Twenty-one patients diagnosed with bacterial spondylodiscitis were analyzed. Results: Women were the most affected, as well as older individuals. Pain in the affected region was the initial symptom in 52% of patients, and 45.5% of the patients had low back pain, and those with dorsal discitis had back pain as the main complaint; the patients with thoracolumbar discitis had pain in that region, and only one patient had sacroiliac discitis. The average time between onset of symptoms and treatment was five months. The lumbar segment was the most affected with 11 cases (52%), followed by thoracolumbar in 24%, dorsal in 19% of cases and a case in the sacroiliac segment. Only seven patients had fever. Pain in the affected level was coincidentally the most common symptom. Conclusions: Early diagnosis of bacterial spondylodiscitis remains a challenge due to the nonspecific signs and symptoms reported by the patient and the wide variability of laboratory results and imaging. The basis for early diagnosis remains the clinical suspicion at the time of initial treatment.

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“…[6][7][8][9][10][11][12] In Europe, the disease varies from 0.4 to 2.4 cases per 100000, and the frequency depends on the inclusion criteria of the study (migrants, children, elderly, etc.). 4,7 SS is more common in men and the ratio of men to women is 2.1:1.5. 4,7,13,14 This sex predominance is not typical in patients under their 20s, and increases signifi cantly in individuals over 80 years, which is explained by the greater comorbidity in men aged over 60 yrs.…”

Section: Epidemiology Of Spontaneous Spondy-lodiscitismentioning

confidence: 99%

“…4,7 SS is more common in men and the ratio of men to women is 2.1:1.5. 4,7,13,14 This sex predominance is not typical in patients under their 20s, and increases signifi cantly in individuals over 80 years, which is explained by the greater comorbidity in men aged over 60 yrs. The frequency of spontaneous spondylodiscitis in recent years has increased as a result of the combined effect of the increase in susceptible population and better diagnosis.…”

Section: Epidemiology Of Spontaneous Spondy-lodiscitismentioning

confidence: 99%

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Spontaneous Spondylodiscitis - Epidemiology, Clinical Features, Diagnosis and Treatment

2017

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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 treatment is necessary in patients with neurological deficit, spinal instability or drug resistance.

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Infectious spondylodiscitis

Cited by 337 publications

References 62 publications

Failure modes in conservative and surgical management of infectious spondylodiscitis

Failure modes in conservative and surgical management of infectious spondylodiscitis

Diagnostic Difficulties in Bacterial Spondylodiscitis

Spontaneous Spondylodiscitis - Epidemiology, Clinical Features, Diagnosis and Treatment

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