Surgical treatment of spondylodiscitis. An update

Guerado, Enrique; Cerván, Ana María

doi:10.1007/s00264-011-1441-1

Cited by 195 publications

(172 citation statements)

References 69 publications

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“…Spondylodiscitis, also known as vertebral osteomyelitis or bacterial spondylitis, is the most common spinal infection, which affects the intervertebral disk, adjacent vertebral bodies, and occasionally also the posterior elements of the spine [1,2]. The incidence of spondylodiscitis ranges from 0.2 till 2.4 per 100.000 per year in the Western countries [2,3].…”

Section: Introductionmentioning

confidence: 99%

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Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

et al. 2015

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Background Spondylodiscitis is a spinal infection affecting primarily the intervertebral disk and the adjacent vertebral bodies. Currently many aspects of the treatment of pyogenic spondylodiscitis are still a matter of debate. Purpose The aim of this study was to review the currently available literature systematically to determine the outcome of patients with pyogenic spondylodiscitis for conservative and surgical treatment strategies. Methods A systematic electronic search of MEDLINE, EMBASE, Cochrane Collaboration, and Web of Science regarding the treatment of pyogenic spondylodiscitis was performed. Included articles were assessed on risk of bias according the Cochrane Handbook for Systematic Reviews of Interventions, and the quality of evidence and strength of recommendation was evaluated according the GRADE approach. Results 25 studies were included. Five studies had a high or moderate quality of evidence. One RCT suggest that 6 weeks of antibiotic treatment of pyogenic spondylodiscitis results in a similar outcome when compared to longer treatment duration. However, microorganism-specific studies suggest that at least 8 weeks of treatment is required for S. aureus and 8 weeks of Daptomycin for MRSA. The articles that described the outcome of surgical treatment strategies show that a large variety of surgical techniques can successfully treat spondylodiscitis. No additional long-term beneficial effect of surgical treatment could be shown in the studies comparing surgical versus antibiotic only treatment. Conclusion There is a strong level of recommendation for 6 weeks of antibiotic treatment in pyogenic spondylodiscitis although this has only been shown by one recent RCT. If surgical treatment is indicated, it has been suggested by two prospective studies with strong level of recommendation that an isolated anterior approach could result in a better clinical outcome.

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Section: Introductionmentioning

confidence: 99%

“…Besides a relative increase in pyogenic spondylodiscitis, there also appears to be an increase in the total incidence [1,3,7,8]. This increase in incidence is thought to be caused by the aging population, by the rise of immunosuppressed patients, of intravenous drug use and of improved diagnostic possibilities [1,3,7,8].…”

Section: Introductionmentioning

confidence: 99%

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

et al. 2015

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“…Antimicrobial therapy was continued for 6 weeks. Surgical intervention was planned for excision of the lesion and reduction of the spondylolisthesis (2), (3) . Histopathological examination revealed tissular and cellular hyperplasia, a proliferating nodule, and granuloma in the focus.…”

Section: A Case Of Brucellar Spondylitis With Lumbar Spondylolisthesismentioning

confidence: 99%

A case of brucellar spondylitis with lumbar spondylolisthesis

Zhang

Zhao

2017

Rev. Soc. Bras. Med. Trop.

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A 46-year-old man was hospitalized with a 6-month history of severe low back pain in addition to weight loss, fatigue, and intermittent febrile symptoms for the past 4 weeks. Physical examination revealed painful and restricted low back movement. His temperature was 37.5℃. Laboratory values were as follows: white blood cell count: 9,600/mm 3 , hemoglobin: 13.5g/dl, erythrocyte sedimentation rate: 45mm/h, and C-reactive protein: 58mg/L. The Rose-Bengal test was (++), and the Brucella agglutination test was positive with a titer of 1:320. Computed FIGURE A -CT revealed intervertebral destruction and narrowing at L4-5, and I° lumbar spondylolisthesis with posterior displacement (arrow in FIGURE A-a). There was marginal damage of the centrum as well as hyperostosis osteosclerosis. The margin of the centrum showed lace-like changes (arrow in FIGURE A-b). MRI revealed L4-5 intervertebral disc tissues, and the L4-5 vertebral bodies were hypointense, heterogeneous, and heterogeneous on T1WI, T2WI and STIR images, respectively (arrow in FIGURE A-c). CT: computed tomography; MRI: magnetic resonance imaging; T1WI: T1 weighted imaging; T2WI: T2 weighted imaging; STIR: Short time inversion recovery. tomography (CT) revealed intervertebral destruction and narrowing at L4-5 and I° l umbar spondylolisthesis with posterior displacement (1) . There was i sthmic spondylolisthesis, and there was marginal damage of the centrum as well as hyperostosis osteosclerosis. The margin of the centrum showed lace-like changes ( Figure A and Figure B). Magnetic resonance imaging (MRI) showed signs compatible with osteomyelitis of the L4 and L5 vertebral bodies with accompanying discitis. L4-5 intervertebral disc tissues were hypointense, heterogeneous, 875Zhang Q et al. -Brucellar lumbar spondylolisthesis and heterogeneous on T1 weighted imaging (T1WI), T2 weighted imaging (T2WI), and S hort time inversion recovery (STIR) MRI images, respectively ( Figure A and Figure C). Antimicrobial therapy was continued for 6 weeks. Surgical intervention was planned for excision of the lesion and reduction of the spondylolisthesis (2),(3) . Histopathological examination revealed tissular and cellular hyperplasia, a proliferating nodule, and granuloma in the focus. Giemsa staining showed positive Brucella (Figure B). On the control X-ray after surgery, the intervertebral height had been restored, and the lumbar spondylolisthesis was reduced ( Figure C).

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“…In our case, surgical treatment was also necessary. Guerado and Cerván [9] reported that there is the indication of surgical treatment if compression signs of a spinal cord, nerve root or dura mater are detected with MRI. In addition, surgical treatment is indicated in case of severe bone destruction and deformity causing spinal instability and anteriorly localized abscess larger than 2.5 cm according to the author.…”

Section: Dear Editormentioning

confidence: 99%

A Case of Brucellosis due to Brucella melitensis Isolated from Epidural Abscess

Karagöz¹,

İrvem²,

Çomoğlu³

et al. 2018

mjima

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Dear Editor,Brucella species can cause a zoonotic infection brucellosis which may affect multiple tissues in the body including musculoskeletal system. Vertebral brucellosis is relatively common in the patients who have musculoskeletal involvement and should be diagnosed rapidly in the endemic regions. Early diagnosis and appropriate antimicrobial therapy combined with surgery are associated with an excellent prognosis; otherwise, delay in diagnosis increases the rate of morbidity and mortality [1] . Isolation of the microorganism from the tissue sample establishes the definite diagnosis and this is also necessary for the differential diagnosis. In this paper we aim to report a patient who presented to our clinic with spondylodiscitis and epidural abscess due to brucellosis.A 46-year-old female patient admitted to our setting with fever for 4 months, chills, and sweating which was exaggerated at night. She also had complaints of lower back pain lasting 2.5 months in addition to fatigue, lack of appetite, and weight loss. She had history of stockbreeding and ate unpasteurized dairy products. On physical examination, her body temperature was 37.5 °C, pain with local pressure was detected on the lumbar vertebrae, and her motor deficit grade was 2/5. The rest of general and neurological examinations were normal. The patient's laboratory test results were as follows: white blood cell count: 4590/mm 3 ; hemoglobin: 9.6 g/dL; hematocrit: 29.2%; erythrocyte sedimentation rate: 95 mm/h; C-reactive protein: 5.9 mg/L (normal, 0 to 0.8 mg/L); and a normal other blood biochemistry profile. The total serum protein, albumin, and globulin were also normal. There was no reversal of the albumin/ globulin ratio, and the Rose Bengal test was positive. The Wright agglutination test for Brucella was also positive at a titer of 1/2560. However, the patient was not tested by the 2-mercaptoethanol. Magnetic resonance imaging (MRI) of the spine was consistent with the diagnosis of spondylodiscitis. The height of the Intervertebral disc between L5-S1vertebrae was decreased in addition to signal abnormality on the vertebral corpus and vertebral endplates in MRI (Figure 1, 2). An epidural abscess, 54x22 mm in size, extending from the posterior of the L5 and S1 vertebrae to the paravertebral space and an abscess, 3x2 cm in size, on the anterior prevertebral space were identified. Upon laminectomy, a purulent epidural and prevertebral mass were evacuated. After decompression, the motor deficit was improved and the pain was relieved. On the Gram stain of the Anahtar Kelimeler: Bakteriyel enfeksiyonlar, Bruselloz, tedavi, epidural apse, dekompresyon cerrahisi

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Surgical treatment of spondylodiscitis. An update

Cited by 195 publications

References 69 publications

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

A case of brucellar spondylitis with lumbar spondylolisthesis

A Case of Brucellosis due to Brucella melitensis Isolated from Epidural Abscess

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