Treatment algorithm for spontaneous spinal infections: A review of the literature

Gregori, Fabrizio; Grasso, Giovanni; Iaiani, Giancarlo; Marotta, Nicola; Torregrossa, Fabio; Landi, Alessandro

doi:10.4103/jcvjs.jcvjs_115_18

Cited by 33 publications

(38 citation statements)

References 61 publications

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“…This case demonstrates that low-dose celecoxib may effectively treat pain in patients with VO. Literature exploring the management of VO has focused on antibiotics, immobilization and surgical indications [ 3 ]. Even with more aggressive antibiotic regimens, back pain often persists for weeks to months due to gradual resolution of the infection [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported to constitute between 3% and 5% of all osteomyelitis cases and most frequently occurs in the lumbar spine [ 1 , 2 ]. Infection most commonly spreads to the spine via hematogenous dissemination, but direct inoculation from trauma or surgery and contiguous spread from adjacent tissues are also possible [ 3 ]. Risk factors include diabetes mellitus, renal failure, liver cirrhosis, autoimmune diseases, history of substance abuse and previous spinal surgeries [ 2 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Back pain is typically insidious, worse at night and can radiate to the chest or abdomen [ 1 , 4 ]. Pain that fails to resolve may become chronic and interfere with activities of daily living [ 2 , 3 ]. The profound impact of chronic low back pain as a disabling health condition is well-documented, with substantial negative impacts on quality of life and increased health care expenditures [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Celecoxib for Management of Refractory Back Pain Secondary to Vertebral Osteomyelitis: A Case Report

2021

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Back pain is the most common symptom of vertebral osteomyelitis and can be difficult to manage. Pain may persist despite appropriate antibiotic medications and may be refractory to common analgesic treatments. We present a case of a 53-year-old man with acute onset severe low back pain. Clinical evaluation and diagnostic workup were consistent with L1 osteomyelitis. The patient continued to report pain following treatment with intravenous antibiotics and typical analgesic therapy. Opioids were discontinued and low-dose celecoxib was initiated with appreciable improvement in pain and activity tolerance. Celecoxib may be a good option and alternative to opioids in the pain management of this population.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Celecoxib for Management of Refractory Back Pain Secondary to Vertebral Osteomyelitis: A Case Report

2021

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“…Our data showed that a daptomycin-containing regimen was strongly associated with clinical cure. Considering that over 70% of VO etiology is caused by Gram-positive strains but etiology of infection is obtained in about 75% of cases, these data may help physicians to choose the appropriate antibiotic regimen, especially in patients without a confirmed etiology of infection, in order to early evaluate also the criteria to switch to oral therapy [ 7 , 35 ]. However, randomized clinical trials are mandatory to confirm or to exclude these observations.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Daptomycin-Containing Regimen for Treatment of Staphylococcal or Enterococcal Vertebral Osteomyelitis: A Prospective Clinical Experience

et al. 2020

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Vertebral osteomyelitis (VO) is a compelling clinical entity for clinicians, because of its insidious and indolent course that makes diagnosis difficult. A concern is reported about the choice of antibiotic regimens, duration of therapy, and criteria to switch to oral therapy. We conducted a prospective observational study. All consecutive hospitalized patients with a confirmed diagnosis of VO caused by staphylococcal or enterococcal strains were analyzed. The primary endpoint was the analysis of clinical cure at the end of therapy. A propensity score for receiving therapy with daptomycin was added to the model. During the study period, 60 episodes of confirmed VO were observed. The main etiology of infection was methicillin-resistant Staphylococcus aureus (29%). Overall, clinical failure at end of therapy was reported in 11 (18.3%) patients. Logistic regression analysis, after propensity score, showed that >2 vertebrae involved (OR 2.4, CI95% 1.12–5.24, p = 0.002) and inadequate drainage of infection (OR 4.8, CI95% 2.45–8.51, p < 0.001) were independently associated with failure of therapy, while the use of a daptomycin-containing-regimen (OR 0.15, CI 95% 0.04–0.46, p < 0.001) with clinical cure. VO caused by staphylococcal or enterococcal strains is associated with an important rate of clinical failure. Daptomycin-containing regimen was strongly associated with clinical cure. Considering that over 70% of VO etiology is caused by Gram-positive strains but the etiology of infection is obtained in about 75% of cases, these data may help physicians to choose the appropriate antibiotic regimen.

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“…Infections of the musculoskeletal system are difficult to treat and frequently require a protracted and rigorous therapy [ 1 ]. Spinal infections, or spondylodiscitis, in particular represent a therapeutic challenge [ 2 , 3 ] The intervertebral disc space is primarily difficult to access antibiotically, so bacteria might persist here and can be reactivated when the immune system is weakened [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Investigation of Risk Factors for Pain Chronification in Patients Suffering from Infections of the Spine

Zhao

Hemmer

Pepke

et al. 2020

JCM

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Background: Spinal infections represent a therapeutic challenge. The often protracted course of the disease is accompanied by pain, which can lead to a chronic pain experience even after the infectious disease has been treated successfully. The aim of this study was to investigate possible risk factors of pain chronification. Methods: In a prospective study, 14 patients with spinal infections were examined at admission (T1), at discharge from inpatient therapy (T2), and three to eight months postoperatively (T3) byquestionnaires on risk factors for pain chronification and by quantitative sensory testing (QST). Results: In-patient treatment lasted on average 45.3 days (±33.13). The patients complained of pain for 3.43 months (±2.77) prior to inpatient treatment. The visual analogue scale (VAS) for pain (0–10) and the Oswestry Disability Index detected significant improvement in the course of the study. However, patients also reported catastrophic thinking, as well as fear of movement and (re)-injury. Conclusion: In summary, our results demonstrate that patients with spinal infections did not suffer from pain chronification, but might benefit from an interdisciplinary therapeutic approach, which emphasizes promoting active pain-coping strategies, as well as addressing fear of movement and catastrophic thinking.

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Treatment algorithm for spontaneous spinal infections: A review of the literature

Cited by 33 publications

References 61 publications

Celecoxib for Management of Refractory Back Pain Secondary to Vertebral Osteomyelitis: A Case Report

Celecoxib for Management of Refractory Back Pain Secondary to Vertebral Osteomyelitis: A Case Report

Efficacy of Daptomycin-Containing Regimen for Treatment of Staphylococcal or Enterococcal Vertebral Osteomyelitis: A Prospective Clinical Experience

Investigation of Risk Factors for Pain Chronification in Patients Suffering from Infections of the Spine

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