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PubMed2003

[Septic spondylodiscitis: diagnosis and treatment].

We studied retrospectively 24 patients with septic discitis of different etiologies (hematogenic, primary and infantile) and the different aspects involved in its diagnosis and treatment. Erythrocyte sedimentation rate proved to be a valuable parameter and should always be interpreted carefully along with the clinical and neuroimaging findings. Biopsies should be reserved for doubtful cases with atypical course. Clinical treatment should be initiated after the following situations have been ruled out: sepsis, neurological deficit, severe deformity, epidural abscess and foreign body (primary disease). The surgical approach may be chosen based on the stage of disease, being preferably posterior in suppurative forms and anterior in the non-suppurative stage. Based on our experience and on information gathered by literature review, we propose an algorithm to guide diagnosis and treatment in patients with septic discitis.

Adolescent↗
PubMed2001

[Spondylodiscitis in 3 children; differential diagnosis and treatment].

Three children, a 4.5-year-old boy and two girls aged 21 months and 10 years respectively, had for several weeks to months experienced lower back pain or walking problems, two of them had an elevated sedimentation and leucocytosis. The MRI scan revealed a narrowing of the lumbal disk. Furthermore, in the case of the 10-year-old girl, Staphylococcus lugdunensis was cultured from the puncture material of the disk. After treatment she continued to experience intermittent complaints of back pain; the other children made a complete recovery. (Spondylo)discitis must be differentiated from vertebral osteomyelitis. In the case of (spondylo)discitis, immobilising the spine with a corset is the mainstay of treatment. Antibiotics are only indicated when osteomyelitis cannot be excluded. Generally, the prognosis is good.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Surgical treatment of spondylodiscitis in ankylosing spondylitis. Two cases report].

INTRODUCTION: Spondylodiscitis in ankylosing spondylitis has a prevalence of 5%. Mechanical and inflammatory factors are involved in its pathogenesis. Neurosurgical operation is required when neurological complications or vertebral instability occur. Surgery is complicated by the increased fragility of the vertebral column, advanced stage of the disease in many patients, and serious pulmonary complications. CLINICAL CASES: We report two patients who had had ankylosing spondylitis for over 20 years. Both presented complaining of symptoms for several months with lumbar pain and signs of spinal cord lesions. There were signs of discitis and destruction of the adjacent vertebral bodies at T11 T12 and T12 L1 on imaging investigations of the first and second patient respectively. In both cases an anterior approach was used for discectomay and resection of the adjacent vertebral plates. Then an autologous rib graft was done, and anterolateral fixation with plate and screws to the adjacent vertebral bodies. The patients condition improved. Their pain and previous clinical neurological disorder had disappeared by 5 and 1 year later. DISCUSSION AND CONCLUSIONS: The prevalence of patients operated on for spondylodiscitis in the context of ankylosing spondylitis is not known. Dorsolumbar pain with inflammatory characteristics of recent onset in patients with chronic ankylosing spondylitis should lead to suspicion of spondylodiscitis. Although it may be related to previous trauma, discitis is the fundamental mechanism. MR is the most sensitive imaging technique. There may be marked osteoporosis and stenosis of the vertebral canal together with marked ossification of all the paraspinal ligaments. This hinders the approach to the vertebral bodies and their subsequent fixation. Decompression of the vertebral canal using an anterior approach (thoracotomy or thoraco phreno laparotomy) and anterior spinal fixation is the treatment of choice in cases with neurological involvement or involvement of the anterior and medial columns of Denis.

Adult↗
PubMed1989

[Non-specific spondylitis in childhood].

Non pyogenic discitis is a benign disease of the pediatric age grup. 1st diagnosis is difficult, as the initial symtons may divert the physician to different organs or systems other than the spine. Establishing the diagnosis in the early stage of the disease is important in order to avoid unnecessary and expensive diagnostic procedures. Non pyogenic discitis is diagnosed on radiograms by the demonstration of the narrow disc-space with involvement of the adjacent vertebral bodies. Four phases are recognised in the development of the imaging changes.

Child, Preschool↗
PubMed1994

[Spondylodiscitis in Bechterew's disease; inflammation or trauma? Description of 6 patients].

OBJECTIVE: To study the prevalence and nature of sterile spondylodiscitis in patients suffering from ankylosing spondylitis. DESIGN: Descriptive. SETTING: Department of Rheumatology, Medisch Spectrum Twente, Enschede, the Netherlands. METHOD: Of all ankylosing spondylitis patients suffering from sterile spondylodiscitis, the medical histories and the radiological and histological findings were analysed. RESULTS: Among about 400 patients, 6 cases of sterile spondylodiscitis were found; 4 men and 2 women. The mean time lapse between diagnosis of ankylosing spondylitis and onset of spondylodiscitis symptoms was 7 years; in I patient discitis was the first symptom. Discitis changed the nature of the backache: it worsened during exercise and improved on resting. There was no history of trauma. Symptomatic and asyptomatic radiological abnormalities were seen at the same time in 2 patients. Symptoms disappeared 3-36 months after start of conservative treatment. Histological examination was performed in 2 cases and showed inflammatory changes. CONCLUSION: Spondylodiscitis in ankylosing spondylitis has a highly variable presentation and in general a good prognosis. Our findings support an inflammatory rather than a traumatic pathogenesis.

Adult↗
PubMed1994

Aspergillus spondylodiscitis: successful conservative treatment in 9 cases.

OBJECTIVE: To assess the effectiveness of medical treatment by clinical, radiological, and biological analysis of outcome in 9 patients with aspergillus spondylodiscitis. METHODS: Retrospective study including 9 patients with aspergillus discitis, in which 7 were immunosuppressed; 3 were heart transplant patients, 2 had acute lymphoblastic leukemia, 1 hairy cell leukemia and one was receiving prednisone for bronchial asthma. Four patients had isolated spinal aspergillosis infection. In 4 cases, disc space infection occurred after pulmonary aspergillosis. In the last case the spondylodiscitis occurred after aspergillus endocarditis and mycotic limb embolism. In all cases a percutaneous needle biopsy of the intervertebral disc was performed; the subsequent culture produced Aspergillus fumigatus in 8 cases and Aspergillus flavus in 1. Itraconazole was given to all patients (mean dose: 350 mg/day); it was given alone in 2 cases, in addition to 5 flucytosine and amphotericin B in 6 cases, and in addition to amphotericin B in the last case. RESULTS: Improvement was obtained in the 9 cases, with full recovery in the absence of any surgical debridement after a mean treatment duration of 5.5 months and a mean followup delay of 16 months. CONCLUSION: Early recognition of aspergillus spondylodiscitis in immunocompromised hosts is important. Itraconazole alone or in combination is an effective therapy. There may be an increased incidence of aspergillus discitis due to the increasing frequency of immunosuppression associated conditions including organ transplantation, chemotherapy, or acquired immune deficiency syndrome.

Adult↗
PubMed1994

Disc space infection.

Disc space infection or discitis, an infection of the intervertebral disc with contiguous subchondral vertebral osteomyelitis, most frequently follows prior intervertebral disc surgery or arises by hematogenous dissemination. The majority of cases are located in the lumbosacral spine and are caused by staphylococci. Clinical findings include localized spinal pain and fever. The diagnosis is suggested by radiologic studies (plain x-ray, bone scan, CT scan and MR imaging) and confirmed by culturing blood or material obtained from the involved disc space. Treatment consists of antimicrobial therapy, spinal immobilization and surgical intervention in selected circumstances. Discitis is associated with a good prognosis but residual back pain, limited spinal mobility and neurologic deficit may occur.

Adolescent↗
PubMed1996

Pyogenic vertebral osteomyelitis and postsurgical disc space infections.

The presentation and clinical course for hematogenous vertebral osteomyelitis and postoperative discitis is presented. The treatment is primarily conservative care in the form of immobilization and parenteral antibiotics. The indications for surgery are rare and should be reserved for patients resistant to treatment or with septic course, abscess formation, or neurologic deficits. In these cases, the infectious process has generally involved the adjacent vertebrae or the neural elements. Surgery usually involves an anterior approach. The principles of surgical treatment involve debridement of necrotic tissue, decompression of neural elements, and stabilization of the spine. The outcome of patients with vertebral osteomyelitis and secondary discitis in general is favorable when appropriate treatment is rendered. Extension of the infection to the spinal canal in the form of an epidural abscess is also reviewed.

Abscess↗
PubMedDate not supplied

Transdiscal approach for hypogastric plexus block.

BACKGROUND AND OBJECTIVES: In this study, we have performed hypogastric plexus block using a posterior transdiscal approach in 20 patients diagnosed with pelvic pain because of cancer. METHODS: The L(5)-S(1) interdiscal space was identified with fluoroscopy. A needle attached to a 5-mL syringe was introduced through the disc and advanced under lateral fluoroscopic control until resistance was lost. After verifying proper position, 5 mL of 10% aqueous phenol was administered through the needle. After drawing back the needle, cephazolin 50 mg in 1 mL was administered to the disc to prevent discitis. The visual analog scale (VAS) values, daily analgesic requirements, and patient satisfaction were evaluated before the procedure, at 24 hours and then every month for 3 months after the procedure. RESULTS: Disc puncture was performed without difficulty in all patients, there were no complications associated with disc puncture such as discitis or disc rupture. Twelve patients had statistically significant pain relief immediately after the block (P <.05). Fifteen patients were satisfied after the block, and their daily analgesic requirement decreased significantly. No pain relief was observed in 5 patients. CONCLUSIONS: Transdiscal approach to the hypogastric plexus appears to be a safe and effective procedure. However, prospective randomized controlled studies comparing different approaches are needed to increase our knowledge of hypogastric plexus block.

Adult↗
PubMed1992

[Follow-up of spondylodiscitis following intervertebral disk operation--on the etiology, therapy and prevention].

Operations on lumbar disc prolapses are the most frequent operations in German neurosurgery divisions. After such operations, spondylodiscitis is a dreaded complication which is sometimes difficult to diagnose. Treatment of spondylodiscitis is always protracted and a burden for doctors and patients. Hence, it appears worthwhile to present a further report on discitis and spondylodiscitis, infections of the intervertebral space and the surrounding tissues after disk operations. Various clinical pictures are described: septic progress forms with neurological disorders and the necessity of open wound treatment as well as clinical pictures without septic signs with good recovery after immobilisation and antibiotic treatment. In two cases, CT-guided puncture of purulent suppuration with identification of the causative organisms and specific antibiotic treatment was possible. All patients had a relatively good result: pareses and/or bladder/rectal disorders disappeared completely in every case. The causes of discitis are discussed. The condition arises when nosocomial microorganisms, or very frequently even harmless skin bacteria, enter the wound. A large number of operations are carried out under pressure of time and under hectic conditions, as well as in a confined space in operation theatres which are too warm; these factors increase the susceptibility to infection. However, the resistance of the patient to infection is also weakened after longterm prior antiinflammatory treatment and a stay in hospital before the operation. Besides appropria to treatment of the infection (immobilisation, wound treatment, antibiotic therapy), psychological management of the patient is an important component of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Arthritis due to Mycobacterium xenopi: a retrospective study of 7 cases in France.

BACKGROUND: Mycobacterium xenopi is a nontuberculous mycobacterium responsible for opportunistic and nosocomial infections, chiefly of the lung; few cases of bone and joint infection have been reported. From July 1989 through May 1993, an outbreak of 58 cases of nosocomial discitis due to M. xenopi infection following percutaneous nucleotomy occurred in a French hospital. Peripheral M. xenopi arthritis seems exceedingly rare. We conducted a study to assess the epidemiological and clinical patterns of M. xenopi arthritis. METHODS: We retrospectively reviewed cases of M. xenopi arthritis reported from May 1993 through October 2004. RESULTS: We identified 7 cases, all of which occurred after invasive surgical procedures were performed on the affected joint, suggesting a nosocomial pattern of infection. Two patients may have been contaminated at the hospital where the M. xenopi discitis outbreak occurred. No source was identified in the other 5 patients. Despite the probable nosocomial nature of the infections, the diagnosis was delayed (mean time until diagnosis, 50 months). Repeated collection of deep tissue specimens for bacteriological analysis seemed crucial to the diagnosis. The treatment relied on combination antimicrobial therapy and surgery. Among 11 cases of M. xenopi osteoarticular infection reported in the literature from 1975 to 2005, (arthritis in 9 cases and osteitis in 2), none were nosocomial. CONCLUSION: A high index of suspicion should be maintained to ensure the diagnosis of M. xenopi arthritis before chronic monoarthritis and before the development of irreversible joint damage.

Adult↗
PubMed2004

Complications associated with cervical endoscopic discectomy with the holmium laser.

OBJECTIVES: Our aim was to determine the rate of surgical complications associated with cervical endoscopic discectomy (CED). BACKGROUND DATA: There are no studies that state the degree of complications after CED. MATERIALS AND METHODS: Forty-one patients underwent CED with holmium laser. RESULTS: Two out of 41 patients incurred vascular compromise during the procedure. One patient developed recurrent laryngeal nerve damage. One patient developed discitis, and two patients complained of a "clicking" sensation postoperatively. CONCLUSIONS: Although CED has a relatively high success rate, there is a 15% rate of complications associated with the procedure. Most of the complications were minor (such as vascular compromise, recurrent laryngeal nerve injury, and postoperative "clicking" sensations), but there was one case of severe discitis, and there is the potential of serious complication from both vascular compromise and neural injury.

Cervical Vertebrae↗
PubMed2004

Crowned dens syndrome misdiagnosed as polymyalgia rheumatica, giant cell arteritis, meningitis or spondylitis: an analysis of eight cases.

BACKGROUND: The crowned dens syndrome, related to microcrystalline deposition in the peri-odontoid articular and abarticular structures, is mainly responsible for acute or chronic cervical pain. PATIENTS: We report eight cases of crowned dens syndrome with atypical presentations mimicking giant cell arteritis, polymyalgia rheumatica, meningitis or discitis. The clinical and radiological aspects of these cases are presented and discussed. RESULTS: For all patients, fever, cervical stiffness, headaches and biological inflammatory syndrome were reported. For three patients, impairment of general condition, occipito-temporal or mandible pain and weakness with inflammatory pain of the shoulder girdle was suggestive of giant cell arteritis and/or polymyalgia rheumatica, leading to temporal artery biopsy and/or long-term steroid treatment. Recurrence of clinical symptoms when tapering steroids was noted. In two cases, previous breast carcinoma led to the initial diagnosis of metastatic spondylitis. For three patients with vomiting, nausea and Kernig's and/or Brudzinski's sign, the first diagnosis was meningitis, leading to unhelpful lumbar puncture. In all cases, diagnosis of crowned dens syndrome once evoked, was confirmed by cervical CT scanning and dramatic improvement with non-steroidal anti-inflammatory drugs or colchicine. CONCLUSION: This under-recognized entity must be considered as a differential diagnosis of meningitis and discitis, but also of giant cell arteritis and polymyalgia rheumatica, as well as a possible aetiology for fevers of unknown origin. CT scanning is necessary for diagnosis. Clinicians should be aware of such misleading clinical presentations.

Aged↗
PubMed1988

A comparison between magnetic resonance imaging and scintigraphic bone imaging in the diagnosis of disc space infection in an animal model.

In a controlled prospective study, 33 rabbits were used to compare the efficacy of magnetic resonance imaging (MRI) to scintigraphy in diagnosing pyogenic infection of the intervertebral disc. A suitable inoculum of Staphylococcus aureus (10(8) organisms) was injected into a test level while a similar volume of sterile culture medium was injected into a control disc in each animal. Plain radiographs, MRI, and scintigraphic bone images then were performed at regular intervals after operation. The imaging studies were interpreted blind, as was the final histologic assessment. Five animals died of respiratory complications following sedation. In the remaining 28 animals, 23 developed infection at the test level, and four developed infection at the control disc. Magnetic resonance imaging was found to be more sensitive than scintigraphy in diagnosing discitis, particularly in the early stages of the disease. The overall results showed MRI had a sensitivity of 93%, specificity of 97%, and accuracy of 95%. There were two false-negative results and one false-positive. In contrast, scintigraphy had a sensitivity of 41%, specificity of 93%, and accuracy of 68%. There were two false-positive and 16 false-negative results. Plain radiographs had a sensitivity of 82%, specificity of 93%, and accuracy of 88%. There were two false-positive and five false-negative results. The MRI appearance of discitis was characteristic from an early stage in the disease, and preceded the changes on scintigraphy and plain radiographs by several days in the majority of cases.

Animals↗
PubMed2006

Surgical treatment of spinal brucellosis.

UNLABELLED: We retrospectively reviewed 10 patients with spinal brucellosis of the thoracic and lumbar spine who were treated successfully with a combination of surgery and antibiotics. All patients had back pain; six patients had radiculopathy and one patient had paraparesis. Patients with spondylodiscitis without epidural abscesses (n = 3) had transpedicle discectomy and drainage. Epidural abscesses in the lumbar area caused by spondylodiscitis (n = 3), spondylitis (n = 2), and discitis with infected disc herniation (n = 1), were drained using a posterior approach combined with posterolateral fusion in two patients with spondylodiscitis and discectomy in the patient with a herniated disc. One patient presented with a pathologic fracture and neural compression and was treated with anterior corpectomy and reconstruction. Antibiotic treatment was given for 3 to 9 months. Mean followup was 3 years. Back pain improved soon after surgery. Recovery from radiculopathy and paraparesis was complete. One patient had recurrence of infection 9 months after initial treatment. Clinical manifestation of spinal brucellosis can include spondylitis, spondylodiscitis, discitis, epidural abscess, paraspinal abscess, and vertebral collapse. Transpedicle drainage allows tissue diagnosis and facilitates treatment. Because brucellosis usually responds to antibiotics, surgery is considered as the last resort in treating spinal brucellosis, but severe neurologic deficit and incapacitating back pain often necessitate surgical intervention. LEVEL OF EVIDENCE: Therapeutic study, level IV (case series). Please see the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMedDate not supplied

Complications of chemonucleolysis for lumbar disc disease.

In 13,700 patients who received one or more lumbar disc injections of chymopapain, 401 complications, adverse reactions, and delayed untoward events were recorded, including eight deaths. The deaths were secondary to anaphylaxis, pulmonary embolism, discitis with subacute bacterial endocarditis, ruptured abdominal aortic aneurysms (two patients), encephalitis (of unknown etiology), and myocardial infarction. Of these, the deaths secondary to anaphylaxis and discitis with subacute bacterial endocarditis can be attributed directly to the procedure of chemonucleolysis.

Anaphylaxis↗
PubMed1986

Intervertebral disc infection after lumbar chemonucleolysis: report of a case.

Intervertebral disc space infection can be a serious and disabling complication of any procedure that affords entry for bacteria into the susceptible disc space. Most disc space infections occur after cervical or lumbar laminectomies. Discitis has been reported after myelography, lumbar puncture, paravertebral injection, and obstetrical epidural anesthesia. A case of septic discitis occurring after intradiscal therapy with chymopapain is presented. Patients who return for evaluation of recurrent spinal pain after chemonucleolysis, especially those with paravertebral muscle spasm, should be evaluated for the possibility of disc space infection by obtaining an erythrocyte sedimentation rate, peripheral white count, differential cell count, and plain roentgenograms. Radionuclide bone scans, although not specific, may provide further objective evidence leading to the diagnosis of an intervertebral disc space infection.

Blood Sedimentation↗
PubMed1985

Kingella kingae infections: a review and a presentation of data from 10 Swedish cases.

Kingella kingae is a fastidious gram-negative rod related to the Neisseriae. Together with data from published cases of K. kingae infection, we report the clinical and laboratory findings from 10 cases in western Sweden; a specific serological reaction is also described. The diagnoses were osteomyelitis, septic arthritis, discitis, endocarditis, occult bacteraemia and phlegmon. The data from the Swedish cases, together with those from previous reports in the literature provided the basis for an analysis of a total of 33 cases, ranging from self-limiting to potentially fatal infections. In orthopaedic infections (n = 19), including 3 cases of discitis, the course was usually protracted but subacute and benign, although the full-blown, acute septic arthritis was also encountered. Endocarditis (n = 10) was characterized by a stormy clinical course and the development of significant sequelae. The majority of the patients were previously healthy children. 42% of them had a current or recent upper respiratory tract infection. After start of antibiotic treatment patients were afebrile within a few days. Betalactam antibiotics should be regarded as the drugs of choice for coping with K. kingae. We stress the insidious course of skeletal infections in children and urge the importance of early puncture of a suspected focus to establish a correct diagnosis without delay. The clinical data suggest that K. kingae should be regarded as a significant pathogen.

Adolescent↗