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At least 289 records · Page 16Linked to original sources
PubMed2002

Anterior microforaminotomy for treatment of cervical radiculopathy: part 1--disc-preserving "functional cervical disc surgery".

OBJECTIVE: Anterior cervical microforaminotomy was developed by the senior author (H-DJ) under the concept of "functional spine surgery which directly eliminates compressive pathological factors while preserving functional anatomic features. The surgical results are reported. METHODS: Among approximately 400 patients who underwent anterior cervical microforaminotomy at the University of Pittsburgh between March 1993 and May 1999, 104 patients met the inclusion criteria for this study. Forty-five patients were men and 59 were women. Patient ages ranged from 26 to 74 years (median, 46 yr). Compressive pathological lesions included spondylotic spurs in 44 cases (42.3%), soft disc herniation in 54 cases (51.9%), and a combination of the two in 6 cases (5.8%). RESULTS: Eighty-three patients (79.8%) experienced excellent results, 20 patients (19.2%) experienced good results, and 1 patient experienced fair results. No patient demonstrated a poor or unchanged outcome. All patients demonstrated excellent decompression in their postoperative magnetic resonance imaging scans, and all patients except one with discitis maintained their motion segments well, as indicated in postoperative dynamic roentgenograms. Two patients developed transient Horner's syndrome, one patient developed transient hemiparesis, and one patient developed discitis, resulting in spontaneous bone fusion. CONCLUSION: Anterior microforaminotomy provided good or excellent outcomes, with minimal morbidities, for 98% of 104 patients with cervical discogenic radiculopathy. The functional anatomic features were well preserved for 99% of the patients.

Adult↗
PubMed1992

Microdiscectomy in treatment of herniated lumbar disc.

The authors studied 122 patients who had undergone microsurgery for herniated lumbar disc or isolated nerve root canal stenosis. The patients were reviewed one month and three months after surgery and then returned for a final evaluation after an average of 1.4 years. Intraoperative or postoperative complications occurred in 13 cases and consisted of misdiagnosis (discovered intraoperatively) of the level of the herniated disc (7 cases), dural laceration (3 cases), and discitis (3 cases). Limited discectomy was performed in 16 cases and complete discectomy in the others. Two patients who had undergone limited discectomy experienced recurrence; this did not occur when complete discectomy was performed. Discitis occurred in patients who had undergone complete discectomy. Most of the patients who underwent operation for disc herniation at one lumbar level with no complications began walking within 24 hours, and 72% were discharged within 36 hours. Eighty-five percent of the patients had a satisfactory result one month after surgery, and 91% had a satisfactory result at the final follow-up. There was no significant difference between patients with protruded herniation and patients with sequestered herniation. In the patients with nerve root canal stenosis the proportion of satisfactory results was 72% at one month and 88% at the final follow-up. The main advantage of microsurgery is the full illumination of the operative field, and this technique is strongly indicated in cases of single-level herniated disc. Over the short-term, microdiscectomy achieves a higher proportion of satisfactory results, requires a shorter hospitalization period, and allows an earlier return to work than traditional surgery. However, no significant difference was found between microsurgery and traditional surgery over the long-term.

Adolescent↗
PubMed1978

The spectrum of intervertebral disc-space infection in children.

Discitis, intervertebral disc-space infection, and vertebral osteomyelitis form a spectrum of disorders with a probably common bacterial etiology. We studied forty-one children who had symptomatic narrowing of the disc space associated with fever and an elevated erythrocyte sedimentation rate and found that the diagnosis of infection in the spine was usually delayed. Technetium 99m polyphosphate bone-scanning proved to be an accurate, rapid, and safe method of establishing an early diagnosis of infection. A positive culture of blood or biopsy material was found in 34 per cent of all the patients (half of the patients for whom cultures were obtained). The clinical and roentgenographic picture that develops is determined both by the virulence and extent of infection and by the resistance and regenerative capacity of the host. Discitis in children is a vertebral osteomyelitis with disc involvement.

Abdomen↗
PubMed1989

Aspergillus disc space infection: case report and review of the literature.

Aspergillus disc space infection is an unusual complication of the immunocompromised state. Magnetic resonance imaging may aid the clinician in arriving at a prompt diagnosis of discitis in affected patients. We report a case of systemically acquired Aspergillus discitis at multiple levels diagnosed by plain x-ray films, bone scan, magnetic resonance imaging, and biopsy. We review the literature on this subject and suggest that aggressive diagnosis with early biopsy, treatment with systemic antifungal agents, and surgical debridement of the infected disc space yield the best outcome for these patients.

Anti-Bacterial Agents↗
PubMedDate not supplied

Computed tomography after lumbar disc surgery.

Computed tomography (CT) findings following lumbar disc surgery were analyzed in a series of 53 patients one week after surgery and in another series of 43 patients 6 months to 20 years (average 4.3 years) after surgery. In addition to changes caused by the surgical exposition (laminotomy or laminectomy, gas bubbles) a mass lesion was found on the posterior aspect of the disc in all cases. Hypodensity of the disc interspace as well as vacuolization were found in several cases. These changes were less in the patients examined late after surgery but the CT findings were never completely normal. Findings characteristic of recurrent prolapse included disc-like attenuation values within the mass and non-enhancement with contrast medium. Hypodensity of the disc interspace is associated with discitis but as a non-specific finding it is insufficient in itself for diagnosis of discitis.

Adolescent↗
PubMed1977

[Complications with ossovenography and discography in the cervical area (author's transl)].

Report on 3 cases of incidents or complications in discography and ossovenography. 1 patient developed reversible damage of the glossopharyngeal and recurrent nerve through hematoma following assovenography. Another patient developed aseptic discitis, the third infective discitis with parpharyngeal involvement. Pain and defects disappeared in all patients after treatment. Their causes are discussed. These rare complications do not represent contraindications considering the value of the diagnostic techniques.

Cervical Vertebrae↗
PubMedDate not supplied

Chymodiactin postmarketing surveillance. Demographic and adverse experience data in 29,075 patients.

Postmarketing surveillance data on 29,075 patients who received Chymodiactin (Smith Laboratories' formulation of chymopapain) intradiscal injections for a herniated lumbar intervertebral disc are summarized and tabulated. The serious adverse reactions reported include death, anaphylaxis, paraplegia, and discitis. Similar problems also have been reported for Discase (Baxter-Travenol's formulation of chymopapain). Of 11 deaths reported following Chymodiactin administration, only 3 appear to be related to the drug or procedure. Two of these three were due to anaphylaxis and the third to bacterial discitis with resultant meningitis. Paraplegia appeared to be primarily due to needle trauma or injection of contrast agent and enzyme into the subarachnoid space. Careful patient selection and needle placement are essential for avoiding serious problems.

Adolescent↗
PubMed1996

[Spinal diseases in a rheumatology hospital unit in Lomé (Togo)].

A retrospective study was conducted to determine the different kinds of spinal diseases in patients attending the rheumatology unit of Lomé hospital, Togo. Among the 4927 patients seen over a 5-year period, 1966 (40%) had spinal involvement. The disease observed were as follows: degenerative spinal disorders: 1872 cases (95%); infectious discitis: 41 cas (2.1%); spondyloarthropathies: 33 cases (1.8%); tumors: 20 cases (1.1%). Degenerative spinal involvement affected mainly lumbar and cervical spine. The only unusual clinical feature was that Schober's index was often normal. Lumbar spinal stenosis was common (233 cases, 12.4%), especially in females, and occurred at an earlier age than in the Western world. Ankylosing spondylitis features included mildness of extra-articular manifestations and an often negative family history. Pott's disease was de leading cause of infectious discitis. The present study suggests that spinal disorders are as frequent in Africa as in Western countries.

Adult↗
PubMed1990

Clinical follow-up after surgery of lumbar disc prolapses. A critical analysis.

A retrospective clinical study was made on 987 patients with lumbar disc disease treated by discectomy. All patients had been operated on in the Department of Neurosurgery (University-Hospital Mainz). 545 patients were males, and 442 females (1.2:1). Patients in the 4th decade of life were affected most often (33.5%). Perioperative complications occurred in 5.4%, with discitis as the single major complication (1.9%). 83% of all patients who underwent discectomy could return to their normal occupation.

Adolescent↗
PubMed1998

Spondylitis caused by Peptostreptococcus.

Peptostreptococcus is an anaerobic gram-positive coccus that is encountered in dental and sinus infections, pelvic infections in women, osteomyelitis, arthritis, skin and soft-tissues infections, conjunctivitis and bacteraemia [1,2]. We report here, what is to our knowledge, the first cases of spondylitis with discitis caused by Peptostreptococcus.

Aged↗
PubMed1991

Ultrasound in advanced pediatric osteomyelitis. A report of 5 cases.

The use and reporting of ultrasound for the evaluation of pediatric osteomyelitis is minimal. However, ultrasound is noninvasive and does not employ ionizing radiation, and it is less expensive than other methods available. Consequently, its application, if contributory, would be desirable in evaluating pediatric osteomyelitis. We examined five patients ranging from 2-weeks to ten-years-old with ultrasound after bony abnormalities were found on plain film. In all cases ultrasound was valuable in assessing the type and location of abnormality (4 cases of osteomyelitis, 1 case of discitis), but unhelpful in determining the age of disease.

Child↗
PubMed1997

Side effects and complications of automated percutaneous lumbar nucleotomy.

We reviewed the records of 243 patients treated at 271 disc levels to determine the incidence of side effects and complications of percutaneous nucleotomy. In our early experience there were 7 technical failures (2.5% of all attempts), of which 6 were at the 5th disc level. The success rate dropped from 67% at 3 months to 60% 1 year after treatment due to recurrences in 16 patients (6.6%). Extruded or sequestered fragments were found in 6 patients (2.4%), and may have been caused by nucleotomy. However, only one was accompanied by aggravation of symptoms. Discitis was seen in 2 patients (0.8%), both treated at two separate disc levels. About half the patients experienced increased low back pain, mean duration 9 days, after treatment, and 3 (1.2%), of whom 2 also had nonorganic disorders, needed admission to hospital because of severe pain. Mild spasm and a sensation of instability were noted by 9.6% and 25% of the patients respectively. Injury to nerves, bowels, vessels or ureters or a dural leak never occurred. The study confirms earlier reports that the rate of serious complications is low.

Adolescent↗
PubMed1997

Intervertebral disc space inflammation in children.

Discitis in children commonly presents with fever, back pain, irritability, and an inability to walk. An elevated ESR and characteristic changes on plain X-rays or bone scan are sufficient for diagnosis, but MRI is more sensitive and more specific, and it shows pathologic changes earlier. Intravenous antibiotics are administered when cultures of the disc space are positive, but in more than half of the cases, no organism can be grown. Symptoms are alleviated with bed-rest or external orthoses, but neither the duration nor the kind of symptomatic treatment influences outcome.

Anti-Inflammatory Agents↗
PubMed2004

Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis.

The natural history of uncomplicated hematogenous pyogenic spondylodiscitis is self-limiting healing. However, a variable degree of bone destruction frequently occurs, predisposing the spine to painful kyphosis. Delayed treatment may result in serious neurologic complications. Early debridement of these infections by percutaneous transpedicular discectomy can accelerate the natural process of healing and prevent progression to bone destruction and epidural abscess. The purpose of this manuscript is to present our technique of percutaneous transpedicular discectomy (PTD), to revisit this minimally invasive surgical technique with stricter patient selection, and to exclude cases of extensive vertebral body destruction with kyphosis and neurocompression by epidural abscess, infected disc herniation, and foraminal stenosis. In a previously published report of 28 unselected patients with primary hematogenous pyogenic spondylodiscitis, the immediate relief of pain after PTD was 75%, and in the long-term follow-up, the success rate was 68%. Applying stricter patient selection criteria in a second series of six patients (five with primary hematogenous spondylodiscitis and one with secondary postlaminectomy-discectomy spondylodiscitis), all patients with primary hematogenous spondylodiskitis (5/5) experienced immediate relief of pain that remained sustained at 12-18 months follow-up. This procedure was not very effective, however, in the patient who suffered from postlaminectomy infection. This lack of response was attributed to postlaminectomy-discitis instability. The immediate success rate after surgery for unselected patients in this combined series of 34 patients was 76%. This technique can be impressively effective and the results sustained when applied in the early stages of uncomplicated spondylodiscitis and contraindicated in the presence of instability, kyphosis from bone destruction, and neurological deficit. The special point of this procedure is a minimally invasive technique with high diagnostic and therapeutic effectiveness.

Adolescent↗
PubMed1998

Possible salmonella osteomyelitis of spine following laser disc decompression.

We report a case of chronic discitis and vertebral osteomyelitis that we believe was caused by Salmonella typhimurium following laser decompression of the L4/5 disc for symptomatic disc protrusion in a 50-year-old Asian man. The infection was successfully treated with intravenous ceftriaxone combined with oral ciprofloxacin. We believe this to be the only report of such a complication following this procedure, which is generally without infective complications.

Discitis↗
PubMed2005

Extension of lumbar spine infection into osteoarthritic hip through psoas abscess.

We present a case of pyogenic lumbar discitis and septic hip arthritis, accompanied by a psoas abscess and pyogenic iliopsoas bursitis, for which the correct diagnosis was delayed. The patho-mechanism was speculated to be initial hematogenous infection in the lumbar spine that spread along the psoas muscle as a psoas abscess and then extended into the hip joint via the iliopsoas bursa. For an early correct diagnosis, clinicians should be aware that the lumbar spine and hip joint regions communicate through the psoas muscle space and iliopsoas bursa, making it possible for infection to spread.

Bursitis↗
PubMed2005

Spondylodiscitis after lumbar microdiscectomy: effectiveness of two protocols of intraoperative antibiotic prophylaxis in 1167 cases.

The role of antibiotic prophylaxis in preventing postoperative lumbar spondylodiscitis is still controversial in medical, ethical, economic, and legal terms. The aim of this retrospective study was to evaluate the efficacy of two intraoperative antibiotic prophylaxis protocols in a large series of lumbar microdiscectomies performed in two different neurosurgical centres. We reviewed the outcome of 1167 patients operated on for a lumbar disc herniation with microsurgical technique, in order to detect the incidence of postoperative spondylodiscitis. Group A included 450 patients operated on in a 3-year period in the Neurosurgical Division of the University Hospital of Ancona; group P consisted of 717 patients operated on in a 4-year period in the Neurosurgical Division of the Sandro Pertini Hospital of Rome. In both groups intraoperative antibiotics for prophylaxis were administered, whereas postoperative prophylaxis was not performed. Protocol of group A: single intravenous dose of cefazoline 1 g at induction of general anesthesia and generous washing with saline solution and irrigation with a solution containing rifamicin at the end of microsurgical procedure. Protocol of group P: single-dose of intravenous ampicillin 1000 mg and sulbactam 500 mg at induction of anesthesia and generous irrigation with saline solution at the end of microsurgical procedure. A diagnosis of postoperative spondylodiscitis was made in three out of 450 patients in group A (0.67%) and in 5 out of 717 patients in group P (0.69%). In all cases, treatment consisted of rigid thoraco-lumbar orthesis and 4- to 6-week administration of amoxicillin/clavulanate compound (500/125 mg). The low incidence of postoperative spondylodiscitis obtained with both our protocols seems to confirm that intraoperative antibiotic prophylaxis is associated with the same rate of discitis of prolonged prophylaxis usually still adopted in many centres, but is more advantageous both in terms of welfare and comfort for patients and in economic terms. However, at the moment it is not possible identify the ideal antibiotic for this purpose. It seems to be reasonable to search for the solution through large multicenter prospective studies.

Anti-Bacterial Agents↗
PubMed2006

Bone and joint infection due to Streptococcus pneumoniae in two immunocompetent adults.

Bone and joint infections due to Streptococcus pneumoniae are uncommon in adults in the absence of risk factors (e.g. alcohol abuse, immunodepression, or preexisting joint disease). We report two cases in previously healthy adults. The clinical picture was septic arthritis of the knee in one patient and discitis with an extensive epidural abscess in the other. The characteristics of S. pneumoniae bone and joint infections are reviewed, with emphasis on risk factors. The therapeutic strategy is discussed in the light of the recent upsurge in S. pneumoniae strains with reduced susceptibility to penicillin.

Adolescent↗