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At least 325 records · Page 18Linked to original sources
PubMed1994

Reoperation in the management of post-operative disc space infection.

Post-operative intervertebral disc space infection had been recognised as a clinical entity with its own characteristics. Various treatments have been described. During the last six years 3127 open lumbar intervertebral disc operations were performed of which 15 (0.5%) showed a post-operative discitis. We treated our patients by reoperation of the infected intervertebral disc space. The reason of reoperation consists of acquiring material for bacteriological culture and removing loose fragments. It appears to us that reoperation is facilitating early mobilisation of patients. Also attention is paid to new diagnostic possibilities.

Adult↗
PubMed1994

Early diagnosis of spinal tuberculosis by MRI.

MRI was performed at three centres in Bombay on 24 patients clinically suspected of tuberculosis of the spine but with normal radiographs. There were 11 males and 13 females and their average age was 24 years (11 to 60). 99mTc bone scans were done in 16 patients before MRI. Eleven patients had the diagnosis confirmed by biopsy and the remainder all responded rapidly to specific antituberculous chemotherapy. On T1-weighted images there was a decrease in signal intensity of the involved bone and soft tissues; on T2-weighted images there was increased signal intensity. Depending on the stage of the disease, three different patterns of infection were revealed: osteitis, osteitis with an abscess, and osteitis with or without an abscess plus discitis. The anatomical pattern of involvement, particularly of the soft tissues and the discs, is specific for tuberculous disease. The ability of MRI to detect tuberculosis of the spine earlier than other techniques could reduce bone destruction and deformity and diminish the need for surgical intervention. Despite the specificity of the patterns revealed by MRI, biopsy is recommended during the stage of osteitis to confirm the diagnosis.

Abscess↗
PubMed1993

[Aspergillus spondylodiscitis. Apropos of 3 cases].

Three cases of Aspergillus discitis are reported in immunodepressed patients. Vertebrae osteomyelitis was preceded in 2 cases by pulmonary infection. The diagnosis was established in every case by disc aspiration or closed-needle-biopsy and mycological examination of the material. Aspergillus fumigatus was identified in two cases; in one case itroconazole led to recovery within three months.

Adult↗
PubMed1993

Aseptic spondylodiscitis: a complication of chemonucleolysis? A case report.

Discitis after intradiscal injection of chymodiactin is nearly always associated with an infection introduced by the needle tip. The authors report a patient with a postchemonucleolysis spondylodiscitis who recovered complete without surgery or antibiotics. The clinical findings and results of CRP and MRI suggested an aseptic spondylodiscitis due to chymodiactin.

Adult↗
PubMed1996

Pediatric spinal infections.

A high index of suspicion for spinal infection and an appropriate and prompt diagnosis are essential for the treatment of pediatric spinal infections. A 3-week course of antibiotics and supportive therapy is effective in the majority of cases of discitis, the most common pediatric spinal infection. Patients who are not toxic may be treated with bracing, or with casting alone in many cases. Neurologic deficit or a failure to respond to early treatment requires more aggressive measures, including biopsy or surgical debridement. It is essential to diagnose rare but serious conditions such as epidural abscess, tuberculosis, or opportunistic infections in patients at risk. The authors stress that clinical evaluation and appropriate diagnosis are critical for prevention of permanent neurologic damage or late bony deformity.

AIDS-Related Opportunistic Infections↗
PubMed1996

Pyogenic infectious spondylitis in children. The evolution to current thought.

The historic evolution of pyogenic infectious spondylitis from its initial descriptions to its current characterization illustrates the degree to which our means of perception and evaluation influence our understanding of an illness. As new concepts resulting from medical innovations challenge traditional beliefs regarding the etiology and optimum treatment of pyogenic infectious spondylitis in children (commonly termed discitis), controversies have arisen. This review attempts to clarify these issues by reconstructing their historic basis and delineating the limitations of our current knowledge. In our opinion, this exercise demonstrates the similarities between pyogenic infectious spondylitis in children and adults and provides support for the management of this illness at all ages with parenteral antibiotics, cast or brace immobilization when needed for symptomatic relief, and, rarely, operative débridement.

Adult↗
PubMed1996

[Spondylodiscitis after operation for lumbar disc herniation].

Postoperative spondylodiscitis (POD) is a rare but severe complication of lumbar disc surgery. There were five patients with POD among 875 patients undergoing surgery for herniated lumbar discs, in the last 16 years. For detecting risk factor of discitis, a POD group of 5 patients was matched to a control group of 870 patients with respect to sex, age, disc type and operation. In five patients with POD follow-up evaluation of clinical symptoms, laboratory data were obtained, and magnetic resonance (MR) imaging was performed. A significant difference between the POD group and the control group was confirmed in sex, operation time and the volume of bleeding during operation. However, there was no significant difference confirmed due to age, disc type, disc level and operative procedure. In the case of males or prolonged operation time or increase of the volume of bleeding, POD may be more frequently observed. All five patients had a period of pain relief after their operations and then reported increasing low back pain with no focal signs. At diagnosis of POD all patients had an erythrocyte sedimentation rate (ESR) greater than 30 per hour and C-reactive protein (CRP) higher than 2.5. After treatment by antibiotics, low back pain gradually receded along with decrease of ESR and CRP. About 40 days later, these patients were almost free of back pain and ESR and CRP were within normal range. MRT1-weighted image during the acute phase demonstrated remarkably decreased signal intensity with loss of distinction between vertebral body and disc space. T2-weighted image showed increased signal intensity in the adjacent vertebral bodies and end-plates. Gadolinium-enhanced T1-weighted image had homogenous enhancement of vertebral body and disc space. During the subacute phase, however, T1-weighted image demonstrated moderately decreased signal intensity noted in the posteroinferior portion of the L5 vertebral body and the narrowed L5/S1 disc space. T2-weighted image showed iso signal intensity in L5 and S1 vertebral bodies. Gadolinium-enhanced T1-weighted image had mild homogenous enhancement in the posteroinferior portion of the L5 vertebral body. Three months after treatment of POD, there was major signal change in neither T1 nor T2 weighted images, though T2 showed subtle abnormalities with decreased signal intensity adjacent to the L5/S1 disc space.

Adult↗
PubMed1996

Evaluating the child with back pain.

The most common causes of serious low back pain in children include spondylolysis, Scheuermann disease and musculoligamentous injury. Questions should be asked about the mechanism of onset and exacerbating factors, and the frequency, duration and severity of the pain. The examination should check gait and alignment, flexibility, strength and reflexes, and localize and evaluate the pain. Warning signs of serious problems include constant pain in a child younger than 11 years of age that lasts for several weeks or occurs spontaneously at night, repeatedly interferes with school, play or sports, or is associated with marked stiffness and limitation of motion, fever or neurologic abnormalities. Pain at the lumbosacral junction may suggest spondylolysis or spondylolisthesis. Scheuermann disease is diagnosed by the observance of wedging, irregularity or growth disturbance of three successive vertebrae. Musculoligamentous pain may result from injury to or overuse of muscles or joints of the back. Rare causes include discitis, tuberculosis, bone or spinal cord tumor, pyelonephritis and retroperitoneal infection.

Algorithms↗
PubMed1997

Complications of cervical discography: findings in a large series.

The use of cervical discography remains controversial. Recently in a small patient group, a high complication rate was reported. The purpose of this study was to determine the incidence of complications associated with cervical discography. Data from 161 cervical discography procedures, involving 269 disc injections, were recorded. There were four complications; thus the complication rate was 2.48% based on the number of procedures and 1.49% based on the number of disc injections. The complications were two cases of discitis, one postinjection hematoma, and one patient developed significant headache pain after the disc injection. Reports of high complication rates associated with cervical discography and serious outcomes from them should serve as a warning that the procedure does have associated risks, and great care is warranted. However, based on the results of our study, discography is not an inherently unsafe procedure. It can be accomplished with few complications when performed in sterile conditions by those well experienced with cervical disc injections.

Adult↗
PubMed1997

[Back pain in children].

OBJECTIVE: The incidence of back pain in children in our country is unknown. Several causes can produce this symptom, but it is necessary to rule out pathologies that require specific treatments. The goal of this work was to study the incidence and the etiology of back pain in children in our country. PATIENTS AND METHODS: We present a prospective study done in our Orthopedic Department during a period of 7 months. Twenty-two patients were referred with back pain of at least two months duration. The incidence was 2.9% compared to the total number of patients. The average age ranged from 7 to 17 years. RESULTS: A careful history and a radiological examination diagnosed 50% (11 cases) of the causes of backache in the present study. An idiopathic etiology was the most frequent cause and represented 9 patients (41%). In the remaining 12 cases (59%) pathological causes that required special treatment were identified including 2 cases of Scheuermann disease, 4 cases of painful scoliosis, 3 spondylolysis with spondylolisthesis, 2 cases of discitis, 1 benign neoplasm and 1 psychogenic cause. CONCLUSIONS: We recommend conservative management with the use of medication for relief of pain and physical therapy in the idiopathic cases. In the remaining cases, the specific treatment of the disease can improve the back pain.

Adolescent↗
PubMedDate not supplied

Magnetic resonance imaging and axial involvement in spondylarthropathies. Delineation of the spinal entheses.

We used magnetic resonance imaging in a prospective cross-sectional study to evaluate the components of axial involvement in spondylarthropathies, to determine whether the entire intervertebral disk is an enthesis and to gauge how useful this imaging technique is in detecting enthesitis of the spine. Thirty-one patients with spondylarthropathies and 14 controls with mechanical spinal disease were included. Images of the thoracic and lumbar spine were obtained using plain radiography, radionuclide bone scanning, and magnetic resonance imaging (sagittal sections, T1-weighted sequences before and after gadolinium injection and fat saturation and T2-weighted sequences). Magnetic resonance imaging signal abnormalities reflected inflammation and hypervascularization of the subchondral bone underlying the affected entheses (low signal enhancing after gadolinium and fat saturation on T1 images, high signal on T2 images). These abnormalities were often visible early in the disease process, at a time when there were not yet any clinical manifestations or radiographic or bone scan changes. In addition to showing involvement of the classic spinal entheses, magnetic resonance imaging also demonstrated evidence of inflammation and hypervascularization of the central part of the vertebral endplates and intervertebral disks, confirming that the center of the disk is an enthesis and that inflammatory enthesitis is the mechanism underlying at least some cases of discitis seen in patients with spondylarthropathies.

Adult↗
PubMed1992

Rheumatic manifestations of infective endocarditis.

Rheumatic manifestations are common and varied in infective endocarditis. We performed a retrospective case analysis on 87 patients with 93 episodes of infective endocarditis admitted to Flinders Medical Centre over an 11 year period (1980-1990). Disabling musculoskeletal symptoms and signs were documented in 22 (25%) of the patients. Thirteen patients developed severe or moderately severe low back pain during their illness, two with radiological evidence of a septic discitis or vertebral osteomyelitis. Two patients developed polyarthralgia/arthritis, four had septic arthritis (all with acute Staphylococcus aureus endocarditis), three developed severe loin pain, two acute gout, two had severe buttock pain and sacroiliac joint tenderness and two each developed disabling jaw/facial pain, neck/scapular pain and flank pain respectively. Five patients presented initially to the orthopaedic or rheumatological unit for management of their musculoskeletal symptoms. Four of seven patients with Streptococcus bovis endocarditis demonstrated prominent low back pain supporting a previously noted association between this organism and back symptoms. Furthermore, in one patient who had three separate episodes of endocarditis involving three different organisms, florid back symptoms were only seen in the infective episode involving Streptococcus bovis.

Aged↗
PubMed1993

Scintigraphy of spinal disorders in adolescents.

Bone scintigraphy in adolescents is useful in helping to differentiate between developmental (atypical lumbar Scheuermann disease), infectious (discitis, osteomyelitis), neoplastic (osteoid osteoma, osteoblastoma), and traumatic (occult fractures, spondylolysis, pseudoarthrosis) disease of the spine. Double-phase (blood pool, delayed images) scintigraphy can characterize the pattern (i.e., linear in fracture, ovoid in nidus of osteoid osteoma). Single-photon emission computed tomography (SPECT) can be helpful in detecting the subtle presence of stress reaction (spondylolyses) not noted on routine planar scintigraphy and radiography. Bone scintigraphy is most beneficial when correlated with other imaging modalities in refining the diagnosis of spinal diseases.

Adolescent↗
PubMed1977

Anterior intervertebral disc herniations in children. Report of four cases.

Four boys with anterior lumbar disc herniations probably secondary to chronic trauma are reported. Anterior disc herniations may appear as separate lesions-as in our patients-or coexist with Scheuermann's disease. Although Scheuermann's disease, discitis and tuberculosis are regarded as the most common causes of intervertebral disc lesions in childhood, trauma should be excluded as a possible cause in all children with chronic back pain who show localised radiographic signs of narrowed disc spaces with erosive and sclerotic changes in the adjacent vertebrae. Localised mild platyspondly may be the result of abnormal, prolonged stress and early osteoarthritic changes are to be expected.

Adolescent↗
PubMed1994

Percutaneous nucleotomy in the treatment of lumbar disc herniation results after a mean follow-up of 2 years.

We have evaluated the clinical outcome of 45 consecutive patients who underwent percutaneous nucleotomy for a single-level disc herniation. Included were 28 (62%) woman and 17 (38%) men, with a mean age of 46 years. The mean postoperative follow-up time was 2 years. Intra-operatively, disc herniation was graded as a protrusion in 23 (51%) patients and as a prolapse in 22 (49%) patients. During the follow-up, sciatic pain completely recovered or markedly diminished in 38 (84%) patients and 35 (78%) patients returned to work. The occupational outcome of the patients operated on for a protrusion was inferior to that of the patients operated on for a prolapse: only 22% of the patients who underwent surgery for a protrusion reported to manage their work well, while as many as 41% of those with a prolapse managed well (p = 0.04). Pre-operatively, clinical examination revealed segmental instability of the lumbar spine in 11 (24%) patients. There was a significant association between instability and unsatisfactory long-term outcome: of the patients with pre-operative instability, 45% were postoperatively retired or on sick leave because of the back, as compared to 15% of the 34 patients without instability (p = 0.03). Furthermore, patients with instability suffered from sciatica and low back pain significantly (p = 0.02) more often than those without instability. Surgical complications were infrequent. There were no nerve root lesions and no vascular injuries. Postoperative discitis developed in 2 (4%) patients. Of all patients, only 1 (2%) has been re-operated on for a recurrent disc.

Adult↗
PubMed1993

Microsurgical treatment of lumbar disc herniation: follow-up of 237 patients.

We have reviewed retrospectively the results of 237 consecutive patients who underwent microsurgical discectomy for a virgin lumbar disc herniation. Included were 128 (54%) mean and 109 (46%) women, with the mean age of 42 years. Intra-operatively, protrusion was found in 60 (25%) patients, prolapse in 127 (54%) patients and sequestration in 50 (21%) patients. The median post-operative follow-up time was 2 years. During the observation period, sciatic pain had completely recovered or markedly diminished in 218 (92%) patients, and 187 (79%) patients had returned to work. The mean duration of preoperative sciatica was 3.8 months in those patients who finally returned to work. In contrast, it was as long as 6.3 months in those patients who lost their working capacity as a consequence of low back pain. The patients operated on for a prolapse or a sequestrum recovered better than those who underwent surgery for a protrusion. Of the patients operated on for a protrusion, 68% returned to work, while 76% of those operated on for a sequestrum and 85% of those operated on for a prolapse returned to work during the follow-up. Difference was seen also in the occupational outcome: only 37% of the patients operated on for a protrusion reported to manage their work well, while 47% of those with a prolapse and 58% of those with a sequestrum managed well. Surgical complications were infrequent in this study. Dural tear appeared in 10 (4%) patients and post-operative discitis in 4 (1.7%) patients. Of all patients, 9 (4%) required re-operation for a true recurrent disc.

Activities of Daily Living↗
PubMed1995

Spinal epidural abscess complicating tuberculous spondylitis.

We report the case of a patient with tuberculous L1-L2 spondylo-discitis complicated by a spinal epidural abscess which extended anteriorly to the cord up to the low cervical level. Mild signs and symptoms of spinal cord involvement improved with antituberculous therapy; however, after seven months of therapy, the MRI appearance of the abscess findings was unchanged. An attempt at surgical decompression and drainage of the abscess was unsuccessful because of the presence of dense scar tissue.

Abscess↗