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PubMed1988

Universal spondylodiscitis in a patient with erosive peripheral arthritis and apatite crystal deposition.

A patient with erosive peripheral arthritis in whom vasculitis and monoclonal IgG kappa paraprotein were associated with sacroiliitis and widespread destruction of intervertebral discs is reported. Crystals resembling apatite were identified in intervertebral disc material, and we postulate that the discitis was accelerated by apatite deposition. Our case illustrates a unique example of axial involvement in rapidly progressive joint disease.

Adult↗
PubMed1986

[Roentgen morphology following interventions of the lumbar intervertebral disk].

We compared x-ray films of 204 patients, evaluating plain radiographs, computer tomograms and myelographies. This study showed that plain radiographs serve as a guide, enabling to localise the level at which bone defects have occurred as a result of surgery. Conventional tomography is important for detecting changes associated with postoperative discitis. In about 50% of the patients, computed tomography enables satisfactory indication for a second intervention if used together with plain roentgenography and clinical examination. Myelography remains an indicated procedure if the disease pattern is not clear and if findings are ambivalent.

Humans↗
PubMed1984

[Kyphosis caused by severe spondylodiscitis in newborn infants and young children].

The authors report their experience of 12 discitis occurring in the new born and in young children. Pyogenic infections were found with general septicemia in the new born children. The onset of cases of Pott's disease occurred later. Anterior destruction of several vertebrae accounted for severe kyphosis which were found on clinical examination. Conservative immobilisation of the kyphosis during growth does not prevent any increase in deformity before puberty with the possible onset of neurological symptoms. The only possible treatment is surgical with anterior arthrodesis of the damaged region together with a corrective osteotomy followed as soon as possible by posterior arthrodesis. If, unfortunately the patient is seen later in the course of the disease, the possibility of corrective osteotomy will depend on the degree of kyphosis and the neurological symptoms.

Child↗
PubMed1983

Evaluation of the lumbar spine. A comparison between computed tomography and myelography.

The CT scan and the metrizamide myelogram are compared in evaluating multiple disorders of the spine. Examples are shown of degenerative disc disease, including lateral discs, isodense discs, and degenerative changes, which cause varying degrees of stenosis of the spinal canal and neuroforamina. Examples of discitis and neoplastic involvement of the vertebral bodies and spinal canal are also shown. Finally, several examples of dysraphic conditions of the spine are presented. CT examination for disc disease is still most often used as an adjunct to the myelogram. However, as knowledge and experience is gained about its value in diagnosing all abnormalities of the spine, its use will increase, and CT may become the primary method of evaluation, after ordinary radiographs.

Humans↗
PubMed1982

The erythrocyte sedimentation rate in orthopaedic patients.

The ESR, a sensitive measure of the inflammatory response, is elevated in 90% of patients who have serious orthopedic infections, e.g., discitis, septic arthritis, and hematogenous osteomyelitis. In most cases, it is sufficient to distinguish these entities from the less serious disease states, i.e., transient synovitis. After major surgical operations or extensive trauma, the ESR often increases to high levels and, if sepsis does not supervene, it returns to normal within six months. Outpatient determination of the ESR, although useless in the early detection of malignancy, is valuable in detecting inflammatory arthridities and major sepsis.

Arthritis, Infectious↗
PubMed1982

[Intervertebral disk infection in children (author's transl)].

Discitis, or infection of an intervertebral disk, is a diagnostic challenge in the preschool age, unless there is good reason for suspicion. Two children, two and four years old, are discussed here. They had abdominal pain for several days, difficulty in movement and anomalous sitting postures. In both, L4-L5 was affected, and laboratory, including bacteriology, studies were negative, except for leucocytosis and slight-to-moderately elevated sedimentation rates. The diagnoses were confirmed by lumbar spine X-rays, though not until the third week after onset of symptoms. Discussed are the values of bone gammagraphy in early diagnosis, favourable clinical evolution in spite of an abnormal radiological picture, and treatment.

Abdomen↗
PubMed1981

Bone scintigraphy in patients with juvenile kyphosis (M. Scheuermann).

A group of 32 patients between 10 and 16 years of age with a positive history and physical examination of juvenile kyphosis were studied. Both radiological and nuclear bone scanning studies of the spinal column were performed. Despite gross radiological abnormalities of the spinal column due to M. Scheuermann the bone scan was always negative. In 2 patients increased radionuclide accumulation was found due to active spondylodiscitis and a healing discitis. Our conclusion is that when a positive bone scan of a patient with M. Scheuermann is found one should consider other causes of involvement of the spinal column than juvenile kyphosis.

Adolescent↗
PubMedDate not supplied

Complications of cervical discography.

Two unusual cases of complications following discography are reported. In the first case cervical discography was performed because of recurrent shoulder-arm-syndrome. The examination was performed on an outpatient basis. Acute cervical spondylodiscitis developed 48 hours later and some symptoms persisted for a 15 months period. In this case the bacterial aetiology of discitis was very likely. In the second case quadriplegia developed within seconds after injection of the contrast medium into the intervertebral space. During the injection the patient reported severe pain in the arm. During the operation sequestrated parts of the intravertebral disc were found in the spinal canal, dorsal to the posterior longitudinal ligament. Most likely additional sequestrated parts of the degenerated disc were pushed into the spinal canal during the examination. Slow recovery of neurological defects took place after the operation.

Adult↗
PubMedDate not supplied

Clinical and radiological investigations on cervical spine involvement in rheumatoid arthritis in adults.

The radiological and clinical features of cervical spine involvement observed in 49 patients with rheumatoid arthritis are described. The forward atlas-odontoid subluxation, after an x-ray with full flexion of the cervical spine, occurred in 36.9% of the cases. The upward subluxation was found in 8 (17.4%) cases, but only in one (2.2%) case it was of high degree. In one case lateral subluxation could be suspected by the asymmetrical involvement of the atlanto-axial joints. Erosions of the odontoid peg, subluxation at various levels, discitis and osteoporosis with various frequency were observed. A statistically significant relation has been observed between duration of the disease and radiological signs at the level C1-C2; between radiological features and severity of general clinic picture; between cervical lesions at the level C1-C2 and presence of osteolysis affecting hands, wrists, feet. Clinically, signs concerned with cervical spine involvement were found in 83.6%. Besides cervical pain and functional limitation, the headache was the most frequent clinical sign. It was confined to the occipital region in 69.4% of the cases, and was present at awakening or occurred in connection with movements of the cervical spine and head (53.1%). This study confirms the frequent involvement of the cervical spine in rheumatoid arthritis and shows that performing a complete examination of C1-C2 area is useful, in the most serious forms of RA, since the third year of course.

Arthritis, Rheumatoid↗
PubMed1995

Successful medical treatment for staphylococcal vertebral osteomyelitis complicated by spinal epidural abscess, psoas abscess and meningitis: a case report.

A 42 year-old farmer was transferred to our hospital for recently exaggerated lower back pain. Neurological examination revealed an L4 radiculopathy on the right side. Meningitis developed after admission. MRI showed L4-5 osteomyelitis and discitis with contiguous spinal epidural abscess and right psoas abscess. Blood culture and CSF culture both grew Staphylococcus aureus. Because the patient refused to receive a drainage procedure, we gave him antibiotics which resulted in a favorable outcome.

Abscess↗
PubMed1995

Cervical epidural infection. Four case-reports.

The authors report four cases of cervical epidural infection, in two females (aged 58 and 82 years) and two males (aged 41 and 51 years). Risk factors were noninsulindependent diabetes mellitus in one patient and multiple myeloma treated by chemotherapy in another. Duration of cervical pain at evaluation was five to 15 days. Three patients had a fever and a neurologic deficit: one had brachial diplegia; the myeloma patient developed brachial diplegia after a lumbar puncture and the diabetic patient developed quadriplegia with respiratory disorders also after a lumbar puncture. Cerebrospinal fluid studies showed elevated protein levels with approximately 20 cells per mm3 and no pathogens in smears or cultures. Roentgenograms were normal at admission. The diagnosis was established by myelography (n = 2) and/or computed tomography (n = 2) and/or magnetic resonance imaging (n = 2). The infected area was anterior in three cases and posterolateral in one. Two to seven vertebral levels were affected. A Staphylococcus aureus was recovered from the blood cultures in all four cases and from a local specimen in one of the two patients who had a laminectomy. Of the two patients who did not have surgery, one had a normal neurologic evaluation and the other was an elderly patient with myeloma. In both, antimicrobial and corticosteroid therapy ensured complete resolution of the infection, and the myeloma patient recovered normal neurologic function. Residual neurologic loss was seen in one of the two surgically-treated patients. Two patients developed discitis.

Adult↗
PubMed1994

[Automated percutaneous nucleotomy. Results in 50 patients].

Automated percutaneous discectomy was introduced by Onik et al. in 1985 for the treatment of lumbar disk herniation. Success rates have ranged from 42% to 86%. We evaluated efficacy and looked for factors with a bearing on outcome in a retrospective study of 50 patients. Patients who did not have subsequent surgery were evaluated at least six months after the procedure, using the criteria developed by Mac Nab and by Stauffer and Coventry. The procedure was successful in 31 patients (62%) and failed in 19 (38%). Thirteen patients with failed automated percutaneous discectomy required surgery. Severe disk degeneration was significantly predictive of treatment failure. Lumbar spinal stenosis was also associated with lower success rates. Two patients developed infectious discitis after the procedure. Automated percutaneous discectomy may be less satisfactory than nucleolysis. Further studies are needed to determine the role and efficacy of this method for the treatment of lumbar disk herniation.

Adolescent↗
PubMed1993

[Chemolysis of intravertebral disk hernia and spinal syndrome].

The authors report a 31 year old patient who underwent L5-S1 chemonucleolysis. The prenucleolysis discogram disclosed intravertebral discal displacement. Severe spinal symptoms and development of geodes in the endplates adjacent to the treated disk occurred after the procedure. This case suggests that intraosseous discal displacement may be a risk factor for postchymopapain nucleolysis discitis and may contraindicate chemonucleolysis.

Adult↗
PubMedDate not supplied

Bone scintigraphy in patients with atypical lumbar Scheuermann disease.

Fourteen patients presenting during an 8-year period with radiographic changes suggestive of atypical lumbar Scheuermann disease (ALSD) involving one or more vertebral levels and low-back pain symptoms were referred for bone scintigraphy. Eleven of these studies included single-photon emission computed tomography (SPECT). The bone scans were reviewed with the intent of defining the scintigraphic characteristic of ALSD. Eleven of the 14 patients had subtle increases in activity on planar bone scintigraphy and/or SPECT at the radiographic sites of involvement. These scintigraphic findings should be distinguished from the more intense radiotracer uptake patterns of infection (osteomyelitis and discitis) and trauma (fracture).

Adolescent↗
PubMed1993

[Stellate ganglion blocks as the suspected route of infection in a case of cervical epidural abscess].

Spinal epidural abscess is a comparatively rare disease. Its prognosis reportedly depends on degree and duration of the neurological symptoms before the treatment. Thus, the importance of early diagnosis and prompt surgical treatment has been emphasized repeatedly. In the case reported here stellate ganglion blocks were considered to be involved in the etiology of a cervical epidural abscess. The 47-year old woman complained of tinnitus and vertigo and repeatedly underwent stellate ganglion blocks over a period of 10 months. In August, 1991, the patient complained of back pain and developed fever. A few days later she noticed motor weakness and sensory disturbances in the legs. Ten days after the onset of these neurological symptoms she complained of rapidly progressive tetraplegia and was referred to this hospital for admission. On admission, she was fully conscious but febrile. Neurologically, she presented tetraplegia, hypesthesia below level of C7 and slight cervical rigidity. Bladder and bowel dysfunction were also observed. MRI examination showed an epidural mass behind vertebral bodies C6-7 compressing the spinal cord. Antibiotic therapy was initiated immediately and emergency surgical decompression was performed through an anterior approach. Intraoperative findings showed a discitis and yellowish liquid pus in the epidural space. Culture of the pus revealed staphylococcus aureus. In this case repeated stellate ganglion blocks before onset of the symptoms were the suspected route of infection. Postoperative MR images confirmed satisfactory decompression of the spinal cord and motor power was gradually recovered after surgery. Approximately 4 months after surgery she could walk independently. Cervical epidural abscess has been rarely reported as a complication of stellate ganglion block.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed1995

[Development and progression of pyogenic spondylitis in a canine experimental model].

An experimental model was prepared to investigate the process of inflammation in pyogenic spondylitis. Forty-seven mongrel dogs were used, involving 24 mature and 23 immature dogs. Under intravenous pentobarbital anaesthesia, the lumbar vertebral bodies were approached posterolaterally and inoculated using a small piece of gauze soaked in a staphylococcus aureus suspension. Roentgenographic and histological examinations were regularly performed for 24 weeks after the inoculation. Histologically, acute inflammation started within 1 or 2 weeks, and subsided by 5 or 6 weeks in both the mature and immature dogs. In 55% of the dogs, the inflammation was confined within the vertebral body, in 10% it invaded into the intervertebral disc, and in 35% inflammation invaded into the anterior longitudinal ligament. In the immature dogs, thickening of the trabeculae and the anterior cortex was observed around the inflammatory focus more often than in the mature dogs. The epiphyseal line acted as a barrier against invasion by the inflammation in the immature dogs. However, direct invasion of the inflammatory process into the disc could have occurred through the vascular buds which were the terminal branches of the metaphyseal artery close to the disc in both the mature and immature dogs. In contrast to the results reported by Ohno who inoculated the lumbar discs of mongrel dogs with staphylococcus aureus, in the present study, the disc space remained intact and was replaced by fibrous tissue. Consequently, it was concluded that pyogenic spondylitis should be defined as a different clinical entity from discitis.

Animals↗
PubMed1998

[Prevertebral abscesses with a protracted insidious clinical course and subsequent lethal, acute pyogenic meningitis and septic shock].

This report concerns a 66-year-old man suffering from prevertebral abscesses with a protracted insidious clinical course and subsequent lethal and acute pyogenic meningitis. The patient had a three-month history of mild neck pain, and died as a result of septic shock due to staphylococcus aureus (methicillin susceptible) infection two days after admission to the hospital. At autopsy, abscesses encapsulated by fibrous connective tissue were found on the ventral surfaces of the cervical and thoracic regions of the spine. The prevertebral abscess on the upper cervical region was organized with dense fibrous tissue and contained a small number of inflammatory cells. On the other hand, the prevertebral abscess on the thoracic region was purulent and contained numerous inflammatory cells, macrophages and gram-positive cocci. Pyogenic spondylitis and discitis accompanying the prevertebral abscesses were multiple and widespread. These features suggested that the abscesses developed initially on the cervical region, extended caudally through the prevertebral space, directly involving the corpus vertebrae and discs, and ultimately caused sepsis. It is important to note that prevertebral abscesses can exhibit a protracted clinical course with only mild symptom such as minor neck pain and then manifest abruptly as acute meningitis and sepsis.

Abscess↗
PubMed1998

Primary psoas abscess. A review of 16 cases.

OBJECTIVE: Most psoas abscesses are secondary. The objective of this study was to report on the clinical features, diagnosis and treatment of primary psoas abscess. METHODS: We retrospectively studied 16 cases seen over a ten-year period (1987-1997) and compared our findings to published data. RESULTS: There were 14 men and two women, with a mean age of 6 years (range, 17-57 years). The right side was affected in nine cases, the left side in six, and both sides in one. Fever, pain and psoas spasm were the presenting symptoms. Laboratory tests for inflammation were positive; four patients had a high neutrophil count. Ultrasonography demonstrated a fluid collection in the psoas in 13 patients. A computed tomography scan was done in 14 patients and showed either a fluid collection (n = 11) or a presuppurative abscess (n = 3). Magnetic resonance imaging was not used. The organism was recovered in nine patients and was a Staphylococcus aureus in seven, an Escherichia coli in one and a Pseudomonas aeruginosa in one. The Brucella agglutination test was strongly positive in two patients. Findings were negative from investigations done to look for a cause (discitis, urinary tract infection, Crohn's disease, ulcerative colitis, malignancy or infection in the vicinity of the psoas muscle). All patients received antimicrobial therapy. Drainage was percutaneous in six patients and surgical in ten. The outcome was favorable in every case.

Adolescent↗