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At least 469 records · Page 26Linked to original sources

Long-term radiographic follow-up in a patient with osteosclerotic sarcoidosis of the spine and pelvis.

Eight-year clinical and radiographic data in a patient with sarcoidosis manifesting as pelvic and spinal osteosclerosis and as mediastinal lymphadenopathy are described, extending the initial report of this case written after three years of follow-up. The osteosclerotic lesions involved the right iliac and sacral wings, as well as two lumbar vertebras, which had an ivory appearance. There was also evidence of right sacroiliitis, pubic symphysitis and T7-T8 discitis. The diagnosis was established by bone and mediastinal lymph node biopsies. Follow-up was eight years at the time of this writing. The osteosclerotic lesions improved, disappearing almost completely at the lumbar spine, and fusion occurred at the right sacroiliac joint, pubic symphysis, and T7-T8 intervertebral disk. A review of the literature found 13 similar cases, with noticeably shorter follow-ups. The characteristics of axial osteosclerotic sarcoidosis are reviewed, and the indications of corticosteroid therapy are discussed.

Female↗

Chymopapain chemonucleolysis: a review of 105 cases.

A review of 105 consecutive cases of chymopapain chemonucleolysis for single level lumbar disc herniation was undertaken. Mean follow-up was 12.2 years (range 10-15.3). Patients were assessed using the Oswestry Disability Questionnaire. Eighty-seven patients were available for follow-up. An excellent or good response occurred in 58 patients (67%); four patients (4.5%) had a moderate response but were only minimally disabled. The treatment failed in 25 patients (28.5%) and 21 of these went on to surgery within a mean of 5.2 months (range 3 weeks-12 months). In 15 patients (71%) disc sequestration or lateral recess stenosis was found. Five of the remaining six cases had a large disc herniation at surgery. Surgery resulted in a significant improvement in nine cases. Discitis following chemonucleolysis occurred in six patients (5.7%). Chymopapain chemonucleolysis has a useful role in the management of lumbar intervertebral disc prolapse. However, its efficacy is dependent on careful clinical and radiological patient selection.

Adult↗

Neurologic abnormalities in children presenting with diskitis.

BACKGROUND: Neurologic impairment is not considered a clinical manifestation of diskitis in children and has seldom been associated with it in the medical literature. OBJECTIVE: To describe neurologic findings and their implications in children with diskitis. STUDY DESIGN: Retrospective medical records review of children discharged with a diagnosis of diskitis between January 1992 and December 2000. The study included children in whom the diagnosis was based on the presence of clinical findings, laboratory evidence of an inflammatory process, and findings on imaging studies compatible with diskitis. RESULTS: Neurologic findings of decreased muscle strength or hyporeflexia in the lower extremities were found in 7 (41%) of 17 children who met the diagnostic criteria for diskitis. Five of the 7 underwent magnetic resonance imaging, 2 of whom demonstrated intraspinal inflammatory involvement. CONCLUSIONS: Neurologic impairment does not exclude the diagnosis of diskitis and may be a common manifestation of the disease in children. Nevertheless, when neurologic findings are present, advanced imaging studies are needed to exclude intraspinal involvement.

Child↗

Cervical spondylodiscitis: a rare complication after phonatory prosthesis insertion.

BACKGROUND: Tracheoesophageal puncture has excellent voice rehabilitation after total laryngectomy. However, despite its easy insertion and use, severe complications have been reported. METHODS: We report a case of cervical spondylodiscitis, occurring in a 67-year-old woman submitted to phonatory prosthesis insertion. After 1 month, she complained of severe cervicalgia associated with fever. Spondylodiscitis involving C6, C7, and the intervening vertebral disk with medullary compression was detected by means of imaging studies. RESULTS: A right cervicotomy with drainage of necrotic tissue was performed, and a de-epithelialized fasciocutaneous deltopectoral flap was interposed between the neopharynx-esophagus and the prevertebral fascia to protect the neurovascular axis. MR performed 1 month later showed a complete resolution of the infectious process. CONCLUSIONS: Severe neck pain after tracheoesophageal puncture should alert the physician about the possibility of a cervical spondylodiscitis. MR is the most useful imaging technique for preoperative and postoperative evaluation. When neurologic symptoms are detected, surgical exploration of the neck is mandatory.

Aged↗

IL-1beta sensitizes intervertebral disc annulus cells to fluid-induced shear stress.

Chronic inflammation and altered mechanical loading are implicated as contributors to intervertebral disc degeneration. Biomechanical and biochemical factors play a role in disc degeneration but have received limited study. Mechanically, intervertebral discs are sheared during bending or twisting of the trunk. Biochemically, IL-1beta, detected in degenerative discs, promotes metalloproteinase expression. We hypothesized that disc cells might respond to shear stress and IL-1beta in a calcium signaling response. We measured the effect of single and combined stimuli on intracellular calcium concentration ([Ca2+]ic) and signaling. Cells were isolated from annulus tissue, cultured to quiescence, plated on collagen-bonded Culture Slips and incubated with Fura-2AM. Cells then were incubated in IL-1beta. Cell response to the effects of fluid flow was tested using FlexFlo, a laminar flow device. Human annulus (hAN) cells responded to laminar fluid flow with a one to three-fold increase in [Ca2+]ic. IL-1beta alone produced a small, transient stimulation. hAN cells pretreated with IL-1beta responded to shear with a more dramatic and sustained increase in [Ca2+]ic, six to ten-fold over basal level, when compared to shear then IL-1beta or shear and IL-1beta alone (P<0.001 for all comparisons). This is the first study documenting synergism of a signaling response to biomechanical and biochemical stimuli in human disc cells. IL-1beta treatment appeared to "sensitize" annulus cells to mechanical load. This increased responsiveness to mechanical load in the face of inflammatory cytokines may imply that the sensitivity of annulus cells to shear increases during inflammation and may affect initiation and progression of disc degeneration.

Adolescent↗

Nucleus pulposus glycosaminoglycan content is correlated with axial mechanics in rat lumbar motion segments.

The unique biochemical composition and structure of the intervertebral disc allow it to support load, permit motion, and dissipate energy. With degeneration, both the biochemical composition and mechanical behavior of the disc are drastically altered, yet quantitative relationships between the biochemical changes and overall motion segment mechanics are lacking. The objective of this study was to determine the contribution of nucleus pulposus glycosaminoglycan content, which decreases with degeneration, to mechanical function of a rat lumbar spine motion segment in axial loading. Motion segments were treated with varying doses of Chondroitinase-ABC (to degrade glycosaminoglycans) and loaded in axial cyclic compression-tension, followed by compressive creep. Nucleus glycosaminoglycan content was significantly correlated (p < 0.05) with neutral zone mechanical behavior, which occurs in low load transition between tension and compression (stiffness: r = 0.59; displacement: r = -0.59), and with creep behavior (viscous parameter eta(1): r = 0.34; short time constant tau(1): r = 0.46). These results indicate that moderate decreases in nucleus glycosaminoglycan content consistent with early human degeneration affect overall mechanical function of the disc. These decreases may expose the disc to altered internal stress and strain patterns, thus contributing through mechanical or biological mechanisms to the degenerative cascade.

Animals↗

Auto-immune spondylodiscitis associated with collagen induced arthritis in rats: high field MRI findings.

The spinal involvement of the tail was studied in Wistar Furth rats immunized with bovine native type II collagen. Focal caudal autoimmune spondylodiscitis occurred 5 weeks after sensitization, as assessed histopathologically. High field Magnetic Resonance Imaging (MRI) was useful in depicting these caudal abnormalities that were related to juxta-diskal enthesitis. The occurrence of such inflammatory enthesopathies could serve as an experimental approach for physiopathological and therapeutical studies of spondylarthropathies.

Animals↗

Exogenous lumbar spondylodiscitis following a stabwound injury and vertebral fracture. A case report and review of the literature.

Exogenous spondylodiscitis is a rare event and is usually iatrogenic. Non-iatrogenic exogenous spondylodiscitis has been described in the literature following transabdominal gunshot wounds associated with injury to the intestines and spine. Several cases of traumatic meningitis and one of a traumatic meningocele following an injury of the spinal sac have been reported. No report of exogenous spondylodiscitis complicating a stabwound has been published. This is a report of exogenous spondylodiscitis following a paravertebral stabwound with a knife in association with a superior wedge fracture of L2.

Adult↗

Kluger's "fixateur interne" for spinal instability.

Kluger's "Fixateur Interne" proved to be an excellent tool not only in spinal trauma for repositioning of impacted fractures and transpedicular stabilization of the dorsal column but also in other forms of thoracic or lumbar instability. After spinal tumor excision from a dorsal approach and vertebral replacement with methylmethacrylate additional stability through dorsal fixation was achieved with this device. Spondylodiscitis, symptomatic spondylolisthesis, spinal instability from degenerative disc disease as well as "non-union" following previous surgery could be cured using Kluger's internal fixation. Rare complications, i.e. from broken screws or rods (5%) caused no problems, but some patients required a second operation for readjustment of malpositioned screws which were causing pain or neurological deficit.

Aged↗

Cervical destructive spondylodiscitis: a report on three cases.

Three patients suffering from hematogenous destructive spondylodiscitis were treated with one-session spondylectomy, bone graft-fusion and halo-device stabilization. A stable osseous fusion was achieved after three months with additional antibiotic therapy.

Cervical Vertebrae↗

Traditional and new types of spondarthritis with special consideration of spondylodiscitis.

In rheumatology the so-called "seronegative spondarthritis" is a group of diseases characterized by the presence of HLA-B 27. This group includes the typical ankylosing spondylitis as well as atypical spondylopathies such as those occurring in psoriasis, Reiter's disease and chronic inflammatory enteropathies, which attack mainly the spine and secondarily the peripheral joints. In some severe cases, non-infectious, sterile spondylodiscitis was observed. These can lead to instability and fracture, followed by pseudarthrosis of the involved segment of the spine. In contrast to these traditional spondarthritides three new types are marked by the lack of HLA-B 27. 1) "Spondarthritis hyperostotica pustulo-psoriatica" (F. Schilling), a very rare variation of psoriatic spondylopathy, sometimes accompanied by spondylodiscitis. 2) Arthritis and spondarthritis in acne fulminans. 3) Destructive arthropathy and spondylopathy in long-term hemodialysis, occasionally occurring with spondylodiscitis, a very new type of spondarthritis. The amyloid B (beta-2-micro-globulin), discovered only four years ago, plays a dominant role in the pathogenetic chain of this disease. Details of the etiology of these very impressive diseases are presented. Destructive spondylodiscitis will no doubt be a challenge to neurosurgeons.

Acne Vulgaris↗

The role of magnetic resonance imaging (MRI) in the diagnosis of spondylodiscitis.

Spondylodiscitis is a well-known as well unavoidable complication of lumbar disc surgery. For diagnosis typical clinical symptoms and diagnostic procedures such as x-ray and scintigram are important but MRI proved to be the most sensitive and reliable. However, meaningful results can only be obtained with MRI if the measurement parameters are carefully considered, where by the field strength of the magnet plays a subordinate role. Therapy of spondylodiscitis using a light cast corset is described and it's advantages over other methods are shown.

Anti-Bacterial Agents↗

Indications for and results of operative treatment of spondylitis and spondylodiscitis.

We present a retrospective follow-up study of 24 patients with spondylitis or spondylodiscitis whose treatment included surgical intervention. Tuberculous spondylitis was diagnosed in 14 patients and 10 suffered from non-specific spondylitis. The average age of the patients was 50.2 years and average follow-up was 3 years. All patients were asymptomatic at the time of examination and showed radiographic evidence of solid fusion. We recommend radical debridement and spinal fusion through a ventral approach in patients with destruction of the ventral vertebral body, progressive neurological impairment, septicaemia and antibiotic-resistant, symptomatic infections of the spine. In the elderly patient, even in reduced states of health, early surgical intervention can be particularly valuable. Although surgical intervention should be reserved for specific indications, we were able to document favourable results in all 24 patients treated with debridement and spinal fusion.

Bone Transplantation↗

Intervertebral disc space infection caused by Aspergillus fumigatus.

The authors describe the case of a 53-year-old woman who suffered from an Aspergillus fumigatus infection of the L2/3 intervertebral disc space unrelated to previous operations on her lumbar spine. After surgical debridement combined with amphotericin therapy she died on the 23rd postoperative day from a fulminant bacterial sepsis of pulmonary origin. Although she had intermittently used steroids for bronchial asthma, this is an unusual case of fungal infection of the lumbar spine in an apparently immunocompetent patient.

Amphotericin B↗

Spondylodiscitis after lumbar disk surgery.

The value of perioperative prophylactic use of antibiotics in lumbar disc surgery is investigated, based on a retrospective study of the operative results of 5041 patients. The rate of occurrence of postoperative spondylodiscitis was significantly higher during the period in which no perioperative prophylaxis was carried out, than it was during the period, in which perioperative prophylaxis was routine. Thus the perioperative prophylactic use of antibiotics seems highly recommendable.

Cephalosporins↗