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PubMed2004

[Spondylodiscitis after perioperative peridural catheter].

Peridural anaesthesia is used to avoid operative, postoperative and chronic pain, especially in surgery, gynecology and urology. Complications have rarely been described but can entail serious local and systemic sequelae. Three cases with spondylitis and spondylodiscitis after peridural anaesthesia are presented. The failure to recognize the peridural catheter as the cause of vertebral pain led to therapeutic delay in two cases. The result of antimicrobial therapy and in two cases radical surgical treatment was complete recovery. The occurrence of spondylodiscitis after the use of peridural catheters is often a late manifestation of disseminated pathogens. The insidious progression of infection and non-specificity of clinical symptoms may lead to diagnostic delay. Awareness of the possibility of even delayed complications after the use of peridural anaesthesia is important.

Adult↗
PubMed2002

[Psoas abscess. Etiology and treatment].

Psoas abscess is in general a syndrome with low incidence. In the following, two cases are presented which describe the etiology, diagnosis, and treatment of primary and secondary retroperitoneal manifestations. The article mainly focuses on the different respective surgical procedures. Because of its rareness, an overview of further cases discussed in the literature is provided.

Aged↗
PubMed2003

[Spondylitis due to Salmonella typhimurium].

Very little is known about Salmonella typhimurium as an agent of spondylitis. Only single cases have been described in the international literature over the last years. We report on three patients suffering from spondylitis with Salmonella typhimurium being isolated as the triggering agent and point out the subtly differentiated diagnostic and therapeutic procedures, especially the possible complications of a Salmonella spondylitis. For one of the patients, we diagnosed a concomitant abdominal aortic aneurysm. Another patient sustained an infection of a known aortic aneurysm, which had been operated on 3 years ago. The source of the infection could be either the aneurysm or the spine, with the other structure being infected subsequently. We also discuss possible pathogenesis.

Aged↗
PubMed2004

[Accuracy of CT-based navitation of pedicle screws in the thoracic spine compared with conventional technique].

The goal of this study was to evaluate the accuracy of CT-based computer-assisted pedicle screw insertion in the thoracic spine in patients with fractures, metastases, and spondylodiscitis compared to a conventional technique. A total of 324 pedicle screws were inserted in the thoracic spines of 85 patients: 211 screws were placed using a CT-based optoelectronic navigation system assisted by an image intensifier and 113 screws were placed with a conventional technique. Screw positions were evaluated with postoperative CT scans by an independent radiologist. In the computer-assisted group, 174 (82.5%) screws were found completely within their pedicles compared with 77 (68.1%) correctly placed screws in the conventional group ( p<0.003). Despite use of the navigation system, 1.9% of the computer-assisted screws perforated the pedicle wall by more than 4 mm. The additional use of the image intensifier helped to identify the correct vertebral body and avoided cranial or caudal pedicle wall perforations.

Adolescent↗
PubMed2006

[Surgical management of spondylodiscitis. An analysis of 78 cases].

Spondylodiscitis is a rare bacterial infection of the spine with an inflammatory, destructive course. To obtain further information on the therapeutic management and clinical course of spondylodiscitis, we retrospectively investigated 78 patients after surgical intervention. Mean age was 64 years (+/-4.6 years; range 21-80 years), the mean length of stay 49 days (+/-8.2 days; 3-121 days) including 24 days (+/-4.7 days; 0-112 days) in ICU. In hospital mortality was 9%. The cervical spine was affected in 10%, the thoracic spine in 35% and the lumbar/sacral spine in 55% of patients. Abscess formation occurred in 65% and destruction of the vertebral body in 74%. A total of 75% of patients presented with neurological deficits which could be improved by surgical intervention in 82% of cases. 24 patients were treated by ventral debridement and stabilization alone, 20 patients with a combined dorsoventral method. Most patients (n=34) were stabilized via dorsal bridging instrumentation without ventral debridement of the focus. Of this group, 23 patients were initially scheduled for secondary ventral debridement but complete healing was achieved prior to this, so further surgical therapy was unnecessary. Successful cure was obtained in 92% of cases. Based on our findings, we favor a split surgical approach: initially with dorsal internal fixation only. Abscesses can be drained percutaneously. Ventral debridement and stabilization is only recommended if insufficient stability can be obtained by dorsal fixation alone, as shown by the persistence of infection or pain.

Adult↗
PubMed2006

[Candida albicans induced spondylodiscitis of the cervical spine of a polytraumatized patient].

With the increasing occurrence of predisposing factors, invasive candidiasis is being diagnosed more frequently. Based on a review of only a few previous reported cases, we describe and discuss the unusual case of candidal cervical spondylodiscitis in a 36 year old man who had sustained a polytrauma, complicated through a Candida albicans pneumonia. The main symptom was disabling neck pain. Clinical, laboratory and radiological findings were unspecific. The definitive diagnosis was determined by MRI imaging and biopsy. The early diagnosis and surgical treatment with a sufficient debridement and stabilisation of the affected segment combined with a prolonged antifungal therapy lead to good results.

Adult↗
PubMed2007

[A vascular pedicled duplicated fibula transplant for treatment of lumbar instability following tuberculous spondylodiscitis].

Operative treatment of tuberculous spondylodiscitis is still an important part of the treatment for lumbar spine instability. We report on a patient who suffered an extensive relapse with microbiological confirmation of tuberculous spondylodiscitis following operative spinal treatment for unspecific spondylodiscitis. X-Ray examination showed development of pronounced lumbar instability, which was first treated with the aid of an external fixateur and later by means of a doubled fibular bone graft with a vascularised stem with no dorsal instrumentation, which led to bony consolidation.

Aged↗
PubMed2000

[Non-Hodgkin lymphoma as differential spondylodiscitis diagnosis].

This case presents the history of a 56-year-old patient suffering from low back pain for a period of several weeks. The radiological und histopathological examination showed hints for a spondylodiscitis of the fifth lumbar vertebra. Due to a progressive destruction of the fifth vertebra a ventral stabilisation was performed. Again the histological examination showed the characteristics of an unspecific spodylodiscitis. The last biopsy, taken during the explantation of the fixateur interne showed a high malignant lymphoma. A course of chemotherapy was started following the CHOP-Protocol accompanied by radiotherapy. This case demonstrates that meticulous clinical examination as well as advanced radiological techniques can fail in rare differential diagnosis of spondylodiscitis.

Diagnosis, Differential↗
PubMed2006

[Spondylitis/spondylodiscitis].

Spondylitis is an inflammation of the vertebral body. If the infection is manifested in the vertebral motor segment it is called spondylodiscitis, which can be divided into specific and nonspecific forms. It is clinically impressive that at the beginning of the disease, the patients who are quite often immunosuppressed suffer from localized, especially nocturnally exacerbated backache. The initial diagnostic work-up generally consists of clinical history, examination, laboratory tests, and (especially advanced) imaging findings. Although computed tomography still remains the most frequently used advanced imaging technique, magnetic resonance imaging is the golden standard for the diagnosis of spondylitis and spondylodiscitis.

Back Pain↗
PubMed1997

[Infectious spondylitis. A retrospective evaluation of MRI markers].

AIM AND METHODS: The aim of the present study was to evaluate the MRI criteria of infectious spondylitis (spondylodiscitis). The MR images of 23 patients suffering from spondylodisitis (78% unspecific, 22% specific) were retrospectively analyzed. RESULTS: The height of the intervertebral discs involved was normal in 40%, reduced in 43% and increased in 17% of the cases. The most common findings can be summarized in an MR triad: 1) The vertebral bodies involved are hypointense in T1-weighted images (100%) with a lack of delineation of the intervertebral discs (53%). 2) The injection of Gd-DTPA yields an enhancement of the vertebral bodies involved and intervertebral discs (95% and 74% respectively). 3) The vertebral bodies and intervertebral discs are hyperintense in T2-weighted sequences (76% and 90% respectively). When present, a paravertebral or intraspinal extension of the infection was isointense compared with the adjacent involved vertebral body in the majority of the patients. A differentiation between unspecific and specific etiology based on the MR images was not possible. CONCLUSIONS: The vertebral bodies affected were usually hypointense in T1-W with enhancement after the administration of Gd-DTPA and hyperintense in T2-W. The discs involved were usually hyperintense in T2-W and demonstrated an inhomogeneous enhancement.

Contrast Media↗
PubMed2001

[Diagnostic methods in spinal infections].

A targeted successful treatment of spinal infectious diseases requires clinical and laboratory data that are completed by the contribution of imaging procedures. Neuroimaging only provides essential informations on the correct topography, localisation, acuity and differential diagnosis of spinal infectious lesions. MRI with its sensitivity concerning soft tissue lesions is a useful tool in detecting infectious alterations of spinal bone marrow, intervertebral disks, leptomeninges and the spinal cord itself. Crucial imaging patterns of typical spinal infections are displayed and illustrated by clinical case studies. We present pyogenic, granulomatous and postoperative variants of spondylodicitis, spinal epidural abscess, spinal meningitis and spinal cord infections. The importance of intravenous contrastmedia application is pointed out.

Diagnosis, Differential↗
PubMed2004

[Spondylodiscitis caused by septicemia after transrectal prostate biopsy. An extremely rare complication--case report].

Spondylodiscitis after prostate biopsy is a very rare complication. Only two cases have been published in the literature.A transrectal prostate biopsy was performed in a 59-year-old man. Postoperatively a septic condition with fever and back pain developed. The correct diagnosis was delayed because of "acute abdomen" and pneumonia. The spondylodiscitis with abscess formation in thoracic vertebral bodies was only found later and adequate and successful surgical treatment was performed.

Back Pain↗
PubMed2003

[Sequelae of diabetes mellitus in the vertebral column and spinal cord].

Diffuse idiopathic skeletal hyperostosis (DISH) is a chronic disease of the spine characterized by a significant association with metabolic alterations such as diabetes mellitus. Diabetes decreases the immunocompetence and increases the susceptibility to infections such as spondylitis, spondylodiscitis, and epidural abscess with spinal cord lesions in a high percentage of the cases. Microangiopathic changes of the intrinsic vasculature of the spinal cord are rare and mild. In a retrospective study of 784 acute spinal cord lesions, suspected diabetes could be found in only 13 patients. Neurophysiological and animal experiments as well as pathological studies have provided proof for the presence of diabetic myelopathy. Diabetic neuroarthropathy of the spine is rare, but important in the differential diagnosis of spinal disorders.

Angiography↗
PubMed2004

[Percutaneous cementing techniques of the spine -- chances and limits].

Vertebroplasty and Kyphoplasty represent minimal-invasive techniques for cement augmentation of vertebral bodies. Both procedures are successfully used for pain-relieving stabilizations of osteoporotic fractures or malignant processes. Advantages of kyphoplasty over vertebroplasty are to be seen in the possibility of deformity correction as well as in a decreased risk of cement extrusions which represent the most important potential for clinical complications. Long-term experiences with the effect of cementing are sparse. Thus it seems even more important, to judge indications and possibilities realistically. The decision whether and when to perform an augmentation is influenced by multiple factors. These include age of the patient, age of the fracture, degree of deformation and further degenerative changes of the spine. This article summarizes the present research and literature und is thought to provide guidelines for the aforementioned decision making processes.

Age Factors↗
PubMed2004

[Osteomyelitis of the spine].

Spinal infections are rare, occurring most often in elderly patients with urinary tract infections or diabetes. With the increasing number of patients with immune suppression, and also the increasing number of immigrants in the population, spinal infections are seen more frequently, especially in young adults. Typically spinal infections are monomicrobial, Staphylococcus aureus being the most common organism. Hematogenous spread of bacteria through the arterial paravertebral collateral vessels into the subchondral bone marrow of the vertebral bodies is the most common source of infection. Clinical presentation is often nonspecific. Important diagnostic measurements are laboratory studies, radiological evaluation including MR image scans, and CT-guided percutaneous biopsy of the lesion for microbiological studies. The management of spinal infections consists of antimicrobial therapy over 6-8 weeks. Surgical intervention is indicated in neurologically compromised patients for spinal instability and abscesses.

Anti-Bacterial Agents↗
PubMed2005

[Multistep surgery for spondylosyndesis. Treatment concept of destructive spondylodiscitis in patients with reduced general condition].

OBJECTIVE: Retrospective assessment of multistage surgery in the treatment of progressive spondylodiscitis in patients with critical physical status. PATIENTS: A total of 34 patients (mean age 58.6 years) with 37 progressive spondylodiscitis foci and destruction of one to three vertebral segments (1.9 mean) were recorded within an 8-year period. Time between first complaints and operative treatment was 3 months (mean). Preoperative health status was critically reduced in 11 patients (ASA IV) and poor general condition (ASA III) was seen in 23 patients when vital indication was seen preoperatively. Considerable systemic disease (n=31), further infection focus (n=18), and nosocomial trauma (n=5) were causally related. Spondylodiscitis was seen more frequently in the lumbar (n=20) and thoracolumbar than in the thoracic (n=10) and cervical spine (n=1). Staphylococcus aureus was detectable from operative specimens and hemoculture in 15 cases, MRSA in 6 of these. METHODS: In cases of monosegmentary involvement (n=7) ventral debridement, biopsy, and application of antibiotic chains were followed by autologous interbody bone grafting in a second stage operation. In 29 cases with destruction of two (n=27) and three (n=3) segments, posterior instrumentation including laminectomy in 4 patients was completed by anterior debridement and application of antibiotic chains during a first surgical intervention. After stabilization of physical condition and having reached a macroscopically indisputable implant bed, the ventral fusion with autologous interbody bone grafting or cage in combination with a plate or internal fixation system was performed as the last of several surgical steps. RESULTS: No case of perioperative mortality was observed. Intensive care continued 9.1 days and hospitalization 49.5 days (mean). During a 37.6-month follow-up two late recurrences were observed. CONCLUSION: A multistep surgical procedure under protection of dorsal instrumentation can limit perioperative mortality in patients in critical general condition by avoiding an extended one stage dorsoventral spondylodesis. After eradication of further infection foci and stabilization of physical condition, ventral instrumentation is completed under elective conditions.

Adult↗
PubMed2001

[Alignment of the sagittal profile after surgical therapy of nonspecific destructive spondylodiscitis: ventral or ventrodorsal method--a comparison of outcomes].

From 1989 to 1998, 129 patients underwent surgery for unspecific spondylodiscitis in the Department of Orthopedics of the Free University of Berlin. Fifty-six of them were followed up, and their clinical and radiological results were evaluated in this study. The surgical results of 40 patients with only ventral removal of a focus and defect coverage with an iliac crest graft were compared to those of 16 with additional dorsal bridging instrumentation by internal fixation. A mean of 2.3 vertebrae were fused in ventral spondylodesis; the mean length of dorsal instrumentation by internal fixation was 3.8 vertebrae. Patients were followed up a mean of 5.1 years after surgery. The mean age of patients was 57.1 years at the time of surgery. Patients were postoperatively mobilized a mean of 5 days after ventrodorsal fusion. A purely ventral procedure required a mean postoperative immobilization period of 3.6 weeks and brace fitting of a mean 8.2 months. There was one case of recurrent spondylodiscitis 25 months postoperatively, which made a revision of the focus necessary. The consolidation rate of the ventral spondylodesis was 84-100% in the different subgroups. A differential view of the spinal areas and ventral fusion segments was used to make a statement about the development of the sagittal spine profile. The segmental position of the spine in the sagittal plane was assessed by comparing the segmental kyphosis angles to normal values in the literature. All subgroups submitted to combined ventrodorsal fusion had a greater preoperative segmental kyphosis angle than those undergoing ventral fusion alone. In marked segmental kyphotic false positioning, the combined ventrodorsal procedure achieved good postoperative repositioning results, and an increase in segmental kyphosis was prevented. Ventral removal of a focus and bone graft spondylodesis seem to be adequate in single-level spondylodiskitis especially in the lumbar spine, but additional dorsal instrumentation should be performed in the case of long ventral fusion.

Adolescent↗
PubMed2001

[MRI diagnosis of intervertebral disk disease].

Magnetic resonance imaging (MRI) is the leading diagnostic procedure for disk pathology and has overtaken other imaging modalities in frequency of use. However, one must be cautious not to overinterpret small abnormalities that are also frequent in asymptomatic subjects. There is conflicting evidence about the correlation of high-intensity zones with clinical symptoms. Bulging disks and protrusions are a common finding in asymptomatic individuals, whilst extrusions are almost always accompanied by back pain and sciatica. In patients with back pain or sciatica, MRI is indicated after failure of conservative management or neurological deterioration. Contrast-enhanced MRI is well suited to differentiate a recurrent disk extrusion from epidural fibrosis. In all cases suspicious of tumor or infection, MRI is indicated as a first-line investigation. The indications and pitfalls of the state of the art of MRI are delineated in this article.

Adolescent↗