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PubMed2004

Thoracic spondylitis from a mycotic (Streptococcus pneumoniae) aortic aneurysm: a case report.

STUDY DESIGN: We report on a 54-year-old man with chronic lower back pain after recent streptococcus pneumoniae pulmonary infection, resulting in a mycotic aortic aneurysm and spondylodiscitis of the eighth vertebrae 6 months later. Successful surgical treatment and recurrence-free survival after 4 years are described. SUMMARY OF BACKGROUND DATA: Osteomyelitis by Streptococcus pneumoniae of the spine combined with contained rupture of a mycotic aortic aneurysm into lung and spine has not been reported to date. Mycotic aneurysms with pulmonary fistulas are reported to carry a mortality rate of up to 100%. Few cases have been reported with different operative and conservative strategies. METHODS: The mycotic aortic aneurysm was excised using extracorporeal circulation and replaced by a Dacron graft. The spondylitic section of the eighth thoracic vertebrae was radically resected, and a tricortical bone block from the iliac crest was inserted into the defect. To keep compartments separated, collagen sponges with antibiotic supplementation were used. A triple antibiotic therapy (Metronidazol 3 x 0.5 g/day, Cefotaxim 3 x 2 g/day, and Flucloxacillin 3 x 2 g/day) was prescribed for 6 weeks and changed to Clindamycin for 1 year thereafter. RESULTS: The patient made a good recovery and is free of recurrence 4 years after surgery. CONCLUSIONS: Lower back pain might be a projected pain. Particularly in older patients or in the presence of comorbidities resulting in an immunocompromised status, an aggressive workup may be indicated. Radical resection of inflammatory tissues, sparse use of implant material, and prolonged administration of antibiotics proved a successful strategy in this patient.

Aneurysm, Infected↗
PubMed2004

Long adult deformity fusions to L5 and the sacrum. A matched cohort analysis.

STUDY DESIGN: A matched cohort analysis of long adult deformity fusions according to distal fusion level (L5 vs. S1). OBJECTIVE.: To compare the results of long adult deformity fusions to either L5 or the sacrum in the presence of a "healthy" 5-1 disc using a matched cohort analysis. SUMMARY OF BACKGROUND DATA: For adult spinal deformity, the decision often arises whether to terminate a long fusion at L5 or the sacrum. The decision is especially challenging in the presence of a "healthy" (Grade 0 to 1 degeneration) 5-1 disc. MATERIALS AND METHODS: A total of 95 adult deformity patients that underwent fusion from the thoracic spine to either L5 or the sacrum were sorted according to five preoperative criteria: 5-1 disc status, patient age, smoking status, number of levels fused, and sagittal balance. Two cohorts (L5, 27 patients; sacrum, 12 patients) were precisely matched according to the five criteria. Patients were evaluated at 2-year minimum follow-up according to radiographic data, complications, and SRS-24 outcomes. RESULTS: Correction of sagittal imbalance was superior for sacrum patients (C7 plumb line: L5, 0.9 cm; sacrum, 3.2 cm; P = 0.03). At latest follow-up (L5, 5.2 years; sacrum, 3.7 years), 67% of L5 patients had radiographic evidence of advanced 5-1 disc degeneration and the L5 cohort tended to have inferior sagittal balance (C7 plumb line: L5, +4.0 cm; sacrum, +1.2 cm; P = 0.06). The sacrum cohort, however, required more surgical procedures (L5, 1.7; sacrum, 2.8; P = 0.03) and experienced a greater frequency of major complications (L5, 22%; sacrum, 75%; P = 0.02), including nonunion (L5, 4%; sacrum, 42%; P = 0.006) and medical morbidity (L5, 0%; sacrum, 33%; P = 0.001). SRS-24 scores reflected a similar patient assessment of outcome and function for the two cohorts (L5, 89; sacrum, 87). DISCUSSION AND CONCLUSION: At 3 to 5 years' mean follow-up, long adult fusions to the sacrum required more procedures and had a higher frequency of complications than similar fusions to L5. For fusions to L5, subsequent subjacent disc degeneration is common and may be associated with a forward shift in sagittal balance. The ultimate influence of these factors on long-term outcomes remains to be seen.

Adult↗
PubMed2004

A randomized clinical trial of treatment for lumbar segmental rigidity.

STUDY DESIGN: A randomized single-blind clinical trial of facet injections plus exercise, versus exercise alone, in chronic disabling work-related lumbar spinal disorders (CDWRLSD), accompanied by pilot interrater reliability and facet syndrome prevalence studies. OBJECTIVES: To systematically investigate the use of facet injections as an adjunct to supervised lumbar stretching exercises in regaining lumbar range of motion (ROM) following prolonged deconditioning after work-related lumbar injuries. To assess interrater reliability of visual assessment of segmental rigidity (SR), and to evaluate the prevalence of facet syndrome in cases of lumbar SR. SUMMARY OF BACKGROUND DATA: Corticosteroid joint injections have often been used to reduce musculoskeletal inflammation to facilitate joint mobilization in the presence of degenerative arthritis. Lumbar segmental rigidity is a recently described entity usually associated with painful chronic spinal disorders and postoperative spine surgery. Previous work has shown that SR and lumbar ROM improves with a brief intervention consisting of facet injections followed by specific stretching exercises. No systematic study has investigated the potential benefits of a combination of facet injections and exercise over supervised exercises alone to treat lumbar SR. Similarly, no study has assessed the association between SR and the facet syndrome. METHODS: From a group of consecutive patients (n = 421) with CDWRLSD referred for tertiary rehabilitation between November 1999 and January 2001, 70 were noted to have SR on intake physical examination. The first part of this study assessed interrater reliability for detecting SR, and intrarater reliability for 3-segment true lumbar ROM measurements. Patients randomly assigned to participate in supervised stretching exercises with the addition of fluoroscopically guided bilateral facet injections at the involved levels (Group A, n = 36) also underwent facet syndrome prevalence assessment at the time of injection. They were compared to a randomly allocated comparison group (Group B, n = 34) undergoing exercises alone in a single-blind design. Physical therapists saw patients an average of twice per week, providing supervision of a progressive home stretching program. Inclinometric joint ROM was measured at the time of group allocation, and again 5 to 7 weeks later. Validated questionnaires of pain (intensity VAS) and disability (Million VAS) related to the CDWRLSD were provided before and after the interventions. RESULTS: Part 1 reliability and facet syndrome prevalence work revealed that interrater reliability for experienced examiners to detect rigid segments was excellent (Pearson's r = 0.97, P < 0.01). Intrarater 3-joint motion measurement reliability was also good for all sagittal/coronal ROM (Pearson's r = 0.95-0.99, P < 0.01). Only 5 of 29 subjects with SR met criteria for facet syndrome (17%), consistent with prior prevalence studies of unselected patients with low back pain. In Part 2, a large majority of patients in both groups improved from the initial to the post-treatment ROM measurements (the primary outcome criterion of the study). However, a higher proportion of Group A (injection) patients (87%-95%) showed ROM improvement, compared to Group B (exercise only) patients (64%-79%). Group A patients showed a significantly greater ROM improvement in all sagittal and coronal movements, both in absolute terms and percent of initial measurement. No significant differences in pain or disability self-report were found between groups, pre- or postintervention, but both groups showed significant improvement from pre- to postintervention in pain and disability assessments. CONCLUSIONS: The detection of SR and measurement of 3-segment true lumbar ROM by experienced examiners is highly reliable. Only 17% of CDWRLSD patients with lumbar SR met criteria for the facet syndrome, a rate approximately equal to that of unselected low back pain cohorts. This indicates that lumbar SR may be found whether or not pain of facet joint origin is present. In the randomized trial, facet injections significantly increased the percentage of patients with SR showing ROM improvement, as well as the degree of improvement in lumbar mobility after treatment. There is no evidence that facet injections increase the improvements in pain/disability report noted in both groups.

Adrenal Cortex Hormones↗
PubMed2004

Cellular, but not matrix, immunolocalization of SPARC in the human intervertebral disc: decreasing localization with aging and disc degeneration.

STUDY DESIGN: Human intervertebral disc anulus tissue was obtained in a prospective study of immunolocalization of SPARC (secreted protein, acidic and rich in cysteine) (osteonectin). Experimental studies were approved by the authors' Human Subjects Institutional Review Board. Discs were obtained from surgical specimens and from control donors. OBJECTIVES: To determine whether SPARC could be detected in the disc with immunohistochemistry and to determine the incidence of SPARC-positive cells. SUMMARY OF THE BACKGROUND DATA: SPARC is a glycoprotein that has an important role in modulating interactions between cells and matrix. It influences remodeling, collagen fibrillogenesis, metalloproteinase expression, and cytokine expression. Little is known about SPARC in the disc, and one previous study reported the absence of its immunolocalization in fetal and adult disc tissue. METHODS: Eight normal human discs from subjects aged newborn to 10 years, and 11 disc specimens from control donors or surgical patients aged 15to 76 years were examined for immunolocalization of SPARC. Anulus cells were also tested for the presence of SPARC in vitro in monolayer or three-dimensional agarose culture. RESULTS: In discs of subjects aged newborn to 0.19 years, SPARC was present in all cells in the outer anulus, in 76.4% of inner anulus cells, and 76.0% of nucleus cells. Localization was significantly lower in anulus cells of study participants aged 4.7 to 76 years (66.7%, P = 0.04). Anulus cells cultured in agarose or monolayer showed positive localization in all cells. CONCLUSIONS: Findings show decreased presence of SPARC in disc cells of older subjects with disc degeneration and point to the importance of future studies designed to elucidate the unrecognized role of SPARC in disc remodeling, aging, and degeneration.

Adolescent↗
PubMed2004

Bacterial spondylodiscitis in the patients with hemodialysis.

STUDY DESIGN: Retrospective clinical and laboratory data analyses were performed on hemodialysis (HD) patients with bacterial spondylodiscitis. OBJECTIVES: The purpose of this study was to investigate clinical characteristics and related problems for the diagnosis and treatment of spondylodiscitis in patients on maintenance HD. Possible factors for the development of spondylodiscitis were also discussed. SUMMARY OF BACKGROUND DATA: Although bacterial spondylodiscitis is one of most serious complications that can occur in HD patients, few reports are seen describing its clinical course and treatment in HD patients. METHODS: A total of 9 HD patients were diagnosed as having bacterial spondylodiscitis at our institute. The onset of infection, characteristics of clinical symptoms, and clinical course were reviewed retrospectively. RESULTS: Latent form occurrence was most frequent, and only 1 in 9 cases presented high-grade fever at the beginning of treatment. Many complications were encountered both in conservatively treated and operated cases. Three patients were operated on, 1 of whom died 2 days after operation. Two of six patients in the conservatively treated group also died during the treatment period. CONCLUSIONS: The presence of bacterial spondylodiscitis must be considered when treating back pain of HD patients even when they are afebrile. Careful observation of general status in addition to local conditions is essential. Indication of operation should be considered carefully because of the poor general status and bone quality of HD patients. MRI, in addition to plain radiographs, was necessary to differentiate destructive spondylarthropathy from bacterial spondylodiscitis.

Adult↗
PubMed2004

Disc inflammation potentially promotes axonal regeneration of dorsal root ganglion neurons innervating lumbar intervertebral disc in rats.

STUDY DESIGN: The expression of growth-associated protein 43 (GAP-43), a marker of axonal growth, in the dorsal root ganglion (DRG) neurons innervating the lumbar intervertebral disc was assessed using the retrograde tracing method and immunohistochemistry. OBJECTIVES: To study whether disc inflammation affects GAP-43 expression in DRG neurons innervating the disc in rats. SUMMARY AND BACKGROUND DATA: Persistent inflammation and nerve ingrowth into the inner layer of degenerated discs can be a cause of discogenic pain. Although the presence of GAP-43-expressing nerve fibers in painful discs has been reported, the expression of GAP-43 in DRG neurons innervating the disc has not been studied. METHODS: Seven days after the application of Fluoro-Gold to the L5-L6 disc, 50 microL of saline (n = 10, control group) or complete Freund's adjuvant (n = 10, inflammatory group) was applied to the disc in rats. Ten days after the Fluoro-Gold application, T13-L5 DRGs were double-stained with GAP-43 and either calcitonin gene-related peptide or isolectin B4 (IB4). RESULTS: The percentage of Fluoro-Gold-labeled neurons that were positive for GAP-43 was significantly higher in the inflammatory group (44%) than in the control group (24%, P < 0.001). In both groups, the majority of GAP-43-positive neurons were small and positive for calcitonin gene-related peptide but not IB4. CONCLUSIONS: The present results suggest that disc inflammation potentially promotes axonal growth of DRG neurons innervating the disc. In light of the strong correlation between the expression of calcitonin gene-related peptide and nerve growth factor receptor, it is most likely that nerve growth factor-sensitive DRG neurons extend their axons following disc inflammation.

Animals↗
PubMed2005

Intervertebral disc cells produce tumor necrosis factor alpha, interleukin-1beta, and monocyte chemoattractant protein-1 immediately after herniation: an experimental study using a new hernia model.

STUDY DESIGN: A new hernia model that simulates human disc herniations was developed in rabbits. The herniated discs were examined by gross appearance and histology and production of tumor necrosis factor alpha, interleukin-1beta, and monocyte chemoattractant protein-1 was investigated. OBJECTIVES: To clarify the early mechanism of spontaneous herniated disc resorption. SUMMARY OF BACKGROUND DATA: Macrophage infiltration in herniated discs is essential for disc resorption. However, surgically removed human herniated disc tissues and existing animal hernia models are not suitable for analyzing the mechanism of macrophage infiltration. Recently, we have demonstrated that intervertebral disc cells are capable of producing monocyte chemoattractant protein-1, a potent macrophage chemoattractant, after stimulation with tumor necrosis factor alpha and interleukin-1beta. METHODS: Intervertebral disc herniations were surgically developed in rabbits using a new technique. The herniated discs were excised at appropriate time intervals after the surgery, and the size and histologic findings were examined. Expressions of tumor necrosis factor alpha, interleukin-1beta, and monocyte chemoattractant protein-1 in herniated discs were investigated immunohistochemically. RESULTS: A new rabbit model of disc herniation was established. The herniated discs spontaneously reduced in size by 12 weeks postsurgery. Infiltrating cells, mainly composed of macrophages, were observed from day 3. Immunohistochemically, intervertebral disc cells in the herniated discs produced tumor necrosis factor alpha and interleukin-1beta on day 1, followed by monocyte chemoattractant protein-1 on day 3. CONCLUSIONS: The new hernia model appears to be very useful for studying herniated disc resorption. Intervertebral disc cells may produce inflammatory cytokines/chemokine immediately after the onset of disc herniation, possibly triggering subsequent macrophage infiltration that leads to disc resorption.

Animals↗
PubMed2005

Spondylodiscitis in childhood: results of a long-term study.

STUDY DESIGN: Retrospective study to gather long-term data clinical, paraclinical, and radiographic data on nonoperatively managed cases of childhood spondylodiscitis. OBJECTIVES: To analyze and assess the clinical, laboratory, and radiologic findings in children with spondylodiscitis and to document the efficacy of conservative treatment based on the long-term clinical, functional, and radiologic outcomes of these patients. SUMMARY OF BACKGROUND DATA: Childhood spondylodiscitis is an extremely rare entity that often presents an nonspecific clinical picture. Treatment strategies are mainly conservative. Assessment of the clinical and radiologic outcomes of these patients is essential for prognosis and for justification of nonoperative management. METHODS: According to our hospital records, 25 children (17 girls and 8 boys) with a mean age of 6.1 years (range: 2 months-12 years) were hospitalized for spondylodiscitis between 1968 and 1988. Parameters related to the duration of symptoms, clinical manifestations, diagnostic workup, and course of treatment were reviewed. Twenty of the patients (75%) returned for clinical and radiologic follow-up at least 10 years after discharge (range 10-23 years). RESULTS: All of the patients presented with uncharacteristic signs and symptoms. Laboratory markers of inflammation were only moderately elevated. On average, the diagnosis of spondylodiscitis was established after a delay of 14 weeks (range 2 days-60 weeks). All levels of the spine were affected, whereby the thoracic and lumbar spine were preferential sites. The radiographic studies revealed destruction of adjacent vertebral bodies in 12 cases (48%). The remaining 13 patients (52%) had isolated disc involvement without radiographically detectable bone destruction. An abscess was detected by computed tomography in only 1 case. At the time of follow-up, 16 patients (80%) were asymptomatic and had unrestricted spinal mobility. Four patients (20%) had restricted spinal mobility with local kyphosis, which could be documented objectively on radiograph film. In 12 cases (60%), healing was accompanied by fibrous ankylosis and high-grade narrowing of the intervertebral disc space, as was demonstrated radiologically. Eight patients (40%) exhibited fusion of the vertebrae (4 partial, 4 complete). Four patients (20%) had residual defects. CONCLUSIONS: Our study shows that the course of childhood spondylodiscitis is generally benign. Segmental orbony ankylosis may occur during the healing process but normally does not lead to serious functional deficits. Neurologic deficits were not observed in any of our patients. Conservative management must be intensive, but the results are good. Biopsy is not required except in the few cases where diagnostic uncertainty prevails.

Adolescent↗
PubMed2007

Polyethylene wear debris and long-term clinical failure of the Charité disc prosthesis: a study of 4 patients.

STUDY DESIGN: A clinical case series of 4 patients undergoing anterior lumbar revision due to failure of total disc replacement surgery. OBJECTIVES: To assess the clinical significance of polyethylene wear debris in salvage surgery after initial total disc replacement, the pattern and the mechanisms of polyethylene wear in the retrieved cores, and the extent of polyethylene debris in the periprosthetic tissues obtained from 4 patients. SUMMARY OF BACKGROUND DATA: Previous in vitro wear tests have demonstrated low wear rates for lumbar artificial discs, suggesting that implant wear may not be a clinically relevant issue with total disc replacement. However, only long-term clinical investigations with analysis of retrieved implants and periprosthetic tissue can ultimately establish the significance of polyethylene wear debris for total disc arthroplasty. METHODS: Starting in 2004, we began routinely performing salvage procedures in patients with failed total disc replacements. We report on the short-term outcomes of 4 patients at our institution who were revised with a Charité prosthesis (DePuy Spine, Raynham, MA). Wear analysis of the retrieved prosthesis and histologic examination of the periprosthetic tissue were also performed. RESULTS: All of the retrieved polyethylene cores showed evidence of wear, but the extent and severity varied among the 4 patients. Wear and fracture of the core were associated with osteolysis of the underlying sacrum in 1 patient. Histologic examination of the periprosthetic tissues confirmed the presence of wear debris lying in inflammatory fibrous tissue. In 3 of the 4 patients, implant wear was associated with an unfavorable biomechanical environment (e.g., subsidence, migration, undersizing, and adjacent fusion). The mechanisms of wear included adhesive/abrasive wear of the central domed region of the polyethylene core, as well as chronic rim impingement, resulting in rim fatigue and fracture. CONCLUSIONS: This study demonstrates the clinical significance of polyethylene wear debris and the potential for osteolysis with total disc replacements. The authors recommend that patients undergoing lumbar disc arthroplasty receive long-term follow-up to monitor the wear and functional status of their implants.

Adult↗
PubMed2007

Clinical outcome of posterolateral endoscopic surgery for pyogenic spondylodiscitis: results of 15 patients with serious comorbid conditions.

STUDY DESIGN: Clinical results of posterolateral endoscopic debridement and irrigation followed by percutaneous drainage for pyogenic spondylodiscitis were analyzed. OBJECTIVES: To report clinical results of transforaminal endoscopic surgery for pyogenic spondylodiscitis and to evaluate the effectiveness of this procedure in treatment of pyogenic spinal infections. SUMMARY OF BACKGROUND DATA: Pyogenic spinal infections have been increasing due to the development of medical treatment for patients with comorbid medical problems. Common treatments for spinal infections are administration of antibiotics or surgical debridement with bone grafts. There have been no reports, however, regarding the clinical outcome of posterolateral endoscopic treatment for pyogenic spinal infections. METHODS: Fifteen consecutive patients with pyogenic spondylodiscitis in the thoracic or lumbar spine were enrolled. Preoperative antibiotic treatment had failed in all the patients. The procedures consisted of posterolateral endoscopic debridement and irrigation followed by percutaneous drainage through single portal under the combination of local and intravenous anesthesia. Pain response using visual analog scale (VAS, 0-100 mm), inflammation parameters, and duration of antibiotic therapy were investigated. Radiologic evaluation focused on bony fusion, local kyphosis, disc height reduction, and abscess formation. RESULTS: All patients showed immediate pain reduction after surgery. Averaged VAS for pain was 86 before surgery and 25 at postoperative 1 week. Average of CRP was 4.00 mg/dL before surgery and 1.88 mg/dL at postoperative 1 week. Averaged duration of antibiotics therapy was 3.7 weeks. Spinal fusion was obtained in 13 patients. Two patients with neurologic deficits due to epidural abscess returned to normal. Preoperative psoas abscess in 6 patients disappeared after surgery on MRI. CONCLUSIONS: Posterolateral spinal endoscopic debridement and irrigation brought immediate pain reduction and good clinical results to patients who had comorbid medical problems and had pyogenic spondylodiscitis.

Adolescent↗
PubMed2003

Favorable outcome of long-lasting thoracic spondylodiscitis with spinal epidural abscess induced by Staphylococcus aureus.

A favorable outcome in chronic spondylodiscitis with epidural abscess is rare. A 65-year-old woman developed recurrent, localized, thoracic back pain over 2.5 years. Nine months after the onset of the pain, sensory disturbances of the left lower leg occurred. Fourteen months before admission, she developed recurrent fever, bladder dysfunction, and weakness and numbness of both lower legs. An incomplete sensory transverse syndrome with paraparesis was diagnosed. Magnetic resonance imaging of the spine suggested destruction of the T11 vertebral body, with spondylodiscitis of the adjacent discs and an epidural abscess between levels T4 and T9. Laminectomy was immediately performed and the abscess was drained. Culture revealed infection with Staphylococcus aureus. After 10 weeks of therapy, recovery was almost complete. Spondylodiscitis with epidural abscess may have a favorable outcome, even if symptoms start more than 2 years before treatment.

Abscess↗
PubMed2005

A case of brucella spondylodiscitis with extended, multiple-level involvement.

Brucellosis is a zoonosis that affects several organs and has a protean presentation. The authors report the case of a 61-year-old male patient with brucellar spondylodiscitis involving several vertebrae and a paravertebral abscess localized in the erector spinae muscle. Diagnosis was made by positive blood culture and MRI. No relapse was seen with a combined treatment (doxycycline/rifampin) for 3 months, followed by doxycycline alone for 6 months. Almost all radiologic findings disappeared at the end of a 1-year follow-up without any further treatment.

Abscess↗
PubMed2006

Successfully treated spondylodiscitis due to a previously unreported mycobacterium.

A non-tuberculous mycobacterium was isolated, following a vertebral needle aspiration, from the blood of a patient with severe spondylodiscitis. The strain turned out to be different from any known mycobacterial species and was quite drug-susceptible in vitro. The patient improved markedly following treatment with meropenem, clarithromycin and amikacin.

Antitubercular Agents↗
PubMed2004

Spondylodiscitis after bilateral sequential lung transplantation in a patient with cystic fibrosis.

We report the case of a 24-year-old woman with cystic fibrosis in whom spondylodiscitis developed after bilateral sequential transplantation. The diagnostic work-up included magnetic resonance imaging, computed tomography-guided disk biopsy, histological examination, and cultures of disk specimens. The infective organism was D group Streptococcus and the patient was successfully treated with intravenous piperacillin followed by oral ampicillin. To our knowledge, this is the first reported case of spondylodiscitis after lung transplantation.

Adult↗
PubMed1994

Thoracoscopic biopsy of a pathological vertebral body.

When computed tomography (CT) guided biopsy of a pathological vertebral body fails, the accepted alternative has been open thoracotomy and biopsy. The authors wish to report the use of a thoracoscopic approach to biopsy of a pathological thoracic vertebra in a child, after an unsuccessful attempt at CT guided percutaneous biopsy.

Acute Disease↗
PubMedDate not supplied

Surgical treatment of lumbosacral instability caused by discospondylitis in four dogs.

OBJECTIVE: To describe a surgical technique involving distraction and stabilization of the lumbo-sacral vertebral segment using an external skeletal fixator in dogs with lumbosacral instability caused by discospondylitis. STUDY DESIGN: Retrospective clinical study. ANIMALS: Four client-owned dogs. METHODS: Medical records of all dogs diagnosed with discospondylitis from 1994 to 1997 were identified and reviewed. Four dogs with lumbosacral discospondylitis requiring surgical treatment were then specifically studied. Surgical technique, clinical signs, preoperative diagnostic investigation, radiographic findings, and the results of short-term and long-term reevaluations were recorded. RESULTS: Twelve dogs with discospondylitis were identified, 4 of which had lumbosacral discospondylitis. These 4 dogs underwent surgical distraction and stabilization because they failed to respond to medical treatment. Three dogs received a cancellous bone graft between L7 and S1 and had rapid interbody fusion of this vertebral segment. The dog that did not receive a graft did not have interbody fusion at the time of fixator removal. This did not affect the final clinical outcome. Lumbosacral pain and neurological deficits present before surgery rapidly subsided after the procedure. All dogs received concurrent antibiotic treatment for a minimum of 4 weeks. All dogs were clinically normal at the time of fixator removal and all continued to do well during the follow-up period (8-48 months; mean, 27.5 months). CONCLUSION AND CLINICAL RELEVANCE: Lumbosacral discospondylitis may not respond well to conservative treatment because of the mobility of the affected space. Surgical treatment involving distraction and stabilization to obtain intervertebral fusion is very effective in treating lumbosacral instability caused by discospondylitis.

Animals↗