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PubMedDate not supplied

Contrast radiographic findings in canine bacterial discospondylitis: a multicenter, retrospective study of 27 cases.

A multicenter, retrospective study was undertaken to evaluate contrast radiographic findings in canine bacterial discospondylitis. Records and myelograms or epidurograms of 27 patients were obtained from five colleges of veterinary medicine. Fifteen cases (56%) were evaluated as having some degree of spinal cord compression. The majority (73.3%) of the cases had only soft tissue as the compressive mass. The median compression for all cases was 5% of the vertebral canal. No difference was noted for compression based on anatomical site (i.e., cervical versus thoracolumbar versus lumbosacral). No significant correlation between degree of lesion compression and clinical outcome was noted, but there was a trend toward increased mortality with greater compression. There was no correlation between the ambulatory status and the ultimate outcome. Three of the 15 (20%) cases showed vertebral subluxation. Results of this study indicate that static spinal cord compression is not a significant component of the neurological dysfunction associated with bacterial discospondylitis. Identification of vertebral subluxation in some patients may indicate a dynamic lesion that should be evaluated with stress radiography.

Animals↗
PubMedDate not supplied

Spinal infections.

Spinal infections can occur in a variety of clinical situations. Their presentation ranges from the infant with diskitis who is unwilling to crawl or walk to the adult who develops an infection after a spinal procedure. The most common types of spinal infections are hematogenous bacterial or fungal infections, pediatric diskitis, epidural abscess, and postoperative infections. Prompt and accurate diagnosis of spinal infections, the cornerstone of treatment, requires a high index of suspicion in at-risk patients and the appropriate evaluation to identify the organism and determine the extent of infection. Neurologic function and spinal stability also should be carefully evaluated. The goals of therapy should include eradicating the infection, relieving pain, preserving or restoring neurologic function, improving nutrition, and maintaining spinal stability.

Adult↗
PubMedDate not supplied

Childhood diskitis.

Childhood diskitis may occur in the thoracic, lumbar, or sacral spine and can affect children of all ages, but it is most common in the lumbar region in children younger than 5 years. Physical examination, laboratory tests, and radiologic studies all aid in the diagnosis of this clinical syndrome, and proper use can prevent unnecessary invasive intervention. Presentation varies with age; the child may refuse to bear weight on the lower extremities or may present with back pain, abdominal pain, a limp, or, if an infant or toddler, with irritability. The etiology appears to be a bacterial infection, usually caused by Staphylococcus aureus. Most children improve rapidly with a 4- to 6-week course of antibiotics. Although not routinely necessary, immobilization decreases symptoms and, in the case of osseous destruction, prevents progression of spinal deformity. Biopsy of the infected disk space is reserved for children refractory to intravenous antibiotics. Follow-up should include plain radiographs at regular intervals for 12 to 18 months to ensure resolution of the destructive process.

Anti-Bacterial Agents↗
PubMedDate not supplied

Orthopaedic management of ankylosing spondylitis.

Ankylosing spondylitis is an inflammatory disease of unknown etiology that affects an estimated 350,000 persons in the United States and 600,000 in Europe, primarily Caucasian males in the second through fourth decades of life. Worldwide, the prevalence is 0.9%. Genetic linkage to HLA-B27 has been established. Ankylosing spondylitis primarily affects the axial skeleton and is characterized by inflammation and fusion of the sacroiliac joints, spine, and hips. The resultant deformity leads to severe functional impairment in approximately 30% of patients. Orthopaedic management primarily involves correction of hip deformity through total hip arthroplasty and, less frequently, correction of spinal deformity with spine osteotomy. Closing wedge osteotomies have the lowest incidence of complications. Whether patients with ankylosing spondylitis are at increased risk for heterotopic ossification remains controversial, but comparison with age- and sex-matched counterparts suggests no dramatically higher risk. Because of the high rate of missed fractures and complications after minor trauma in patients with ankylosing spondylitis, plain radiographs are usually not sufficient for evaluation. Thorough patient assessment should include a comprehensive history, physical examination, and laboratory studies.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

Pyogenic spondylodiskitis: a radiologic/pathologic and culture correlation study.

BACKGROUND: Intervertebral disk tissue is resistant to hematogenous infection because of its avascularity. However, spondylodiskitis is being diagnosed with increasing frequency because of advancement in magnetic resonance imaging technology. There is a dearth of information regarding the bacteriology, histomorphologic features, and radiopathologic correlation of spondylodiskitis. DESIGN: The study population consisted of 20 patients diagnosed as having spondylodiskitis by magnetic resonance imaging with and without gadolinium 67 enhancement and bone scans with technetium Tc 99m or gallium citrate Ga 67. Twenty-seven biopsy and debridement specimens were obtained from these patients. The specimens were cultured for microorganisms and also processed for histopathologic testing. Tissue sections were examined with hematoxylin-eosin and stains for infectious agents (Gomori's methenamine-silver, Gram, and Ziehl-Neelsen stains). RESULTS: Where intervertebral disk tissue was present (23 of 27 cases), the morphologic changes included vascularization (with or without granulation tissue), myxoid degeneration, and necrosis. Chronic osteomyelitis was present in all 27 specimens and was associated with acute osteomyelitis in 7 cases (25%). Twenty-one of 27 cases had positive culture results (mostly pyogenic bacteria), but special stains revealed microorganisms in sections of the disk in only 4 cases (3 cases with gram-positive cocci and 1 with yeast consistent with Blastomyces). Florid acute inflammation was present in all the 4 cases. CONCLUSION: Histopathologic features of acute spondylodiskitis include vascular proliferation, myxoid degeneration, and necrosis of the disk tissue with adjacent chronic osteomyelitis. Acute inflammation is variable and when florid is usually associated with identifiable organisms on histologic examination. At biopsy, tissue should be submitted for culture, since culture has a high sensitivity and specificity for detecting the etiologic organism.

Adult↗
PubMed1990

Echographic evaluation of tubercular abscesses in lumbar spondylitis.

Thirty-two patients with tubercular lumbar spondylodiskitis were studied by using traditional x-rays and echography. Computed tomography (CT) scans were also employed in six patients. Ultrasound scans detected tubercular abscesses in 17 cases, whereas traditional x-rays diagnosed abscesses in only 10. Echographic patterns are reported depending on the site and contents. Besides assessing the abscess, it was possible to diagnose a case complicated with hydronephrosis due to compression of the ureter. Analysis of the results obtained indicates that the association of traditional x-rays with echography is sufficient to obtain, in most cases, complete and exact diagnoses and that using CT scans can be limited to doubtful cases or those complicated by paraplegia.

Abscess↗
PubMed1999

[Endocarditis manifesting as a spondylodiscitis and psoas abscess].

The revealing of a bacterial endocarditis by a spondylodiscitis is relatively rare. Only 80 cases have been reported ever since De Sèze's and his team's first publication in 1965. We report the case of a 59 year old women, hospitalized for a meningitis who presents signs of a spondylodiscitis and psoas abscess revealing an endocarditis. This case shows that one always have to search for an endocarditis when dealing with a spondylodiscitis. A thorough examination including a cardiac ultrasound is mandatory and a six weeks follow-up is necessary, since the prognosis depend mainly on the valvular disease.

Discitis↗
PubMed1999

[Serious bacterial and fungal infections in intravenous drug addicts].

Invasive infections caused by bacteria and fungi are common complications of intravenous drug abuse. Various vital organs and structures may be affected, e.g. the cardiac valves, the larger arteries, the bones, the joints and the central nervous system. However, due to the high frequency of low-virulent microbes of skin and oral origin, the clinical picture may be atypical with subacute course and few focal signs and symptoms. The complexity of this problem is illustrated by eight cases of serious bacterial and fungal infections recently diagnosed at our hospitals. All patients were HIV negative intravenous heroin addicts. The clinical spectrum was wide and included skin abscesses, pyomyositis, spondylodiscitis, septic arthritis, costal osteomyelitis, infective endocarditis, recurrent bacteraemia, and multiple brain abscesses.

Abscess↗
PubMed1999

[Spontaneous infectious spondylodiscitis in adults. Analysis of 30 cases].

We revised retrospectively 30 cases of Spontaneous Infectious Spondylodiskitis (SIS) in adults, diagnosed between 1986 and 1997. The mean age of the patients was 68.8 years; 56.7% were males. The identifiable causes were infectious endocarditis 13 (43.3%); tuberculosis 7 (23.3%); urinary tract infection 4 (13.3%); bacteremia with focus 2 (6.7%) and without focus 2 (6.7%). The cause was not identified in other 2 cases (6.7%). Infections were due to pyogenic bacteriae in 19 (63.3%); tuberculosis 6 (20%) and unknown 5 (16.7%). All patients had localized pain, 70% fever, 36.7% irradiated pain and 23.3% paraparesis. Fever was more frequent in patients with pyogenic etiology than in those with tuberculous SIS (p = 0.004). Blood cultures were positive in 70.4%. Percutaneous aspiration of the disc was performed in 13 patients; cultures were positive in 7. Causal germs were Streptococcus spp. 33.3%; Mycobacterium tuberculosis 20%; Staphylococcus spp. 16.6%; Escherichia coli 6.6%; Pseudomonas aeruginosa 6.6%. There was no bacteriological recovery in 5 (16.7%). Localization was lumbar in 18 (60%), dorsal in 8 (26.6%) and cervical in 4 (13.3%). X-ray of the spine was positive in 63.3% of the cases. Technetium scan in 90.5%, CT in 85.7% and MRI in 100% of cases in which it was carried out. All patients received antibiotic treatment with a median duration of 6 weeks for pyogenic SIS and one year for tuberculous SIS. Eighty three percent required immobilizing brace and 10% surgery for stabilization. Thirty six percent of patients presented complications, most of them related to the causal disease. There was a statistically significant association between mortality and diabetes.

Adult↗
PubMed1999

[Chronic spondylodiscitis. Clinical aspects and imaging features].

INTRODUCTION: The diagnosis of a chronic inflammatory process involving the vertebral body and disk is often very difficult because patient's history, subjective symptoms and physical findings are often unconclusive. Thus imaging techniques play a decisive role. Radiography, tomography, CT and MR have different capabilities and limitations and provide different findings in spondylodiscitis. MATERIAL AND METHODS: We observed 18 cases of spondylodiscitis in the last three years. The responsible microbe, a Staphylococcus aureus from extraosseous sites, was found in two cases at blood culture. Small cell inflammatory infiltration was confirmed with CT-guided biopsy in one case, while the other cases were diagnosed based on constant chronic back pain, feveret, moderate neutrophile leukocytosis or increased erythrosedimentation speed, plus changes in radiographic patterns following antibiotic therapy. RESULTS: Plain radiography and tomography are the techniques of choice to detect or suspect the lesion, which is then studied with CT or MRI. Clear-cut irregularities and erosions on opposing vertebral bodies, reactive bone sclerosis and reduced disk space were typical signs in our series; nine patients presented irregular cavitations(s), like bone caries, surrounded by reactive sclerosis in the body near the frontal vertebral plate. CONCLUSIONS: Together with the imaging patterns of all cases, we studied in detail three cases, relative to physical findings and diagnostic techniques. We also compared the changes in chronic spondylodiscitis with those in intraspongious herniation, intervertebral osteochondritis and severe degenerative arthritis. Bone erosions on the anterior cortical surface of the vertebral body were seen in 50% of our cases and may represent a specific sign of chronic spondylodiscitis if the finding is confirmed in further studies.

Chronic Disease↗
PubMed1999

[Spondylodiscitis due to Propionibacterium acnes. Case report and review of the literature].

Propionibacterium acnes, a gram positive anaerobic organism, is a component of normal skin flora. It can exceptionally be a source of osteoarticular infection (osteitis, arthritis, spondylodiscitis). We report a case of Propionibacterium acnes spondylodiscitis following lumbar puncture. This observation should alert the clinician to the fact that Propionibacterium acnes may rarely cause spondylodiscitis and lumbar pain, and should be considered a causative agent of bone infections after local procedures.

Clindamycin↗
PubMed1999

[Lumbago and radicular complaints: not always a herniated disk or degenerative stenosis of the spinal canal. A differential diagnosis of infrequent diseases].

Low back ache and pain in the legs are not always due to disc displacement and lumbar spinal degenerative changes. Some infrequent, but really not very rare diseases are presented in order to avoid mistakes which can have serious consequences for the patients. Degenerative changes of the lumbar spine are very common, not only in aged people. A superficial examination of the patient with back ache and/or pain in the legs can lead to a fallacious tie-up between such lesions and disturbances and complaints which are not connected to them.

Diagnosis, Differential↗