Thoracic discitis following 'Woodbury' rash.
A case of thoracic discitis secondary to a pyodermal skin condition known as 'Woodbury' rash is described.
Adult↗
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Discitis in young children.
Discitis is uncommon in children and presents in different ways at different ages. It is most difficult to diagnose in the uncommunicative toddler of one to three years of age. We present 11 consecutive cases. The non-specific clinical features included refusal to walk (63%), back pain (27%), inability to flex the lower back (50%) and a loss of lumbar lordosis (40%). Laboratory tests were unhelpful and cultures of blood and disc tissue were negative. MRI reduces the diagnostic delay and may help to avoid the requirement for a biopsy. In 75% of cases it demonstrated a paravertebral inflammatory mass, which helped to determine the duration of the oral therapy given after initial intravenous antibiotics. At a mean follow-up of 21 months (10 to 40), all the spines were mobile and the patients free from pain. Radiological fusion occurred in 20% and was predictable after two years. At follow-up, MRI showed variable appearances: changes in the vertebral body usually resolved at 24 months and recovery of the disc was seen after 34 months.
Anti-Bacterial Agents↗
[Discitis in children. Study of 8 cases].
The authors report the study of eight children with discitis diagnosed through clinical, neurological and orthopedic evaluation. The evidence of self limiting inflammation or infection of the intervertebral disk space and of soft tissue were available by image studies. Findings with routine roentgenograms, computed tomography and magnetic resonance imaging are discussed.
Adolescent↗
Haemophilus aphrophilus discitis and vertebral osteomyelitis.
An unusual case of discitis and vertebral osteomyelitis due to Haemophilus aphrophilus is described. Infections due to this organism have usually responded to treatment with beta-lactam antibiotics. However, our isolate was resistant to third-generation cephalosporins which has not been reported previously in the world literature. The patient made a good clinical response to ciprofloxacin treatment.
Abscess↗
Discitis in childhood. 12-35-year follow-up of 35 patients.
We report a follow-up of 35 children, on average 17 years after they had intervertebral discitis. 15 patients still complained of backache. Flexion of the low back was normal in 32 patients, while extension was markedly restricted in 30. 26 patients had a block vertebra, and 28 patients had narrowing of the vertebral canal. Mode of treatment did not appear to affect the outcome.
Adolescent↗
Single-stage autogenous bone grafting and internal fixation in the surgical management of pyogenic discitis and vertebral osteomyelitis.
OBJECT: Patients with deep wound infections complicating previously placed internal instrumentation have been successfully treated by debridement and prolonged postoperative antibiotic therapy, which avoided removal of the hardware. Comparatively fewer patients with pyogenic discitis and vertebral osteomyelitis (PDVO) have undergone single-stage debridement, arthrodesis, and internal fixation. The purpose of this study was to determine the efficacy of combining debridement, arthrodesis in which iliac autograft is used, and segmental internal fixation in a single-stage procedure for patients in whom nonoperative management of PDVO has failed. METHODS: A retrospective analysis of 17 consecutive patients with PDVO treated between July 1996 and September 1999 was performed. Follow-up data (mean 30 months) included office examinations and telephone interviews, and patients were grouped according to the duration of preoperative antibiotic therapy. All patients experienced significant postoperative reduction in pain, and those with neurological deficits improved. Eleven patients were independently ambulatory, and three required a walker; only five had been ambulating independently preoperatively. Two patients died during the 1st postoperative week of medical complications; another developed a wound dehiscence that was managed with debridement, prolonged antibiotic administration, and removal of the hardware 1 year later. In no case was pseudarthrosis demonstrated on dynamic radiography. Most patients received only a 6-week course of intravenous antibiotics postoperatively. CONCLUSIONS: The authors conclude that single-stage debridement, arthrodesis, and internal fixation can be effective in the treatment of PDVO. A 6-week course of postoperative intravenous antibiotics may be sufficient in patients with few risk factors. The harvesting of iliac autograft through the same operative exposure may not increase the risk of secondary infection.
Adult↗
Discitis in children.
Discitis is usually a benign, self-limiting disease that is frequently misdiagnosed. The disease usually leads to spontaneous disc-space narrowing and end-plate irregularity, which require no treatment and rarely cause morbidity.
Adolescent↗
[Roentgenological and pathological studies on the development of discitis in canine models].
Discitis was experimentally induced in 42 dogs by intradiscal injections of bacterial suspensions and sequentially studied by X-rays and histopathology up to 24 weeks. 1. A narrowing of the serpentine intervertebral disc space was seen roentgenologically in the Pseudomonas and E. coli groups. 2. Histologically, the acute inflammation began to subside in eight weeks, at which time new bone formation started to appear, and fusion of the adjacent vertebrae became apparent in eight weeks. The degree of the disease process was more advanced in the Staph. aureus group and less severe in the Pseudomonas group. The E. coli group lay in between. 3. The inflammatory process seemed to be confined in the disc for a week after the injection, during which time the cartilagenous cells in the nucleus pulposus underwent atrophy and degeneration. This resulted in direct exposure of the cartilagenous plate to the infection, causing invasion of the inflammatory process into the vertebral body. 4. The presence of the epiphyseal line, however, seemed to act as a barrier to hinder the inflammatory process invading the vertebral body.
Animals↗
Bone scintigraphy in calcific discitis of childhood.
The bone scintigraphic findings of calcific discitis of childhood is described and one new case is presented. A brief review of the value of bone scintigraphy in the diagnosis of this syndrome as well as pathogenesis, clinical course, and treatment is provided.
Calcinosis↗
[Pseudomonas aeruginosa arthritis and discitis in systemic lupus erythematosus].
Patients with systemic lupus erythematosus (SLE) are prone to develop opportunistic infections. Nevertheless, arthritis due to Pseudomonas aeruginosa in SLE is very rare and seems to be related to corticosteroid therapy and previous penetrating injury. A 17-year-old girl with SLE and Pseudomonas arthritis and discitis which followed laparotomy is described. Arthritis is a common manifestation of SLE, but arthritis due to infection with Pseudomonas is very serious and the diagnosis should not be missed.
Adolescent↗
[Intervertebral discitis in children].
Intervertebral discitis in children is a benign inflammatory condition with a varied clinical picture and quite characteristic radiographic findings. The etiology is still unknown and infectious and traumatic geneses have been discussed. A case in a girl aged three years is described and treatment with antibiotics and immobilisation are discussed.
Child, Preschool↗
[Diagnosis of discitis using MRI in children].
Two patients developed unsteady gait and presented pathological neurologic signs in lower extremities which lead to suspect an expansive process in the spinal cord. The radiological exploration was normal in both cases. Magnetic resonance imaging resulted in diagnosis of discitis. A revision has been carried out of the different diagnostic procedures and the possible indications for magnetic resonance imaging.
Child, Preschool↗
[Aspergillus lumbar discitis in a patient with acute lymphoblastic leukemia following induction therapy].
A 47-year-old female was admitted in October 1988 because of anemia and lymphoblastic cells in peripheral blood. A bone marrow aspirate was hypercellular with 93.9% lymphoblasts negative for peroxidase staining. The case was diagnosed as ALL (L2), and treated with JALSG ALL-87 regimen. She developed spiky fever and endotoxin shock due to bacteremia caused by pseudomonas aeruginosa, then was treated with several antibiotics. With the recovery of leukocytes, the chest X-ray showed an infiltrative shadow and a cavity forming lung abscess resembling aspergilloma in her left lung. The cavity improved of transbronchial infusion following amphotericin B (AMPH-B). Although she achieved complete remission, she felt severe lumbago accompanied by a marked erosion of the vertebral body with disc space narrowing on her X-ray. Then she underwent surgery to remove a disc abscess, and 1 colony of the aspergillus species was cultured from the specimen. She was treated with intravenous AMPH-B, and post remission therapies were performed under the injection of anti-fungal agents. No remarkable symptoms of complications were recognized during the chemotherapy. AMPH-B is useful and safe for the management of aspergillus discitis.
Antineoplastic Combined Chemotherapy Protocols↗
[Discitis in children. Report of two cases].
Two cases of intervertebral disk infection in 2 3-year-old boys are presented. The study reported on the anamnesis, clinical, laboratory and instrumental findings as well as therapy in both cases. Diagnosis was suspected on the basis of pain, refusal to assume any position that flexes the spine and irritability. Low-grade fever, the moderate increment of inflammatory indexes and the characteristic changes seen in 1 case on Magnetic Resonance Imaging (MRI) only and in the other one on both Technetium 99m polyphosphate bone-scanning and MRI verified the clinical diagnosis. Furthermore the authors briefs discuss the differential diagnosis of disc-space inflammation and several acute and subacute diseases of infancy and childhood some of them not localized in the spine (myopathy, appendicitis, peritonitis, urinary infections) for which discitis may be often mistaken.
Anti-Bacterial Agents↗
Automated percutaneous biopsy in the diagnosis and treatment of infectious discitis.
The author's experience using automated disc aspiration for the diagnosis of discitis indicates that skinny needle aspiration biopsy has a very high false-negative rate. A negative skinny-needle biopsy, therefore, must be followed by a procedure to obtain a better sample of pathologic material. Automated disc aspiration, because of its safety and ability to provide a large specimen, is the procedure of choice. Attention, however, must be paid to technical details of the procedure and the poor annular integrity of the infected disc to carry out the procedure safely.
Automation↗
[Postoperative lumbar discitis. Types, diagnosis and treatment].
Medical reports of 17 patients with discitis after lumbar disc operation (PD) were analyzed retrospectively. None of the patients had had previous lumbar disc operations. The diagnosis was confirmed by laminar tomography. The prevalence of PD was 2.75%. We found indications of bacterial infection in 82% of the cases. For all patients the infection was long lasting, with hospital contact for a mean period of eight months. PD was classified into three categories according to symptoms and laboratory investigations (ESR, CRP, WBC and alkaline phosphatase): type I = acute septic PD (53%), type II = subacute septic PD (29%), and type III = aseptic PD (18%). For PD type I and type II we recommend that antibiotics be administered intravenously until a fall in ESR and CRP are seen, followed by peroral antibiotics until normalisation. For all three types immobilisation of the back and analgetics are necessary.
Anti-Bacterial Agents↗
[Discitis in children. Description of the condition illustrated by two case reports].
Discitis in children is usually a self-limiting and non-infectious inflammation in the intervertebral disc. The symptoms are diffuse and vary from patient to patient; most often back pain, walking difficulties, crying and irritability. Radiology is often negative initially, and there may be a long delay from onset of symptoms to diagnosis. Magnetic resonance imaging may help in making an early diagnosis. Treatment is controversial; most authors recommend antibiotics only in special cases. It is important to be aware of the condition in order to avoid unnecessary investigations and treatment. We describe two patients, to illustrate the etiology, symptoms and treatment.
Child, Preschool↗
Contiguous discitis and osteomyelitis in children.
Magnetic resonance imaging of 16 patients with contiguous discitis and osteomyelitis provided a specific diagnosis and defined the anatomic extent of vertebral and soft-tissue involvement. Altered signal changes were evident in the disc, adjacent vertebra in the end plate and metaphyseal equivalent regions, and the anterior prevertebral tissues. Significant posterior spread and disc herniation were not evident. Fourteen patients had lumbar involvement; two had cervical involvement. The patients were followed-up for an average of 4 years 5 months. Scoliosis has developed in one patient, and four continue to have a loss of lumbar lordosis. By comparing serial roentgenograms, the mean decrease of disc-space height after the acute episode was 43% (range, 51-61%). There was no restitution of normal disc-space height at the latest follow-up roentgenogram in any of the patients. A 14% (average) narrowing of the vertebral foramina was evident in seven cases. In one patient, a fusion progressively developed 7 years after the acute episode (before full skeletal maturity). However, several patients appear to be progressing toward fusion of adjacent vertebra. A study of histologic specimens elucidated vascular anatomy of the immature vertebra that further explain the disease characteristics.
Adolescent↗