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PubMed2000

[Cervical pyogenic spondylodiscitis: 4 cases report and a review of the literature].

We report 4 cases of cervical spondylodiscitis presenting neurological and/or neuroradiological abnormalities. Such a lesion is rare in the cervical spine of adults, but should be suspected when the patient has radiculopathy and/or myelopathy associated with inflammatory signs. We discussed the clinical characteristics and the procedures of the diagnosis and treatment of cervical spondylodiscitis. Early and definitive diagnosis can be achieved by cervical X-ray, MR imaging and biopsy. It is very important to evaluate the pyogen for the lesion by needle biopsy. When the patient has the compression of the spinal cord and/or nerve roots and the neurological findings of radiculopathy and/or myelopathy, surgical exploration and decompression of the spinal cord and/or nerve roots should be carried out as soon as possible. Anterior debridement and fusion should be performed using the effective antibiotics. We were able to achieve good prognosis by treatment following this procedure of diagnosis in the four cases of cervical spondylodiscitis mentioned.

Adult↗
PubMed2000

Beware of short-course therapy for Staphylococcus aureus bacteremia without a removable cause.

Staphylococcus aureus bacteremia has long been known to cause significant morbidity and mortality. The optimal treatment of this disease has evolved over the years. Recently, criteria have been established for the use of shorter courses of antibiotic therapy in certain patients, most notably those with an easily removed source of the bacteremia. We present the case of a 55-year-old man with S aureus bacteremia unrelated to an intravascular device. He was treated with "short-course" antibiotic therapy, and lumbar diskitis and an epidural abscess developed.

Anti-Bacterial Agents↗
PubMed2000

[Aspergillus spondylodiscitis].

Four weeks after an Amanita phalloides poisoning, a 29-year-old man presented an ocular aspergillosis. One month later he developed a bilateral L5-S1 radicular syndrome. The diagnosis of aspergillar spondylodiscities was established on the basis of x-ray, CT-scan, MRI and pathology findings. Clinical and radiological improvement was obtained with fluconazole.

Adult↗
PubMedDate not supplied

Combined imaging in spondylodiscitis.

At present, in spite of the advancement in antibiotic therapy no significant decrease in the incidence of spinal infections is observed: most likely, this is correlated to the increased immigration flows, high risk behaviors (drug addiction, alcoholism), immunosuppressive diseases (AIDS, leukemia, lymphoma), interventional procedures (iatrogenic causes). Early diagnosis, at times difficult and often misunderstood, is facilitated by the use of a correct diagnostic algorithm, supported by blood culture, needle aspiration and biopsy. Aim of this report was to evaluate the role of the different imaging procedures, CT and MRI in particular, for prompt correct therapeutic management.

Diagnosis, Differential↗
PubMed2000

[Cervical spondylodiscitis in an infant].

Spondylitis in childhood is rare, presenting a great variety of symptoms that are related to the child s age and to the site of the inflammatory process. We present the case of a nine-month-old infant, who presented to the emergency department with a torticollis of six weeks evolution. The diagnosis of spondylitis (C6-C7) was confirmed by MRI. Intravenous antibiotic therapy was administered. The patient showed complete regression of symptoms and imaging tests were normal. The rarity of this disease in patients in this age group, as well as the site and form of presentation are emphasised as is the importance of diagnosing this disease to prevent permanent neurological injuries or bone deformities.

Cervical Vertebrae↗
PubMed2000

Diskography.

Diskography has become a vital study in the evaluation of spinal pain, particularly in patients who are considered candidates for possible surgical intervention. It has been the author's experience that when diskography is performed with appropriate clinical indication by skilled and experienced practitioners who are thoroughly familiar with spinal pathology, the results lead to improved clinical outcomes. Diskography is a study ideally suited for procedural radiologists.

Discitis↗
PubMed2000

[Indications and limitations of surgery of common low back pain].

Surgical treatment of the low-back pain remains controversial in term of efficacy. Surgical treatment is advocated only when conservative management fails, a clearly identifiable cause of lumbar pain is identified, worker's compensations are detected, psychological disorders are treated and disability and pain are still present. In addition, we used a preoperative external diagnostic immobilisation with hip spica cast to select the patients. Posterior instrumented fusion is more often used, however several studies demonstrated the interest of interbody fusion when an inflammatory signal of the disc was detected on the MRI. Spinal fusion provide 50-93% of clinical success in the literature, spondylolisthesis remains the better indication. Only 30% returning to work were obtained.

Discitis↗
PubMed2000

The role of laparoscopic biopsies in lumbar spondylodiscitis.

Infection of an intervertebral disk is a serious condition. Diagnosis often is elusive and difficult. It is imperative to obtain appropriate microbiological specimens before initiation of treatment. The authors describe a 51-year-old woman with lumbar spondylodiscitis that was because of infection after the placement of an epidural catheter for postoperative analgesia. A spinal magnetic resonance imaging confirmed the diagnosis, but computed tomography-guided fine needle biopsy did not provide adequate material for a microbiologic diagnosis. Laparoscopic biopsies of the involved disk provided good specimens and a diagnosis of Propionibacterium acnes infection. The authors believe that this minimally invasive procedure should be performed when computed tomography-guided fine needle biopsy does not provide a microbiologic diagnosis in spondylodiscitis.

Analgesia, Epidural↗