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PubMed2000

[Radiologic diagnosis of spondylodiscitis: role of magnetic resonance].

PURPOSE: To report the Magnetic Resonance Imaging (MRI) features of acute and chronic spontaneous spondylodiscitis as well as any typical patterns which can be useful for the differential diagnosis between pyogenic and tuberculous forms. MATERIAL AND METHODS: Eleven patients affected with spontaneous spondylodiscitis were selected for the study; they were 7 men and 4 women ranging in age 33-87 years (mean: 64). We excluded the patients with iatrogenic spondylodiscitis. MR images were acquired with a superconductive magnet at 1.5, with the following sequences: sagittal PD and T2-weighted TSE, sagittal T1-weighted SE, axial PD and T2-weighted TSE for the lumbar spine, axial T2-weighted GRE for the cervical and dorsal spine and axial and sagittal T1-weighted SE after contrast agent (gadolinium DTPA) injection. MR images were reviewed by three experienced radiologists and morphological and signal intensity changes of vertebral body and disk were recorded on a standard form. In 9 patients it was possible to compare MR to CT findings. RESULTS: At the time of our observation all patients reported pain at the spine level, associated with fever and weight loss in 50% of cases and with increased values of the inflammatory markers. Three patients had infectious diseases in other organs and 2 were diabetics. Biopsy was performed in two cases only and demonstrated Staphylococcus aureus in one and Mycobacterium tuberculosis in the other patient. MRI allowed the correct diagnosis to be made in all cases, demonstrating the pathological involvement of the paravertebral structures and into the spinal canal earlier and more accurately than CT. A common finding in pyogenic and tuberculous spondylodiscitis was the low signal of the subcortical bone marrow on T1-weighted sagittal images, which enhanced after Gd-DTPA administration and became intermediate or high on T2-weighted images. Moreover, the steady high signal intensity of the disk on T2-weighted images and its contrast enhancement on T1-weighted images is typical for an acute inflammatory process. CONCLUSIONS: Based on our personal experience and literature data, we believe MRI to be the most sensitive technique for the diagnosis of spondylodiscitis in the acute phase, whereas it is comparable to CT in the chronic stage of the disease. At present MRI does not allow to differentiate pyogenic from tuberculous forms.

Acute Disease↗
PubMedDate not supplied

[Rheumatic spondylodiscitis in spondylarthropathies].

The involvement of enthesis like disc space is the typical lesion of spondylarthropathies. Out of 240 patients with spondylarthropathies, 10 (7 M, 3 W; mean age: 37 years) have spondylodiscitis, affecting a total of 13 disc spaces: 1 cervical, 2 thoracic, 10 lumbar. The mean duration of spondylarthropathy at the time of diagnosis of spondylodiscitis is 10 years. Spondylodiscitis has a variable clinical presentation: painful (6 cases), asymptomatic (4 cases). Its coexistence with typical radiographic signs of spondylarthropathy added to the exclusion of bacterial origin, permit to link it to spondylarthropathy. Its evolution is generally favourable.

Adult↗
PubMed2001

[Cold parapharyngeal abscess in spondylodiscitis].

BACKGROUND: The principle danger of pharyngeal abscess is the risk of rupture overflow into the upper respiratory track. Pyogenic abscesses are the most frequent and tuberculosis is rare. We report two cases of retro and parapharyngeal abscesses with tuberculous spondylodiscitis. CASE REPORTS: The first case occurred in a 54-year-old woman, the second in a 19-year-old man. Both had a laterocervical swelling associated with a oropharyneal bulge that progressed over several months. Computed tomography showed abscess formation and spinal disease in both cases. Drainage of the abscess led to the distological diagnosis of tuberculosis. Medical management was successful with resolution of the abscess and spinal lesions. DISCUSSION: Spinal tuberculosis should be suspected in patients with a parapharyngeal abscess without detectable portal that progresses slowly. A biopsy specimen is required for diagnosis. Magnetic resonance imaging can provide early evidence of spondylodiscities. Medical treatment is indicated.

Adult↗
PubMed2001

[Bacterial spondylodiskitis: pyogenic or tuberculous?].

We retrospectively studied the epidemiological, clinical, radiological and evolutive aspects of bacterial spondylodiskitis observed in 39 patients diagnosed from January 1989 to December 1998, in order to find criteria to distinguish between pyogenic spondylodiskitis (PS) and tuberculous spondylodiskitis (TS). During the study period, we collected 13 patients (33.3%) with PS and 26 patients (66.7%) with TS. The mean age was 44 years. The delay in diagnosis was much longer in TS (8.4 months) than in PS (2 months). Diagnosis was certain in 6 cases (46%) of PS and in 12 cases (46%) of TS. Clinically, paravertebral abscesses and neurologic complications were significantly more frequent in TS. The main causative agents in PS were staphylococci. Diagnosis of spondylodiskitis is based on the imaging techniques, especially magnetic resonance imaging which is more sensitive and specific than computed tomography. Except in patients with positive blood cultures or positive urine culture in PS, and isolation of Mycobacterium tuberculosis in another visceral foci in TS, bacteriologic diagnosis was based on discovertebral needle biopsy. The yield of this technique was poor in our study (12.5%), even if bacteriologic confirmation of spondylodiskitis was made in 15 patients (38.5%). In the other cases, diagnosis rested on a set of clinical, biological and radiological criteria.

Adolescent↗
PubMed2001

[Spondylodiscitis due to Histoplasma duboisii. Report of two cases and review of the literature].

We report two cases of African histoplasmosis caused by Histoplasma duboisii located in the spine, on two Malian adults aged 40 and 47 years respectively. Clinical signs consisted of dorsal spinal syndrome in both cases and a paraplegia in one case. Radiography and CT scan revealed a spondylodiscitis without any bone reconstruction in both cases and a prevertebral abscess in one case. Diagnosis was confirmed by mycological and pathological examinations of surgical specimen which revealed Histoplasma duboisii fungus. Medical treatment, after surgical repair, consisted in ketoconazola with positive results after 12 months. This localisation is rare. It raises diagnosis problems with tuberculous spondylodiscitis because of their radio-clinical resemblance.

Abscess↗
PubMedDate not supplied

A definite case of spondylodiscitis caused by Streptococcus equisimilis.

To shed light on the role of Streptococcus equisimilis (SE) in the pathogenesis of intervertebral disc infection, we report here a case of lumbar spondylodiscitis in a 37-year-old male caused by SE, with identification of this strain by cultures from L4-L5 lumbar disc biopsy. Intravenous therapy with penicillin and gentamycin combined with immobilization resulted in a rapid and complete recovery. The patient did not have underlying disease and showed no obvious history of exposure to animals. We conclude that SE may be responsible for both septic arthritis and spondylodiscitis.

Adult↗
PubMedDate not supplied

Aseptic spondylodiskitis in rheumatic diseases.

Aseptic diskitis is relatively common. Several rheumatic diseases involving the spine may have this complication. As this condition mimic infectious diskitis, it is important to recognize it. Clinically, it is characterised by vertebral pain of an inflammatory nature, occasionally accompanied by fever and an increase in the erythrocyte sedimentation rate. Radiologically, the decrease in the articular space and the irregularity of the vertebral plates are of particular importance. Although uncommon, it is necessary to bear in mind this possibility when the etiological search for a possible infectious diskitis proves fruitless. A MEDLINE (1986-2000) and PUBMED (1966-2000) search of relevant articles was performed. Descriptors used were aseptic diskitis, spondylodiskitis, pseudodiskitis and pseudoarthrosis.

Diagnosis, Differential↗
PubMed2001

[Osteomyelitis of the spine and its surgical treatment--personal experience].

PURPOSE OF THE STUDY: Evaluation of surgical treatment of osteomyelitis of the spine, determination of efficient diagnostic and therapeutic criteria. MATERIAL: The examined group comprised in total 27 patients. No selection was made, all patients who were operated on and treated at the Department of the authors were followed gradually as they were admitted at the Department. METHODS: Evaluation was based on the monitoring of the clinical condition of patients including laboratory tests. Evaluated was also the achievement of vertebral body fusion three months after the surgery. The surgical procedure always contained a radical debridement of inflammatory focus, a massive autogenous cancellous bone grafting mixed with Gentamycin foam, either separately or in combination with instrumentation. Approach to the inflammatory focus was in 9 cases transforaminal posterior, in 2 cases transforaminal combined with transversectomy, in 2 cases transforaminal combined with laminectomy, in 4 cases transthoracic, in 1 case transabdominal, in 7 cases retroperitoneal and once percutaneous technique was used. RESULTS: All patients operated on healed without complications. Local pain and temperature subsided rapidly (in terms of days). Also objective inflammatory criteria returned to normal (in terms of weeks). Seven patients show improved neurological status. X-ray examination 3 months after the surgery always shows consolidation and ingrowth of cancellous bone grafts without local relapse or loss of correction. DISCUSSION: The numbers of patients of the authors' group correspond with the numbers of patients presented in literature. There is also agreement with other authors that a modern treatment of spinal osteomyelitis should include a radical debridement of the focus combined with instrumentation, neurological decompression and application of cancellous bone grafts completed by local antibiotics. As compared to other authors who present a prevalence of abscess the histological examination of our cases shows predominantly inflammatory granuloma. CONCLUSION: Radical surgical treatment of spinal osteomyelitis including debridement, cancellous bone grafting, internal fixation (instrumentation) and decompression together with a general treatment and orthotic management seems to be an efficient way of the treatment of this serious disease.

Adolescent↗
PubMed2001

[Cervical spondylodiscitis: a rare complication of phonatory implants].

Cervical spondylodiscitis is described more often in children than in adults. Many cases occur after cervical or facial surgery, usually as a complication after difficult intubation, endoscopy or foreign body extraction. We report the first case of cervical spondylodiscitis occurring subsequent to secondary tracheoesophageal puncture for implantation of a phonatory prosthesis. Signs were not specific leading to difficult diagnosis and treatment. We discuss the impact of bacterial contamination during tracheoesophageal puncture.

Aged↗
PubMed2002

[Tc-99m ciprofloxacin in clinically selected patients for peripheral osteomyelitis, spondylodiscitis and fever of unknown origin--preliminary results].

AIM: Retrospective evaluation of Tc-99m ciprofloxacin (infection) scintigraphy consecutively performed in a series of patients clinically suspected for peripheral osteomyelitis (OM), spondylodiscitis (SD) and fever of unknown origin (FUO). METHODS: A total of 20 patients clinically suspected for OM (n = 12), SD (n = 3) and FUO (n = 5) were included in our retrospective analysis. The additional criterion was a positive 3-phase bone scan for OM, or a 2-phase bone scan in case of SD. Planar whole body scans and static acquisitions were performed 1 and 4 h after application of 370 MBq Tc-99m ciprofloxacin. In 10 patients with suspected OM, additional immunoscintigraphy using Tc-99m labelled monoclonal antibodies (Mab BW 250/183) was performed and the correlation of infection to bloodpool and antigranulocyte scintigraphy was analysed. RESULTS: OM: Bacterial infection was confirmed in 8 of 15 lesions. Infection demonstrated true positive (TP) results in 7 of 8, true negative (TN) results in 2 of 7, false positive (FP) results in 5 of 7 patients and one false negative (FN) result. A strong correlation could be demonstrated between T/NT ratios of infection and bloodpool Tc-99m medronate imaging (r = 0.84, 0.88) and between infection and BW 250/183 (r = 0.92, 0.90). Using a threshold of 2.0 for T/NT ratio, only TP results could be observed whereas a T/NT in the range of 1.0-2.0 could not discriminate between septic and aseptic inflammation. Concordant results with Mab BW 250/183 could only be observed in 5 of 10 patients (4 TP, 1 TN) by showing 4 FP and 1 FN lesions with IF. CONCLUSION: Non-specific uptake of infection can be observed in a variety of clinical situations with moderate uptake, by showing a strong correlation with blood-pool imaging. Nevertheless, intense uptake may be specific for septic inflammation.

Adult↗
PubMedDate not supplied

Nontuberculous spondylodiscitis in children.

Forty-two children with nontuberculous spondylodiscitis treated between 1966 and 1997 were reviewed, and the clinical, paraclinical, and therapeutic results are presented. The study shows the difficulties of diagnosis and understanding the pathophysiology of the disease. Additional information is provided by new imaging techniques, disc aspiration, and biopsy. The mean age at treatment was 4 years 6 months. The initial clinical presentation was often misleading and the diagnosis was often delayed (42 days average). Standard radiographs and technetium bone scans were important for diagnosis and patient follow-up. Magnetic resonance imaging and needle aspiration of the disc gave an additional reliable aid in differential diagnosis and helped to guide treatment. Bacteria were isolated in 22 of the 35 samples taken (55% Staphylococcus aureus, 27% Kingella kingae; Coxiella burnetii in one sample). The functional outcome is good if treatment is properly carried out. Disc fibrosis and occasional vertebral fusion develop inevitably in the long term. According to these results, nontuberculous spondylodiscitis is truly osteomyelitis of the spine.

Adolescent↗
PubMedDate not supplied

[Cervical spondylodiscitis].

Eighty patients were treated for spondylodiscitis with the cervical spine involved in nine cases. Conservative treatment was applied in seven cases with Minerva jacket and antibiotics, and surgical treatment was applied in severe, rapidly, progressive, complicated cases and in patients with involvement of nervous system (two cases). The good and satisfactory results in both group were similar. These results show that when the indications are properly established, both conservative and operative methods have satisfactory results.

Adult↗