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At least 973 records · Page 54Linked to original sources
PubMed1992

[Infectious spondylodiscitis. Analysis of a series of 105 cases].

Among 105 cases of infectious spondylitis diagnosed and treated from 1971 through 1990, 23 were due to tuberculosis (TS) and 82 to other causes (NTS). The annual number of cases of NTS rose over the study period, partly because of an increase in iatrogenic spondylitis, whereas the number of TS cases fell. In both groups, mean age of patients was higher than in earlier studies. The leading causative agents in NTS were staphylococci, followed by streptococci, then Escherichia coli. Diagnosis of spondylitis was dependent on the imaging techniques used; among available methods, the most reliable was magnetic resonance imaging which improved diagnostic performance by detecting early, specific changes. Except in patients with positive blood cultures and in TS patients with Koch bacilli recovered from other visceral foci, bacteriologic diagnosis rested on studies of samples taken from the spinal infection site. Half the subjects underwent discovertebral needle biopsy, with a success rate of 47.5%, a figure comparable with those reported in other studies. In 30% of patients, bacteriologic documentation of the infection was not obtained and diagnosis rested on a set of clinical, biological, and radiological criteria.

Bacterial Infections↗
PubMed1992

[Cytology of the cerebrospinal fluid in dogs with brain tumors and spinal cord compression. Part 4].

The results of cerebrospinal fluid (CSF) cytology of 9 dogs with brain tumors and 50 dogs with spinal cord compression are discussed. Of the 50 dogs with spinal cord compression, disc protrusion was diagnosed in 31, myelomalacia in 7, discospondylitis in 3 and spinal cord tumors in 9 dogs. In 4 of 9 dogs with brain tumors, tumor cells could be found by the sedimentation apparatus of Kölmel. Pleocytosis existed in 6 patients. In about 70% (29 of 41) of cases with disc protrusion, more than 200 cells could be evaluated in the CSF sediment, consisting mostly of transformed lymphocytes and activated monocytes. As the neurologic deficits increased, the amount of cells and especially cell complexes increased. This was especially evident in cases with myelomalacia of the spinal cord. Only in cases with discospondylitis or spinal cord neoplasia was the CSF cytology unchanged.

Animals↗
PubMed1992

Pain of musculoskeletal origin in children.

Pain in infants and children may be manifest by deformity, altered function, or discomfort. These manifestations are highly age related. Pseudoparalysis may be the only manifestation of septic arthritis of the hip in the neonate; a limp is often the presenting complaint in Perthes' disease, and scoliosis may be the primary manifestation of a herniated disc in an adolescent. New imaging methods aid in diagnosis. Ultrasound is helpful in assessing joint effusions; bone scans localize the cause of a limp; and magnetic resonance imaging shows spinal cord and root lesions. The traditional methods of assessment have not been replaced. History and physical examination are most essential to provide a rational basis on which to select the appropriate imaging study.

Back Pain↗
PubMed1992

MRI of spondylitis.

MRI of proven spondylitis was performed in 39 patients. Acute spondylitis appeared hypointense on T1-weighted and hyperintense on T2-weighted images. Following intravenous administration of Gd-DTPA, enhancement of the marrow and disc was seen. With progressive healing an increasing signal was seen on T1-weighted images. This was caused by the presence of focal fat marrow representing the first sign of therapy response. As healing progressed, the T1-signal increased due to fatty marrow, while the T2-signal decreased as well as the enhancement following Gd-DTPA administration. Therefore, MR imaging can be recommended as the method of choice for early diagnosis of spondylitis and assessment of therapy response.

Adult↗
PubMed1992

Diskospondylitis associated with Brucella canis infection in dogs: 14 cases (1980-1991).

A retrospective study of 135 dogs with diskospondylitis revealed 14 dogs with concurrent Brucella canis infection. Sexually intact male dogs and dogs in the southeastern United States appeared to be at higher risk. Results of bacteriologic culturing of blood were less likely to be positive for dogs with diskospondylitis caused by B canis infection than for dogs with diskospondylitis caused by other organisms. Follow-up evaluation of 13 of the 14 dogs revealed complete remission of clinical signs in nine, but serologic test results continued to be positive for B canis infection long after resolution of clinical abnormalities. Radiographic follow-up evaluation in 6 dogs revealed active lesions despite complete remission of clinical abnormalities.

Animals↗
PubMed1992

[Imaging of the spine].

Modern imaging techniques allow early and precise diagnosis of spinal diseases. Their sensitivity and specificity are variable, but in general they are more complementary than competitive. After emphasizing the different patterns which characterize the late evolution of diagnostic imaging, the author reviews the indications and limits of plain films, bone scintigraphy, computed tomography, and in particular of magnetic resonance, in trauma, degenerative lesions, inflammations, infections and tumors of the spine.

Diagnostic Imaging↗
PubMed1992

The development of discopathy in lumbar discs adjacent to a lumbar anterior interbody spondylodesis. A retrospective matched-pair study with a postoperative follow-up of 16 years.

Of 46 patients who underwent a lumbar or lumbo-sacral anterior interbody fusion at one or two levels, 16 were available for a follow-up of 16-20 years. The indications for operation were instability, degenerative disc disease, pseudarthrosis of a posterior fusion, and spondylolisthesis. Preoperative roentgenograms were compared with those made at follow-up 16 years (or more) later. In only a minority of patients was discopathy or instability found. The roentgenographic findings of the operated patients at a follow-up of at least 16 years were compared with those of a group of age- and sex-matched controls not previously treated for backache. We found that most degenerative changes of the adjacent discs occurred at a rate nearly similar to that in the corresponding levels of the controls. These results may suggest that lumbar anterior interbody spondylodesis does not accelerate the development of degenerative changes in adjacent discs.

Adolescent↗
PubMed2003

[Acute Gemella haemolysans spondylodiscitis in an immunocompetent patient].

INTRODUCTION: Gemella is a commensal bacterium of the upper respiratory tract responsible for rare infections such as acute endocarditis and meningitis. We report the case of an acute Gemella haemolysans spondylodiscitis. OBSERVATION: A 72 year-old woman was hospitalised for an etiological control and treatment of acute L4-L5 spondylodiscitis with epiduritis, confirmed on MRI. The clinical picture was composed of backache with shivering and alteration in general status of health. The peripheral bacteriological samples, intra-dermal reaction and brucella serology were all negative. The surgical L5 biopsy, following bacteriological enrichment, isolated Gram-positive cocci, later identified as Gemella haemolysans. The antibiogram showed good sensitivity to amoxicillin, dalacin and erythromycin, and strong resistance to aminosides. The search for a contamination point was negative. The patient rapidly improved with antibiotics combining 6 g/d of amoxicillin and 1200 mg/d of clindamycin, and the biological and clinical signs regressed. The antibiotic bi-therapy was continued for two and a half months and then relayed to amoxicillin alone for two further weeks. COMMENTS: The first descriptions of Gemella haemolysans infection were made in the seventies. Cases of infectious endocarditis were succeeded by septicaemia on cirrhosis and later a few cases of acute post-neurosurgical meningitis. In the majority of cases, a dental contamination point was found. The difficulties in its etiological diagnosis, related to the problems in identifying this germ that has similar characteristics to Streptococcus viridans, suggests that the prevalence of Gemella haemolysans infections is greatly underrated. The sensitivity profile generally observed is sensitivity to penicillins and aminosides--the association of which is synergic--, to cyclines and glycopeptides, and resistance to trimethoprime-sulfamethoxazole.

Acute Disease↗
PubMed2003

Interobserver error in interpretation of the radiographs for degeneration of the lumbar spine.

We examined 114 segments in 23 patients' lumbar spine plain radiographs affected by disc degeneration. Two consultant orthopaedic surgeons, two consultant radiologists, and one spine nurse practitioner made independent observations on the radiographs. MRI scan films of the corresponding 114 segments were used as a gold standard. Kappa coefficients were used to evaluate the interobserver error, and the error between the independent observers and the MRI scanning reports. The systematic differences between the observers for the diagnosis of the disc degeneration at each segment level was recorded. There was significant interobserver error between the independent observers. The pairwise interobserver agreement ranged from fair to substantial on the plain radiograph observations [Weighted kappa coefficient, mean: 0.517 (CI=0.388-0.646)]. The pairwise interobserver agreement between the independent observers and the MRI scan ranged from fair to moderate [Weighted kappa coefficient, mean: 0.388 (CI=0.259-0.518)]. There is significant error in interpretation of the plain radiographs for the diagnosis of lumbar disc degeneration. MRI may be more accurate in the diagnosis of lumbar disc degeneration.

Adult↗
PubMedDate not supplied

CT-guided percutaneous needle biopsy in spine lesions.

Vertebral bone biopsy is an accurate, rapid, and cost-effective method to diagnose benign and malignant spine lesions. The major complications are uncommon. Nondiagnostic or insufficient specimens are encountered in less than ten per cent. The accuracy of the biopsy depends on the location and type of the lesion, needle system, and biopsy route. The major indications are focal lesions with non-specific medical imaging findings, to exclude metastasis in patients with known primary malignancy, lesion without response to treatment, no clinical improvement in children with diskitis after six weeks of therapy to exclude occult tumor and extreme pain due to vertebral collapse. If histology yields only peripheral blood elements in an obviously destructive mass, biopsy can be repeated, by directing at a slightly different area of the lesion. No more than three percutaneous biopsies of the same lesion should be performed.

Adult↗
PubMed2003

[Non-tubercular and non-brucellar spondylodiscitis: preliminary clinico-microbiologic analysis of 37 cases].

Disk-space infection caused by organisms other than Mycobacterium tuberculosis or Brucella species seems to be an emerging disease due to an increase of the population at risk. However, few data are presently available from Italian institutions. In this article we report our "tot" month prospective experience on etiology and clinical presentation of disk-space infections in relation to their community (COM) or nosocomial (postoperative [POS] or non-postoperative [NPOS]) acquisition. Major results were: 1) a different microbial distribution among etiologies of COM, NPOS and POS infections; 2) more frequent distance infection as predisponing factor among NPOS infection than among COM and NPOS ones; 3) absence of fever and more frequent radicular extension of pain among POS infections. Due to the numerous potential microbial etiologies, culture of TC guided-disk aspirated material is of paramount importance for pathogen-targeted antimicrobial therapy.

Discitis↗
PubMed2003

[Non-tubercular vertebral osteomyelitis: diagnosis and therapy of 45 patients from a single Italian centre].

AIM OF THE STUDY: to evaluate the episodes of non-tubercular spondylodiskitis diagnosed between 1998 and 2002 at Ospedale S. Corona, Pietra Ligure (SV). METHODS: prospective evaluation of vertebral osteomyelitis classified as spontaneous or iatrogenic if associated with procedures on the spinal cord, with detection of associated risk factors, localization, etiology and treatment. RESULTS: 45 episodes, 71% spontaneous and 29% iatrogenic were observed. Associated risk factors were present in 47% of spontaneous spondylodiskitis. Lumbosacral localization was detected in 68% of spontaneous and 100% of iatrogenic episodes. Other localizations in spontaneous spondylodiskitis were dorsal (25%) or cervical (7%). Methicillin-sensitive staphylococci caused the majority of spontaneous spondylodiskitis, while methicillin-resistant strains were more frequently involved in iatrogenic episodes. Among spontaneous spondylodiskitis, 63% healed with antibiotics for 8 weeks, but surgery was often needed in dorsal localizations. In iatrogenic forms antibacterial therapy for 8 weeks-6 months was effective in cases not associated with foreign bodies but their presence always required surgery for healing. CONCLUSIONS: spondylodiskitis is more frequently localized at the lumbosacral level. Beta-lactams are generally effective in spontaneous episodes, while iatrogenic episodes often require associations of drugs. Surgery may be required in the case of dorsal localization or in the presence of foreign bodies.

Adult↗