SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The case of a sixty-two year old man with Campylobacter fetus spondylodiscitis is reported. Despite of adequate antibiotherapy, the outcome was bad and death occurred. Three other cases of Campylobacter fetus spondylodiscitis are reported in the literature. Tomodensitometry disclosed a paravertebral abscess with gas, that make our observation original.
We report a case of severe retroperitoneal fibrosis (RPF) secondary to lumbar spondylodiscitis caused by infection with Prevotella resolving after antibiotic therapy. Infection is an unusual cause of RPF, and infection in such cases with this anaerobic bacterium has never been described.
We report a case of thoracic spine diskitis of unknown cause that had aggressive and destructive features on MR images. Results of two biopsies were unremarkable. The process began after sneezing, also produced extensive paraspinous enhancement, and resolved without antibiotic therapy both clinically and radiologically after four months. A discussion of case similarities to Reflex Sympathetic Dystrophy (RSD) in the extremities render this possibly the first reported imaging evidence of RSD in the axial skeleton.
Spondylodiscitis is a rare but serious complication of epidural catheter use. It is controversial as to which mechanism is responsible for development of this complication. It may develop due to direct contamination or hematogenous spreading. We report a 54-year-old woman who developed spondylodiscitis after epidural catheter was inserted and to whom analgesic and steroid treatment was given for chronic lumbar pain. In this case, each of 2 pathological mechanisms may be responsible. The diagnostic methods, mechanisms and management are discussed.
Tuberculosis (TB) remains endemic in most of the developing countries. However, a resurgence of tuberculosis has also been reported in the past decades in developed countries, not only in the lungs, but also in extrapulmonary sites, e.g. the vertebral column. Vertebral TB is most often found in the lower thoracic and upper lumbar regions. Diagnosis is often difficult; clinical findings are usually non-specific and radiologic features may mimic those of other bacterial, fungal, inflammatory and neoplastic diseases. However, recognition and understanding of the radiological findings may help in diagnosis. Two distinct patterns of vertebral tuberculosis may be seen: the classic finding of spondylodiscitis, characterized by destruction of two or more contiguous vertebrae and opposed end plates, disk infection, and commonly a paraspinal mass or collection. The second pattern, increasing in frequency, is a atypical form of spondylitis without disk involvement.The value of CT and MR imaging are discussed in the diagnostic workup of vertebral tuberculosis. A positive culture or histopathologic analysis of CT-guided needle aspiration or biopsy specimens is required in the absence of pulmonary manifestations of tuberculosis for definitive diagnosis and adequate treatment.
Pediatric musculoskeletal infections are common disorders that can result in significant disability. Because the understanding, diagnosis, and treatment of infections of the bones, joints, and soft tissues have continued to improve over time, it is important for orthopaedic surgeons to have an understanding of the etiology, diagnosis, basic treatment principles, and recent advancements to achieve successful outcomes. Although each infectious process is unique, there are certain treatment principles that apply to all pediatric musculoskeletal infections. These include prevention, a prompt and accurate diagnosis, and timely medical and/or surgical intervention. Continued evaluations are mandatory to assure good long-term outcomes. Because the effects of infection may last beyond the acute episode in pediatric patients, long-term follow-up is needed to assess for late sequelae such as angular deformities and limb-length inequalities.
INTRODUCTION: Infections account for 3% of all non-traumatic spinal cord injuries. The demographic distribution and clinical course are still not fully understood in these patients. AIMS: The aim of this study was to determine the clinical-epidemiological characteristics and clinical course in patients with infectious spinal cord injury referred to our centre. PATIENTS AND METHODS: A retrospective study (over the period 1997-2003) was carried out. Variables examined included age, sex, type of injury, aetiology, causing agent, ASIA classification on admission and discharge. RESULTS: N = 27 (8% of the total number of non-traumatic spinal cord injuries). Mean age: 37.3 years (range: 14-75). Higher prevalence was found between the ages of 20 and 39 years (48.1%) and in males (70.4%). A prevalence of dorsal injuries (59.3%) was also observed. On hospital admission most of the injuries were incomplete (70.4%) and this figure increased to 77.8% on discharge. Spondylodiscitis was the most frequent cause (51.9%) and Staphylococcus aureus was found to be the most common microbiological causing agent. The greatest prevalence of complete injuries was observed in cases of dorsal injuries (43.75%). All cases of tuberculosis were situated in the dorsal region (p < 0.05). CONCLUSIONS: In our care centre, non-traumatic spinal cord injuries of an infectious origin seem to be most often caused by spondylodiscitis due to S. aureus, with a higher incidence in the dorsal region. They predominantly affect males in their thirties and forties, and usually give rise to incomplete injuries.
Explore the source record for details and available documents.
The frequency of iatrogenic spondylodiscitis is clearly increasing, which may reflect the increasing number of aggressive interventional procedures which may cause it. One of these is oocyte retrieval for in vitro fertilisation. The authors describe a case of Streptococcus faecalis L5-S1 spondylodiscitis. Conservative treatment is the rule, but surgery may be indicated in specific cases such as the one presented.
A comparative study of the parts played by technetium-99m diphosphonate and gallium-67 citrate bone scanning in the early diagnosis of infectious spondylodiscitis is presented. Nineteen patients were included in the study. All patients (11 men aged 19-70 years and eight women aged 18-72 years) had a history of back pain varying in duration from one to 15 weeks. A 99mTc diphosphonate bone scan was positive in 17 patients. The two patients with negative results had less than two weeks of back pain. The 67Ga citrate bone scan showed uptake in all patients.
We retrospectively evaluated the results after corporectomy and vertebral body replacement in 40 patients with thoracic or lumbar spine collapse due to tumour osteolysis, unstable fractures, spondylodiscitis and Paget's disease. They underwent posterior transpedicular instrumentation followed 7 to 21 days later by vertebral body replacement with a distractible device, the "Obelisc" cage, filled up with autogenous/allogeneic bone graft. The mean residual kyphosis after surgery was only 13.8 degrees. After a mean follow-up period of 16.3 months, there was a mean loss of correction of 1.1 degrees. Perioperative complications occurred in 25 patients (62.5%); one died of septic shock, and the others were treated conservatively. Postoperatively, neurological improvement was noted in 8 patients. Using this in situ distractible vertebral body replacement system to achieve intraoperative stabilisation, neurological improvement and minimal postoperative displacement were achieved with an acceptable perioperative risk.
PURPOSE OF THE STUDY: The complex anatomy of the cervicothoracic junction region makes a reliable assessment of plain radiographs in lateral projection difficult or even impossible, which may result in failure to detect fracture or other pathology in this region of the spine. The aim of this study was to evaluate the patients with spinal disorders in the region of the seventh cervical to the third thoracic vertebrae treated at our department. MATERIAL: During the period from November 2001 to June 2004, 34 patients with disorders of the C7-T3 region were treated surgically at the Department of Spinal Surgery, Motol Teaching Hospital, which accounted for 2.1% of the 1537 patients treated for spinal diseases in this period. Instability of the cervicothoracic junction was caused by tumors in 15 and by injury in 14 patients. Other diagnoses included deformity associated with rheumatoid arthritis (RA) in two patients, spondylodiscitis in one, and hemivertebral deformity at C7 and T1, each in one patient. The group included 16 women and 18 men between 8 and 75 years, with the mean of 52.3 years (after excluding the two children with hemivertebral deformity aged 8 and 9 years, respectively). The trauma subgroup had a significantly lower mean age (43.6 years) than the tumor subgroup (59.9 years). METHODS: We placed the patients in three groups according to the etiology of cervicothoracic junction disorder, namely, 1. tumors and spondylodiscitis; 2. injuries; 3. others. Group 1 included 16 patients, 15 with tumors and one with spondylodiscitis. Two patients were treated by dorsal stabilization, one by ventral stabilization and the rest underwent combined surgery. Of 14 patients in group 2, three were treated from the posterior approach, six from the anterior approach and five by the combined approach. All group 3 patients underwent surgery from the posterior approach, with two patients being treated without instrumentation. RESULTS: Of the 34 patients, only 33 were included; one was lost to follow-up soon after the operation. In group 1, no excellent, five very good, five satisfactory and two unsatisfactory outcomes were recorded. No intraoperative complications such as injury to the major vessels or nerve structures occurred; in one patient, profuse bleeding from arteries supplying a metastatic tumor had to be arrested. Late complications included loosening of the dorsal instrumentation in two patients, who required repeat operations. In group 2, there were six excellent, four good, two satisfactory and one poor outcomes. Late complications in one patient included loosening of the ventral instrumentation, followed by repeat surgery. Group 3 showed two excellent and two satisfactory outcomes; the latter were in the RA patients. Late complications involved one loosening of the dorsal instrumentation requiring repeat surgery. No injury to the major vessels or nerve structures was recorded in either group 2 or group 3. No deep infection was recorded in any of the three groups. DISCUSSION: The results of our evaluation are in agreement with those of other authors and, similarly to them, we had to deal with the difficult issues of diagnosis. Currently, we prefer, in addition to conventional X-ray examination, CT scans including sagittal and frontal reconstruction, recently completed with magnetic resonance imaging, in all patients with cervicothoracic junction disorders. This policy allows us to avoid delays in making correct diagnosis and to provide conditions for effective treatment. In stabilization from the posterior approach we use rod-screw fixation that, in the majority of cases, is not combined with thoracic fixation. Previously, we have inserted screws in the articular processes at the C7 level, but now we prefer transpedicular fixation. Complicated anterior surgical procedures, such as complete or partial sternotomy, are always performed with the assistance of a thoracic surgeon. A noticeably high number of patients with neurological deficit was seen also in our group. Postoperative care is always provided in cooperation with the spinal unit of our hospital. Intensive inter-disciplinary cooperation has an important role in that our patients have a minimum of complications in comparison with the literature data. CONCLUSIONS: Injuries and diseases of the spine at the cervicothoracic junction present a complex issue with a high potential for mistakes and complications. The principle of success lies in a high-quality X-ray examination, CT scans with sagittal and frontal reconstruction, and magnetic resonance imaging of the region affected. The complex anatomy of that region requires demanding surgical procedures, which can be performed only by a highly qualified and specialized team with appropriate facilities.
We reported a case of lombar spondylodiscitis caused by Salmonella enteritica serotype Typhi in an immunocompetent patient. Salmonella is a rare causative agent of spondylodiscitis. Early bacteriological diagnosis is essential to avoid longterm sequelae.
Explore the source record for details and available documents.
We report the MR appearance of a rare case of sarcoidosis of the spine presenting as spondylodiskitis. Vertebral and disk signal changes were typical for diskitis. In the appropriate clinical setting the differential diagnosis of diskitis should include sarcoidosis.
OBJECTIVE: To characterize the clinical, biological, and imaging features and outcomes of patients with streptococcal and enterococcal spondylodiscitis (SESD). METHODS: This retrospective study of patients with SESD was carried out in 2 departments of rheumatology from 1990 through 2002. Comparison was made with cases of staphylococcal spondylodiscitis (SSD) seen during the same period, excluding postoperative cases. RESULTS: Fifty cases of SESD were reviewed and compared with 86 cases of SSD. The main finding was a higher frequency of concomitant infective endocarditis in patients with SESD (11/42 vs 1/37; p = 0.009). Evidence of inflammation, imaging features, and neurological impairment at admission appeared to be less severe in SESD, but the difference did not reach statistical significance. Duration of treatment was shorter in SESD than in SSD (105 +/- 26 days vs 130 +/- 49 days; p = 0.003). CONCLUSION: Our study confirms the high incidence of infective endocarditis (26%) during SESD. Clinicians must look for predisposing factors and clinical abnormalities in patients with spondylodiscitis whenever a streptococcal or enterococcal agent is identified. Echocardiography should be performed as routine in such situations.
Infective endocarditis in association with spondylodiscitis is rarely observed. It is sometimes difficult to distinguish between rheumatologic diseases and infective endocarditis. We reported a 61-year-old male with Streptococcus viridans endocarditis suffering from low-back pain as initial symptom. Infective endocarditis was diagnosed according to Duke Criteria. L4-5 spondylodiscitis was revealed on the lumbar magnetic resonance imaging. He responded to antibiotic treatment. Infective endocarditis should be considered in patients with fever and low-back pain due to spondylodiscitis.
The case of a 55-year-old female patient with discogenic sclerosis of a thoracic vertebra is illuminated by a radiologic vignette. The clinical and radiologic features, including those of conventional radiography, computed tomography scanning and magnetic resonance imaging are hallmarked in this portrait. The importance of differentiating the condition particularly from infectious spondylodiscitis and metastatic disease to the spine is underpinned.