Purpose Pyogenic infections of the spine are relatively rare with an incidence between 1:100,000 and 1:250,000 per year, but the incidence is increasing due to increases in average lifeexpectancy, risk factors, and medical comorbidities. The mean time in hospital varies from 30 to 57 days and the hospital mortality is reported to be 2-17%. This article presents the relevant literature and our experience of conservative and surgical treatment of pyogenic spondylodiscitis. Method We have performed a review of the relevant literature and report the results of our own research in the diagnosis and treatment of pyogenic spondylodiscitis. We present a sequential algorithm for identification of the pathogen with blood cultures, CT-guided biopsies and intraoperative tissue samples. Basic treatment principles and indications for surgery and our surgical strategies are discussed. Results Recent efforts have been directed toward early mobilisation of patients using primary stable surgical techniques that lead to a further reduction of the mortality. Currently our hospital mortality in patients with spondylodiscitis is around 2%. With modern surgical and antibiotic treatment, a relapse of spondylodiscitis is unlikely to occur. In literature the relapse rate of 0-7% has been recorded.

The determination of bone density with preoperative CT scanning can predict the risk of screw loosening and inform the decision to use cement augmentation to reduce the incidence of screw loosening.

This study compares vertebroplasty and kyphoplasty with regard to their effectiveness, safety, and restoration of vertebral body height, and complications. There were no differences between the groups with regard to quality of life and pain improvement, but the rate of serious complications was higher after vertebroplasty. Mean vertebral body height restoration at 1 year follow-up was significantly higher (p<0.05) in the kyphoplasty group. It remains to be seen in future long-term studies whether or not restoration of vertebral body height has an effect on the clinical result.

Ultimately, if surgery is indicated the operative risks should be borne in mind, but advanced age should not be the crucial factor in decision-making.

Boxing remains a subject of controversy and is often classified as dangerous. But the discussion is based mostly on retrospective studies. This survey was conducted as a prospective study. From October 2012 to September 2013, 44 competitive boxers were asked to report their injuries once a month. The questionnaire collected general information (training, competition) and recorded the number of bouts fought, injuries and resulting lost days. A total of 192 injuries were recorded, 133 of which resulted in interruption of training or competition. Each boxer sustained 3 injuries per year on average. The injury rate was 12.8 injuries per 1?000?h of training. Boxers fighting more than 3 bouts per year sustain more injuries (p=0.0075). The injury rate does is not a function of age (age?19 vs. >?19a, p=0.53). Injuries to the head and the upper limbs occur most frequently. The most common injuries are soft tissue lacerations and contusions. Head injuries with neurological symptoms rarely occur (4.2%). Boxing has a high injury rate that is comparable with other contact sports, but most injuries are minor. Injury frequency is not a function of whether the boxer competes in the junior or adult category. Athletes fighting many bouts per year have a greater risk of injury.

Competitive bodybuilding is a weightlifting sport similar to powerlifting, strongman competition and Olympic weightlifting, which aims to increase muscle mass, symmetry, and body definition. Although data regarding rates of injury, overuse syndromes and pain during routine training is available for these other disciplines, it is rare for competitive bodybuilding. The aim of this study was to investigate rates of injury, pain during workouts and/or overuse syndromes, as well as the influence of particular intrinsic and external factors. Data was collected using questionnaires from 71 competitive and elite bodybuilders. The information included training routines and prior injuries. Participants were recruited from bodybuilding clubs in Germany. 45.1% of athletes reported symptoms while training. The overall injury rate was computed to be 0.12 injuries per bodybuilder per year (0.24 injuries per 1 000 h of bodybuilding). Athletes over 40 exhibited higher rates of injury (p=0.029). Other investigated parameters showed no effects. Most injuries occurred in the shoulder, elbow, lumbar spine and knee regions. A large proportion of bodybuilders complained of pain not resulting in interruptions of training/competition. The injury rate is low compared to other weightlifting disciplines such as powerlifting, Olympic weightlifting or strongman competition. In comparison to team or contact sports the injury rate is minimal.

Purpose Vertebral osteomyelitis (VO) has a high mortality and leads to chronic pain and functional disability. Surgical treatment is often necessary. To date, little is known about the consequences of surgery on patient outcome. The aim of this study was to determine the quality of life (QoL) and mortality rates of surgically treated VO patients for a period of 2 years. Methods Patients with VO undergoing surgical treatment in a tertiary referral hospital from 2008 to 2015 were included prospectively. Data were collected before (T0) as well as 1 year (T1) and 2 years (T2) post-surgery. Within the European Spine Tango registry, prospective patient and QoL data were collected using validated outcome scores: Oswestry Disability Index, Short Form 36/EuroQol, Visual Analog Scale, and Core Outcome Measures Index. Results From 195 patients surgically treated for VO, QoL data were available from 136 patients at T0, 100 patients at T1, and 82 patients at T2, respectively. The 1-and 2-year mortality rates were 20% and 23%. Mainly all QoL outcome scores showed significant improvement at T1 and did not change significantly from T1 to T2. Conclusion Surgical treatment of VO patients leads to significantly improved QoL. Nevertheless, QoL levels were below those of the general population. Our results underscore that spine disability questionnaires measuring QoL are mandatory to demonstrate comprehensively the severity of this entity. Our study confirms a high mortality and points out the role of VO as a potentially life-threatening condition.

The occurrence of spondylodiscitis in HIV-positive patients is associated with a low CD4 T-cell count. The probability of mixed infections rises with a CD4 T-cell count <100/microL. The occurrence of spondylodiscitis in HIV-positive patients is accompanied by high mortality. Operative therapy of spondylodiscitis in HIV-positive patients is not associated with an increased surgical complication rate. HIV infection or AIDS should not have an influence on decision-making regarding conservative or operative therapy of spondylodiscitis.