BackgroundPyogenic spondylodiscitis is a form of spinal infection that can result in severe back pain and even death. However, information is lacking on the relative effectiveness of various therapies. A retrospective chart review was conducted to investigate whether early surgical treatment of pyogenic spondylodiscitis coupled with intravenous antibiotics results in better patient prognoses than intravenous antibiotics therapy alone.MethodsAll patients treated for pyogenic spondylodiscitis at a single medical center from July 2006 to July 2011 were retrospectively reviewed. The inclusion criteria consisted of diagnosis of an early stage infection without neurological deficit, and patients without severe sepsis who were suitable candidates for early surgery as determined by a Pittsburgh bacteremia score < 4, and patients with delayed diagnosis and lost to outpatient follow-up were excluded. Clinical outcomes included patient demographic data, kyphosis angle, length of treatment, Oswestry Disability Index and visual analogue pain scale were analyzed.ResultsOf 90 enrolled patients, Group 1 (n = 47) received only antibiotic therapy and Group 2 (n = 43) received early surgery with post-surgery antibiotics for 2 to 4 weeks. Group 2 exhibited significantly better results than Group 1 for mean antibiotic administration period, mean hospitalization period, kyphotic angle correction. Of 61 patients who participated in telephone follow-up after discharge, Group 2 (n = 26) had significant lower mean ODI score, and mean back pain score than Group 1 (n = 35).ConclusionsWhile infection control was similar for both groups, patients treated with early surgery and antibiotics were hospitalized for fewer days and required less antibiotics than those treated with antibiotics alone, also having better functional outcomes. In short, early surgical treatment of pyogenic spondylodiscitis typically achieves a better prognosis, shorter hospitalization period, and subsequent significant improvement in kyphotic deformity and quality of life.

Early recognition of this critical infection and early initiation of appropriate antibiotic treatment by surgical intervention or drainage is essential.

Here we investigated interfacial reactions and interdiffusion of titanium/gold ohmic contacts with a tin-doped single-crystal β-Ga2O3 (010) substrate. After annealing at 470 °C for 1 min in N2 to form an ohmic contact, we studied the interface via scanning transmission electron microscopy and transmission electron microscopy with energy dispersive X-ray spectroscopy as well as electron energy loss spectroscopy. At the interface, annealing causes Ti to diffuse and oxidize, reducing Ga2O3 at the interface. This forms a defective β-Ga2O3 layer of 3-5 nm that has a relatively high Ti concentration. Above this is a 3-5 nm layer of Ti-TiOx that is partially lattice matched to the β-Ga2O3 substrate. The thermodynamic favorability of these redox reactions was explained by calculating Gibbs free energies of the reactions. In addition, the anneal causes interdiffusion of Ti and Au, until Au is in contact with the thin Ti-TiOx layer. A layer of Ti-rich nanocrystals, around 5 nm in diameter, is formed within the Au-Ti intermixed matrix, about 3 nm above the Ti-TiOx layer. Based on these observations, the ohmic properties are tentatively attributed to the interdiffusion of Ti and Au and the resulting thin Ti-TiOx layer, which helps band alignment. In addition, lattice matching of the defective Ga2O3 and Ti-TiOx layers to β-Ga2O3 facilitates the transport of carriers. A physical understanding of Ti/Au metallization can provide insights into future materials selection for thermally stable contacts in β-Ga2O3 power devices.