Cervical spondylodiscitis: change in clinical picture and operative management during the last two decades. A series of 50 patients and review of literature

Shousha, Mootaz; Heyde, Christoph E.; Boehm, Heinrich

doi:10.1007/s00586-014-3672-5

Cited by 46 publications

(44 citation statements)

References 23 publications

(41 reference statements)

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“…There seems to be a strong publication bias in favor of surgical treatment. This phenomenon was also observed in the 16 abstracts of scientific conferences found in our literature search [8,[54][55][56][60][61][62][63][64][65][66][67][68][69][70][71]. Nine of the 16 abstracts are focusing purely on surgical strategies, whereas only three on the antibiotics treatment were found.…”

Section: Future Researchsupporting

confidence: 65%

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

et al. 2015

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Background Spondylodiscitis is a spinal infection affecting primarily the intervertebral disk and the adjacent vertebral bodies. Currently many aspects of the treatment of pyogenic spondylodiscitis are still a matter of debate. Purpose The aim of this study was to review the currently available literature systematically to determine the outcome of patients with pyogenic spondylodiscitis for conservative and surgical treatment strategies. Methods A systematic electronic search of MEDLINE, EMBASE, Cochrane Collaboration, and Web of Science regarding the treatment of pyogenic spondylodiscitis was performed. Included articles were assessed on risk of bias according the Cochrane Handbook for Systematic Reviews of Interventions, and the quality of evidence and strength of recommendation was evaluated according the GRADE approach. Results 25 studies were included. Five studies had a high or moderate quality of evidence. One RCT suggest that 6 weeks of antibiotic treatment of pyogenic spondylodiscitis results in a similar outcome when compared to longer treatment duration. However, microorganism-specific studies suggest that at least 8 weeks of treatment is required for S. aureus and 8 weeks of Daptomycin for MRSA. The articles that described the outcome of surgical treatment strategies show that a large variety of surgical techniques can successfully treat spondylodiscitis. No additional long-term beneficial effect of surgical treatment could be shown in the studies comparing surgical versus antibiotic only treatment. Conclusion There is a strong level of recommendation for 6 weeks of antibiotic treatment in pyogenic spondylodiscitis although this has only been shown by one recent RCT. If surgical treatment is indicated, it has been suggested by two prospective studies with strong level of recommendation that an isolated anterior approach could result in a better clinical outcome.

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Section: Future Researchsupporting

confidence: 65%

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

et al. 2015

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“…7,8 Considering both degenerative and non degenerative cases in our study, cervical spondylodiscitis accounted for only (13/721) 1.8% cases which showed it as uncommon cause of cervical pain. We encountered diffuse marrow signal change in 5 (4.13%) patients.…”

Section: Jcms Nepal 2015;11(4):20-23 Prediction Of Outcome Of Acute Bmentioning

confidence: 54%

Non degenerative disease in MRI cervical spine of symptomatic patients

Karki

Panta

Gurung³

2016

J Coll Med Sci-Nepal

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Background & Objectives: The most common etiology of neck pain is degenerative disc disease, however non-degenerative disease can be important cause of neck pain. This study aims to study the non-degenerative findings in cervical MRI in symptomatic patients with neck and radicular pain.Materials & Methods: The study was a institutional record based retrospective study performed for the duration of 3 years. MRI performed for patients with neck pain and/ or radiculopathy were reviewed. Patients with post operative findings were excluded from the study. Statistical analysis was done using SPSS 21.0.Results: A total of 721 MRI were performed for neck pain and radiculopathy, among which 91 (12.13%) cases had non-degenerative changes. Most common non degenerative change was traumatic lesions followed by neoplastic lesions and syrinx. Traumatic lesions were more common in males as compared to females. Infection was more common in females as compared to males. C5 and C6 vertebrae were most common vertebra involved in trauma and infection. Some cases like signal change in spinal cord, and syrinx were also noted in our study.Conclusion: Non degenerative cause of neck pain were less common but important cause of neck pain. Traumatic lesions were the most common cause of non degenerative neck pain.Journal of College of Medical Sciences-Nepal, Vol.11(4) 2015: 20-23

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“…Regarding the formation of epidural abscess from an underlying osteodiscitis, guidance regarding urgent treatment is limited to class III evidence in the literature and no clear statistical benefit has been shown with early versus delayed (>24 hours) surgical evacuation of a cervical spinal infection treatment due to very small populations of study. 16-22 …”

Section: Discussionmentioning

confidence: 99%

Anterior Cervical Infection: Presentation and Incidence of an Uncommon Postoperative Complication

Ghobrial

Sasso

Tannoury

et al. 2017

Global Spine Journal

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Study Design:Retrospective multi-institutional case series.Objective:The anterior cervical discectomy and fusion (ACDF) affords the surgeon the flexibility to treat a variety of cervical pathologies, with the majority being for degenerative and traumatic indications. Limited data in the literature describe the presentation and true incidence of postoperative surgical site infections.Methods:A retrospective multicenter case series study was conducted involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network, selected for their excellence in spine care and clinical research infrastructure and experience. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify the occurrence of 21 predefined treatment complications. Patients who underwent an ACDF were identified in the database and reviewed for the occurrence of postoperative anterior cervical infections.Results:A total of 8887 patients were identified from a retrospective database analysis of 21 centers providing data for postoperative anterior cervical infections (17/21, 81% response rate). A total of 6 postoperative infections after ACDF were identified for a mean rate of 0.07% (range 0% to 0.39%). The mean age of patients identified was 57.5 (SD = 11.6, 66.7% female). The mean body mass index was 22.02. Of the total infections, half were smokers (n = 3). Two patients presented with myelopathy, and 3 patients presented with radiculopathic-type complaints. The mean length of stay was 4.7 days. All patients were treated aggressively with surgery for management of this complication, with improvement in all patients. There were no mortalities.Conclusion:The incidence of postoperative infection in ACDF is exceedingly low. The management has historically been urgent irrigation and debridement of the surgical site. However, due to the rarity of this occurrence, guidance for management is limited to retrospective series.

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Cervical spondylodiscitis: change in clinical picture and operative management during the last two decades. A series of 50 patients and review of literature

Abstract: Cervical spondylodiscitis has increased and became more aggressive. While radical surgical debridement, stable reconstruction together with antibiotic therapy remained a reliable approach to achieve complete healing of the inflammation, anterior alone surgery became more applicable.

Cited by 46 publications

References 23 publications

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review

Non degenerative disease in MRI cervical spine of symptomatic patients

Anterior Cervical Infection: Presentation and Incidence of an Uncommon Postoperative Complication

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