Die mehrzeitige Spondylodese

Isenberg, J.; Jubel, A.; Hahn, Ulrich; Seifert, Harald; Prokop, Aram

doi:10.1007/s00132-004-0722-4

Cited by 22 publications

(6 citation statements)

References 32 publications

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“…In short, recommendations relating to the wisdom of treating spondylodiscitis via surgical means (i.e., in addition to antibiotic therapy), remain a source of some controversy [7, 9–11]. In the present study, then, we sought to clarify this controversy by comparing the clinical outcomes of pyogenic spondylodiscitis patients treated with both early surgery and antibiotics who received surgical treatment immediate after confirming the diagnosis of spondylodiscitis at a early stage of infection with no neurological deficit and complications such as sepsis presented with those of patients treated with antibiotics only, and excluded patients treated with delayed surgery who received surgical treatment following the failure of prolonged medical management or delayed diagnosis of pyogenic spondylodiscitis presenting with neurological deficit or spinal instability with intractable back pain.…”

Section: Introductionmentioning

confidence: 99%

Early surgery with antibiotics treatment had better clinical outcomes than antibiotics treatment alone in patients with pyogenic spondylodiscitis: a retrospective cohort study

Tsai

Yang

Niu

et al. 2017

BMC Musculoskelet Disord

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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.

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Section: Introductionmentioning

confidence: 99%

Early surgery with antibiotics treatment had better clinical outcomes than antibiotics treatment alone in patients with pyogenic spondylodiscitis: a retrospective cohort study

Tsai

Yang

Niu

et al. 2017

BMC Musculoskelet Disord

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“… 8 – 10 Thus, we decided to perform a two-stage procedure. 11 – 14 First, we performed debridement and laminectomy, and thereafter, we performed anterior and posterior reconstruction and stabilization. During the second surgery, after posterior reconstruction and stabilization, anterior stabilization with an expandable cage was performed.…”

Section: Discussionmentioning

confidence: 99%

Cervical Osteomyelitis with Thoracic Myelitis and Meningitis in a Diabetic Patient

Ohnishi

Iwatsuki

Ishida

et al. 2015

Clin Med Insights Case Rep

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A 45-year-old man with a history of untreated diabetes mellitus had a persisting fever, back pain, and diarrhea. The primary care physician diagnosed the patient with the flu and gastroenteritis. The patient developed paraplegia for two weeks and was admitted to another hospital. The physician in this hospital suspected infectious meningitis and myelitis, and administered piperacillin and steroids without cerebrospinal fluid (CSF) examination. On referral to our hospital, he presented a high fever and complete paraplegia. The lumbar puncture revealed a yellowish CSF, polynucleosis, and hypoglycorrhachia. Bacteria were not detected on Gram’s staining and were not confirmed by CSF culture. Magnetic resonance imaging (MRI) showed no thoracolumbar lesion and suggested a cervical epidural abscess without any spinal cord compression. He was diagnosed as having osteomyelitis with meningitis and thoracic myelitis. The infection subsided with broad-spectrum antibiotics. After two weeks, bilateral sensorimotor disturbances of the upper extremities appeared. MRI findings showed the epidural abscess compressing the cervical spinal cord. We performed debridement of the epidural abscess. The infection was clinically controlled by using another antibiotic. One month after the infection subsided, a 360° reconstruction was performed. In this case, the misdiagnosis and the absence of CSF examination and culture to detect the pathogenic bacteria at an earlier stage in the patient’s disease course might have led to the exacerbation of the pathology.

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“…Lilienqvist et al [15] fanden in 20% (n=20) und die Arbeitsgruppe Lerner in 29% [13] und 30% [14] ihrer untersuchten Fälle thorakale Spondylodiszitiden (n=62). Isenberg et al [11] beschrieben sie bei 27% der Patienten (n=34).…”

Section: Epidemiologieunclassified

“…Auch Candida albicans und Aspergillus sind als Erreger von Spondylodiszitiden beschrieben [11]. Einige Autoren unterscheiden septische von aseptischen Spondylodiszitiden [7].…”

Section: Epidemiologieunclassified