Espondilodiscitis infecciosa espontánea en un servicio de medicina interna: estudio epidemiológico y clínico de 41 casos

Hernández, Pedro Luis Martínez; López, Manuel Fernández; Vargas, Fachin; Paso, P. García De; Francisco, Carolina Navarro-San; Fernández, Elia Pérez; Lozano, Fidel; Muñoz, E. Vázquez

doi:10.1157/13124314

Cited by 13 publications

(8 citation statements)

References 20 publications

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“…Subacute spondylodiscitis, a relatively uncommon clinical scenario, is becoming more common because of aging and higher incidence of bacteremia and sepsis episodes following use of invasive diagnostic and treatment methods [13,21]. The onset of symptoms usually is insidious, with persistent back or neck pain being the most common presenting complaint [6,7].…”

Section: Discussionmentioning

confidence: 99%

“…Spondylodiscitis accounts for 0.15%–5% of all cases of osteomyelitis [1,3-5]. The incidence of nontuberculosis, nonpostoperative spondylodiscitis has been estimated previously to be 2.2–2.4 cases per 100,000 person-years [7,8,10-13] and is increasing mainly due to an increasing elderly population [7,8,10,13]. The onset of symptoms usually is insidious, with back or neck pain.…”

Section: Introductionmentioning

confidence: 99%

“…Staphylococcus aureus is the most frequent causative microorganism, accounting for approximately half of the cases of bacterial spondylodiscitis and also is predominant in iatrogenic spondylodiscitis. In approximately one-third of patients with pyogenic spondylodiscitis, the infectious agent never is identified, which may increase up to 44% in iatrogenic cases by direct inoculation [5,13,14]. Due to the nonjudicious use of antibiotics in the Indian subcontinent, the low grade pyogenic spine infections may present in subacute or chronic phase as a nonrelieving backache.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Challenges in Diagnosis of Spontaneous Subacute Pyogenic Spondylodiscitis in Immunocompetent Patients: Experiences from a Tertiary Care Center

et al. 2019

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Study Design Prospective clinical study. Purpose We evaluated the challenges faced during diagnosis and management of patients with subacute pyogenic discitis and discussed various clues in clinical history, radiologic and hematologic parameters of these patients that helped in establishing their diagnosis. Overview of Literature Present literature available shows that in patients with subacute spondylodiscitis and infection with less virulent organisms, the clinical picture often is confusing and the initial radiologic and hematologic studies do not contribute much toward establishing the diagnosis. Methods Demographic pattern, predisposing factors, clinical presentation, comorbidities, microbiology, treatment, neurologic recovery, and complications of 11 patients were prospectively reviewed regarding their contribution toward the conformation of diagnosis of subacute pyogenic discitis. Results Mean age at presentation was 46.0 years with average preoperative Oswestry Disability Index and Visual Analog Scale scores of 83.4 and 7.18, respectively. Mean follow-up duration was 12.0 months. The most common site of infection was the lumbar spine, followed by the thoracic spine (n=1). Infective organisms were isolated in only 45% of cases. Staphylococcus aureus was the most common causative organism isolated. Conclusions Diagnosing subacute spondylodiscitis in a patient presenting with subacute low backache poses a diagnostic challenge. Clinical and radiologic picture are deceiving, and bacteriologic results often are negative, further complicating the picture. A detailed medical history along with clinical, radiologic, and biochemical parameters prevents missing the diagnosis. Serial serum Creactive protein and alkaline phosphatases were more reliable blood parameters in cases of subacute presentation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of Challenges in Diagnosis of Spontaneous Subacute Pyogenic Spondylodiscitis in Immunocompetent Patients: Experiences from a Tertiary Care Center

et al. 2019

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“…Pyogenic spondylodiscitis is a challenging medical disease with poor prognosis that requires immediate diagnosis and treatment with suitable antibiotics [ 1 ]. In recent years, an increased incidence of pyogenic spinal infections has been associated with immunocompromised status, advanced age, invasive medical procedures, and underlying medical comorbidities [ 2 , 3 ]. Surgical intervention is indicated when non-surgical treatment fails, neurologic deficit develops, or tissue biopsy is required.…”

Section: Introductionmentioning

confidence: 99%

Comparison of two-stage open versus percutaneous pedicle screw fixation in treating pyogenic spondylodiscitis

Lin

Tsai

et al. 2014

BMC Musculoskelet Disord

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BackgroundPercutaneous pedicle screw instrumentation is a minimally invasive surgical technique; however, the effects of using percutaneous pedicle screw fixation in treating patients with spinal infections have not yet been well demonstrated. The aim of this study, therefore, was to determine whether percutaneous posterior pedicle screw instrumentation is superior to the traditional open approach in treating pyogenic spondylodiscitis.MethodsWe retrospectively reviewed data for 45 patients treated for pyogenic spondylodiscitis with anterior debridement and interbody fusion followed by a second-stage procedure involving either traditional open posterior pedicle screw fixation or percutaneous posterior pedicle screw fixation. Twenty patients underwent percutaneous fixation and 25 patients underwent open fixation. Demographic, operative, and perioperative data were collected and analyzed.ResultsThe average operative time for the percutaneous procedure was 102.5 minutes, while the average time for the open procedure was 129 minutes. The average blood loss for the percutaneous patients was 89 ml versus a 344.8 ml average for the patients in the open group. Patients who underwent the minimally invasive surgery had lower visual analogue scale scores and required significantly less analgesia afterwards. After two years of follow-up, neither recurrent infection nor intraoperative complications, such as wound infection or screw loosening, were found in the percutaneous group. Moreover, there was no significant difference in outcome between the two groups in terms of Oswestry Disability Index scores.ConclusionsAnterior debridement and interbody fusion with bone grafting followed by minimally invasive percutaneous posterior instrumentation is an alternative treatment for pyogenic spondylodiscitis which can result in less intraoperative blood loss, shorter operative time, and reduced postoperative pain with no adverse effect on infection control.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-443) contains supplementary material, which is available to authorized users.

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“…The incidence of pyogenic spinal infections is increasing over the last few years and is associated with immunocompromised status, advanced age, invasive medical procedures, and underlying medical comorbidities [3, 4]. Pyogenic spondylodiscitis has a mortality rate up to 5% and a morbidity rate more than 7% [5].…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive spine surgery in the treatment of pyogenic spondylodiscitis: an initial retrospective series study

Yuan

Gong

2019

wiitm

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Introduction Pyogenic spondylodiscitis is a bacterial infection affecting the intervertebral disc and its adjacent vertebrae. Although relatively rare, it is a challenging medical disease with a poor prognosis that requires immediate diagnosis and treatment with suitable antibiotics. Aim To evaluate the clinical outcome of minimally invasive spine surgery (MIS) for pyogenic spondylodiscitis. Material and methods The retrospective study cohort consisted of 10 consecutive patients who had undergone MIS decompression and/or discectomy for thoracic or lumbar pyogenic spondylodiscitis in our hospital. Data including patient characteristics, symptoms, visual analog scale (VAS) score, surgical approach and postoperative outcomes were obtained for retrospective analysis. Results Between January 2005 and December 2013, 10 patients underwent MIS decompression in the Department of Orthopedics in our medical university. Seven of these patients had lumbar infections and 3 had thoracic infections. All 10 patients had improved VAS scores immediately after surgery and after discharge. The VAS score (respectively on postoperative day 1 and day 7) suggested that the patients in this study had significantly less pain than preoperatively (day 1: 5 vs. 9, p < 0.001; day 7: 2.9 vs. 9, p < 0.001). The organism was obtained in 10 (100%) patients by the operative cultures. All patients achieved an excellent clinical recovery without the need for further spine surgery. All patients underwent postoperative imaging during follow-up and showed complete resolution or dramatically improved magnetic resonance imaging changes. Conclusions Minimally invasive spine surgery is a safe and effective surgical approach for pyogenic spondylodiscitis.

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Espondilodiscitis infecciosa espontánea en un servicio de medicina interna: estudio epidemiológico y clínico de 41 casos

Cited by 13 publications

References 20 publications

Evaluation of Challenges in Diagnosis of Spontaneous Subacute Pyogenic Spondylodiscitis in Immunocompetent Patients: Experiences from a Tertiary Care Center

Evaluation of Challenges in Diagnosis of Spontaneous Subacute Pyogenic Spondylodiscitis in Immunocompetent Patients: Experiences from a Tertiary Care Center

Comparison of two-stage open versus percutaneous pedicle screw fixation in treating pyogenic spondylodiscitis

Minimally invasive spine surgery in the treatment of pyogenic spondylodiscitis: an initial retrospective series study

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