Management of Pyogenic Spinal Infection, review of literature

Aljawadi, Ahmed; Jahangir, Noman; Jeelani, Ana; Ferguson, Zak; Niazi, Noman; Arnall, Frances; Pillai, Anand

doi:10.1016/j.jor.2019.08.014

Cited by 27 publications

(39 citation statements)

References 35 publications

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“…Although it is very difficult to differentiate the common mechanical back pain from a spinal infection, spondylodiscitis should always be investigated in febrile patients with back pain [1]. However, although fever is a common symptom, it is not always present; approximately 50% of the patients with pyogenic spine infections, and even in a higher percentage of patients with fungal, mycobacterial, and brucellar infections are afebrile [3].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…In rare cases, where the infection has significantly spread and affected a major part of the anterior spinal column, a longer period of bed rest, up to six weeks, could be necessary [1]. However, a long immobilization period is associated with increased morbidity, especially in elderly patients, in whom the risk for certain complications such as pressure ulcers, pulmonary embolism, or respiratory tract infections is high [3]. In cases of cervical spine infections, immobilization can be obtained with a neck collar or with a halo-vest in more advanced cases with extensive bone destruction.…”

Section: Conservative Treatment Antibioticsmentioning

confidence: 99%

“…Antibiotics therapy can be discontinued when clinical improvement with resolution of symptoms is evident, and the inflammatory markers are normalized [3]. However, in spinal infections caused by Brucella or Mycobacterium tuberculosis, a longer antibiotic treatment is required.…”

Section: Conservative Treatment Antibioticsmentioning

confidence: 99%

“…Last, infections can develop due to direct inoculation of the culprit microorganism during surgery or following local trauma (surgery or injury). The risk for postoperative infection following spinal surgery varies because it depends on many factors, importantly the type of the spinal procedure; the overall incidence of postoperative spinal infection is estimated from 0% to 18% [3]. In the last scenario the infection is also called secondary, as opposed to primary spinal infection that occurs without any previous history of trauma [3].…”

Section: Introductionmentioning

confidence: 99%

“…The risk for postoperative infection following spinal surgery varies because it depends on many factors, importantly the type of the spinal procedure; the overall incidence of postoperative spinal infection is estimated from 0% to 18% [3]. In the last scenario the infection is also called secondary, as opposed to primary spinal infection that occurs without any previous history of trauma [3]. This article aims to summarize and critically examine the current evidence for spinal infections in a comprehensive review that the curious reader may find interesting and educative.…”

Section: Introductionmentioning

confidence: 99%

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Spinal Infections: An Update

et al. 2020

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Spinal infection poses a demanding diagnostic and treatment problem for which a multidisciplinary approach with spine surgeons, radiologists, and infectious disease specialists is required. Infections are usually caused by bacterial microorganisms, although fungal infections can also occur. The most common route for spinal infection is through hematogenous spread of the microorganism from a distant infected area. Most patients with spinal infections diagnosed in early stages can be successfully managed conservatively with antibiotics, bed rest, and spinal braces. In cases of gross or pending instability, progressive neurological deficits, failure of conservative treatment, spinal abscess formation, severe symptoms indicating sepsis, and failure of previous conservative treatment, surgical treatment is required. In either case, close monitoring of the patients with spinal infection with serial neurological examinations and imaging studies is necessary.

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Section: Clinical Presentationmentioning

confidence: 99%

Section: Conservative Treatment Antibioticsmentioning

confidence: 99%

Section: Conservative Treatment Antibioticsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Spinal Infections: An Update

et al. 2020

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Spinal infection with intraspinal abscess or empyema and acute myelopathy: comparative analysis of diagnostics, therapy, complications and outcome in primary care

Kreutzträger

Lübstorf

Blex

et al. 2022

Eur J Trauma Emerg Surg

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Introduction This study on pyogenic spinal infections with intraspinal epidural involvement (PSI +) compared the outcome of patients with spinal cord injury (SCI) to those without (noSCI) taking diagnostic algorithm, therapy, and complications into account. Methods Patients were enrolled in an ambispective study (2012–2017). Diagnostic and therapeutic algorithms, complications, and neurological outcome were analyzed descriptively. Survival was analyzed applying Kaplan–Meier method and Cox regression. Results In total, 134 patients with a median (IQR) age of 72 (61–79) years were analyzed. Baseline characteristics were similar between the SCI (n = 55) and noSCI (n = 79). A higher percentage of endocarditis (9% vs. 0%; p = 0.03) was detected in the noSCI group. The majority (81%) received combinatorial therapy including spinal surgery and antibiotic treatment. The surgery complication rate was 16%. At discharge, improvement in neurologic function was present in 27% of the SCI patients. Length of stay, duration of ventilation and the burden of disease-associated complications were significantly higher in the SCI group (e.g., urinary tract infection, pressure ulcers). Lethality risk factors were age (HR 1.09, 95% CI 1.02–1.16, p = 0.014), and empyema/abscess extension (≥ 3 infected spinal segments, HR 4.72, 95% CI 1.57–14.20, p = 0.006), dominating over additional effects of Charlson comorbidity index, SCI, and type of treatment. The overall lethality rate was 11%. Conclusion PSI + are associated with higher in-hospital mortality, particularly when multiple spinal segments are involved. However, survival is similar with (SCI) or without myelopathy (noSCI). If SCI develops, the rate of disease complications is higher and early specialized SCI care might be substantial to reduce complication rates.

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