Multidisciplinary management of pyogenic spondylodiscitis: epidemiological and clinical features, prognostic factors and long-term outcomes in 207 patients

Pola, Enrico; Taccari, Francesco; Autore, Giovanni; Giovannenze, Francesca; Pambianco, Virginia; Cauda, Roberto; Maccauro, Giulio; Fantoni, Massimo

doi:10.1007/s00586-018-5598-9

Cited by 84 publications

(137 citation statements)

References 21 publications

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“…In addition, specific parameters for the treatment of individual grades of severity can be determined in a clinical pathway [30]. Furthermore, the organizing and optimization of treatment remain in the scientific focus and form the basis of stage-appropriate spondylodiscitis therapy by means of classification [31, 32].…”

Section: Resultsmentioning

confidence: 99%

SponDT (Spondylodiscitis Diagnosis and Treatment): spondylodiscitis scoring system

et al. 2019

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Background Spondylodiscitis is a chameleon among infectious diseases due to the lack of specific symptoms with which it is associated. It is nevertheless a serious infection, with 7% mortality of hospitalized patients, in large part because of delayed diagnosis. The aim of this study was to develop a diagnosis and course-of-disease index to optimize its treatment. Material and methods Through analysis of 296 patients between January 1998 and December 2013, we developed a scoring system for spondylodiscitis, which we term SponDT (Spondylodiscitis Diagnosis and Treatment) based on three traits: (1) the inflammatory marker C-reactive protein (CRP) (mg/dl), (2) pain according to a numeric rating scale (NRS) and (3) magnetic resonance imaging (MRI), to monitor its progression following treatment. Results The number of patients receiving treatment increased over the past 15 years of our study. We also found an increasing age of patients at the point of diagnosis across the study, with an average age of 67.7 years. In 34% of patients, spondylodiscitis developed spontaneously. Almost 70% of them did not receive treatment until the first diagnosis using SponDT. Following treatment against spondylodiscitis, pain intensity decreased from 6.0 to 3.1 NRS. The inflammatory markers also decreased (CRP from 119.2 to 46.7 mg/dl). Similarly, MRI revealed a regression in inflammation following treatment. By employing SponDT, patients were diagnosed and entered into treatment with a score of 5.6 (severe spondylodiscitis) and discharged with a score of 2.4 (light/healed spondylodiscitis). Conclusion SponDT can be used to support the diagnosis of spondylodiscitis, particularly in patients suffering from back pain and elevated levels of inflammation, and can be used during the course of treatment to optimize control of therapy. Level of evidence IIa—evidence from at least one well-designed controlled trial which is not randomized

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Section: Resultsmentioning

confidence: 99%

SponDT (Spondylodiscitis Diagnosis and Treatment): spondylodiscitis scoring system

et al. 2019

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“…Spondylodiscitis represents a diagnostic challenge, often characterized by diagnostic delay since the clinical presentation often lacks in specific signs and symptoms, with a subacute or chronic presentation. [2829]…”

Section: Discussionmentioning

confidence: 99%

Treatment algorithm for spontaneous spinal infections: A review of the literature

Gregori

Grasso

Iaiani

et al. 2019

J Craniovert Jun Spine

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Background: Primary spinal infections are rare pathologies with an estimated incidence of 5% of all osteomyelitis. The diagnosis can be challenging and this might result in a late identification. The etiological diagnosis is the primary concern to determine the most appropriate treatment. The aim of this review article was to identify the importance of a methodological attitude toward accurate and prompt diagnosis using an algorithm to aid on spinal infection management. Methods: A search was done on spinal infection in some databases including PubMed, ISI Web of Knowledge, Google Scholar, Ebsco, Embasco, and Scopus. Results: Literature reveals that on the basis of a clinical suspicion, the diagnosis can be formulated with a rational use of physical, radiological, and microbiological examinations. Microbiological culture samples can be obtained by a percutaneous computed tomography-guided procedure or by an open surgical biopsy. When possible, the samples should be harvested before antibiotic treatment is started. Indications for surgical treatment include neurological deficits or sepsis, spine instability and/or deformity, presence of epidural abscess and failure of conservative treatment. Conclusion: A multidisciplinary approach involving both a spinal surgeon and an infectious disease specialist is necessary to better define the treatment strategy. Based on literature findings, a treatment algorithm for the diagnosis and management of primary spinal infections is proposed.

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“…The role of serum galactomannan (SG) in vertebral aspergillosis is still debated 79 , whereas the PCR on bone samples has not been validated yet, although it could be useful in the case of non-diagnostic culture and histology. Clinical presentation does not recognize any pathognomonic symptom or sign, as well as in pyogenic spondylodiscitis 97,98 . Back pain and neurological deficits are commonly reported by patients at the time of hospitalization, affecting the chances for a correct diagnosis 99 .…”

Section: Diagnosismentioning

confidence: 99%

Spontaneous Vertebral Aspergillosis, the State of Art: A Systematic Literature Review

Perna

Ricciardi²,

Fantoni

et al. 2021

Neurospine

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Objective Vertebral aspergillosis is quite rare conditions, often misdiagnosed, that requires long-term antibiotic therapy, and sometimes, surgical treatments. The present investigations were aimed to investigate the epidemiology, clinical-radiological aspects, treatment protocols, and outcomes of Aspergillus-mediated vertebral osteomyelitis. Methods A systematic review of the pertinent English literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. The research was conducted on Cochrane library, MEDLINE, PubMed, and Scopus using as search-terms “Aspergillus,” “vertebral osteomyelitis,” “spondylodiscitis,” “spine infection.” A case of vertebral aspergillosis conservatively managed was also reported. Results Eighty-nine articles were included in our systematic review. Including the reported case, our analysis covered 112 cases of vertebral aspergillosis. Aspergillus fumigatus was isolated in 68 cases (61.2%), Aspergillus flavus in 14 (12.6%), Aspergillus terreus in 4 (3.6%), Aspergillus nidulans in 2 (1.8%). Seventy-three patients (65.7%) completely recovered at the last follow-up evaluation; in 7 patients (6.3%) radiological signs of chronic infection were reported, whereas 32 patients (28.8%) died during the follow-up. Conclusion This systematic review summarized the state of the art on vertebral aspergillosis, retrieving data on clinical features, diagnostic criteria and current limitations, treatment alternatives, and their outcomes.

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Multidisciplinary management of pyogenic spondylodiscitis: epidemiological and clinical features, prognostic factors and long-term outcomes in 207 patients

Cited by 84 publications

References 21 publications

SponDT (Spondylodiscitis Diagnosis and Treatment): spondylodiscitis scoring system

SponDT (Spondylodiscitis Diagnosis and Treatment): spondylodiscitis scoring system

Treatment algorithm for spontaneous spinal infections: A review of the literature

Spontaneous Vertebral Aspergillosis, the State of Art: A Systematic Literature Review

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