Primary Pyogenic Infection of the Spine in Intravenous Drug Users

Wang, Zhi; Lenehan, Brian; Itshayek, Eyal; Boyd, Michael; Dvorak, Marcel F.; Fisher, Charles; Kwon, Brian K.; Paquette, Scott; Street, John

doi:10.1097/brs.0b013e31823b01b8

Cited by 49 publications

(67 citation statements)

References 25 publications

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“…Concomitant surgical stabilization is [28,36,[44][45][46]. The two studies focusing on immunosuppressed patients described that surgical treatment in HIV patients is not associated with more complications, while early hardware failure was more common in surgically treated IVDUs [33,47].…”

Section: Discussionmentioning

confidence: 99%

“…Solely percutaneous posterior procedures could be a good alternative in patients with multiple morbidities [56,57]. Surgical treatment of spondylodiscitis could be more complex in specific patient groups, for example, in IVDUs where early hardware failure and surgical site infections were more common [47]. Interestingly surgical treatment in HIV patients is not related with higher complication rates [33].…”

Section: Discussionmentioning

confidence: 99%

“…Sobottke et al retrospectively compared surgical with systemic antibiotics therapy alone in HIV patients and found no statistically increased complication or relapse rate in the surgically treated patients [33]. Wang et al prospectively compared the outcome of spondylodiscitis in intravenous drug users (IVDUs) and nonIVDUs [47]. A higher percentage of hardware failure and a longer hospital stay was found in de IVDU groups; however, a higher in-hospital mortality was found in the non-IVDU group (Table 9).…”

Section: Treatment Of Hiv and Ivdu Patientsmentioning

confidence: 99%

“…Two studies focused on the treatment of specific patient groups [33,47]. Sobottke et al retrospectively compared surgical with systemic antibiotics therapy alone in HIV patients and found no statistically increased complication or relapse rate in the surgically treated patients [33].…”

Section: Treatment Of Hiv and Ivdu Patientsmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Treatment Of Hiv and Ivdu Patientsmentioning

confidence: 99%

Section: Treatment Of Hiv and Ivdu Patientsmentioning

confidence: 99%

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

et al. 2015

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“…Moreover, only 2 cases were associated with intravenous drug abuse. 56 Crohn's disease, uncontrolled diabetes mellitus, hepatitis, and rheumatoid arthritis were present in 7 of 19 cases.…”

Section: Discussionmentioning

confidence: 99%

Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques

Smith

Kochar

Manjila

et al. 2014

FOC

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Despite the increasing prevalence of spinal infections, the subcategory of holospinal epidural abscesses (HEAs) is extremely infrequent and requires unique management. Panspinal imaging (preferably MRI), modern aggressive antibiotic therapy, and prompt surgical intervention remain the standard of care for all spinal axis infections including HEAs; however, the surgical decision making on timing and extent of the procedure still remain ill defined for HEAs. Decompression including skip laminectomies or laminoplasties is described, with varied clinical outcomes. In this review the authors present the illustrative cases of 2 patients with HEAs who were treated using skip laminectomies and epidural catheter irrigation techniques. The discussion highlights different management strategies including the role of conservative (nonsurgical) management in these lesions, especially with an already identified pathogen and the absence of mass effect on MRI or significant neurological defects. Among fewer than 25 case reports of HEA published in the past 25 years, the most important aspect in deciding a role for surgery is the neurological examination. Nearly 20% were treated successfully with medical therapy alone if neurologically intact. None of the reported cases had an associated cranial infection with HEA, because the dural adhesion around the foramen magnum prevented rostral spread of infection. Traditionally a posterior approach to the epidural space with irrigation is performed, unless an extensive focal ventral collection is causing cord compression. Surgical intervention for HEA should be an adjuvant treatment strategy for all acutely deteriorating patients, whereas aspiration of other infected sites like a psoas abscess can determine an infective pathogen, and appropriate antibiotic treatment may avoid surgical intervention in the neurologically intact patient.

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