Spinal infections: evolving concepts

Kourbeti, Irene S.; Tsiodras, Sotirios; Boumpas, Dimitrios T.

doi:10.1097/bor.0b013e3282ff5e66

Cited by 48 publications

(42 citation statements)

References 146 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The optimal duration of antibiotics use remains controversial because no randomized clinical trial comparing short with longer treatment course has been undertaken. However, Asamoto [1] reported that 2 months use of antibiotics after normalization of laboratory data was sufficient, and Kourbeti [9] suggested 6-8 weeks minimum up to 3 months antibiotic treatment. Previously reported incidence of paralysis in patients with pyogenic spondylitis are relatively low: 5.2% [12], 7.1% [3], 8% [8], 9.5% [18], and 18% [13].…”

Section: Discussionmentioning

confidence: 99%

Pyogenic spondylitis in the elderly: a report from Japan with the most aging society

et al. 2010

View full text Add to dashboard Cite

Pyogenic spondylitis can be life-threatening for elderly patients. To discuss the characteristics of the disease in the elderly, medical records of 103 consecutive cases of pyogenic spondylitis were reviewed. Of these, 45 cases were 65 years of age or older, and these 45 cases were enrolled into further study. In this study, the proportion of elderly patients among the total number with pyogenic spondylitis was 43.7%, and this figure has increased with the passing of time as follows: 37.5% (1988-1993), 44.4% (1994-1999), and 55.5% (2000)(2001)(2002)(2003)(2004)(2005). The microorganisms were isolated in 16 cases: Staphylococcus aureus in 13 cases (including methicillin-resistant Staphylococcus aureus in nine) and others in three. Twenty-five patients had associated diseases: diabetes in 18 patients and malignant tumors in seven. Thirty patients were treated conservatively, and 15 patients underwent surgery. Twenty-six patients had paralysis. All 15 patients treated surgically, and eight of the 11 patients treated conservatively showed improvement in paralysis. Bone union was achieved in all cases except one. Our results indicate that a good outcome can be expected from conservative treatment in elderly patients as well as the young.

show abstract

Section: Discussionmentioning

confidence: 99%

Pyogenic spondylitis in the elderly: a report from Japan with the most aging society

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Skeletal involvement is present in 1-3% of affected individuals and, of these, half have spinal involvement [2,3]. Spinal tuberculosis was described in 1779 by Percival Pott as ''…that kind of palsy of lower limbs which is frequently found to accompany a curvature of the spine'' [4]; nowadays, it is considered a disease of children in developing nations and elderly in the industrialized world.…”

Section: Diagnostic Imaging (Figs 1 2 3)mentioning

confidence: 99%

“…Spinal tuberculosis was described in 1779 by Percival Pott as ''…that kind of palsy of lower limbs which is frequently found to accompany a curvature of the spine'' [4]; nowadays, it is considered a disease of children in developing nations and elderly in the industrialized world. Tuberculosis has a predilection for the thoracic vertebrae, with only 3-5% of spinal infections located in the cervical or lumbar regions [2].…”

Section: Diagnostic Imaging (Figs 1 2 3)mentioning

confidence: 99%

“…Documented history of tuberculosis with involvement of posterior vertebral elements and presence of psoas abscesses is almost pathognomonic of spinal tuberculosis even when lacking positive cultures [10]. Purified protein derivative (PPD) testing should be performed in all suspected patients, but a positive result does not confirm the diagnosis, and false-negative results in extrapulmonary disease may approach 30% [2]. Polymerase chain reaction (PCR) is valuable where available, but sensitivity for non-respiratory specimens varies.…”

Section: Diagnostic Imaging (Figs 1 2 3)mentioning

confidence: 99%

“…Polymerase chain reaction (PCR) is valuable where available, but sensitivity for non-respiratory specimens varies. Antitubercular antibodies by enzyme-linked immunosorbent assay (ELISA) may be sought if molecular techniques are unavailable [2]. MRI is the most useful diagnostic tool for typical and atypical spinal tuberculosis; it affords detection of the disease several months earlier than conventional methods, provides greater detail of soft tissue and disc, and allows better visualization of posterior vertebral elements [1].…”

Section: Diagnostic Imaging (Figs 1 2 3)mentioning

confidence: 99%

See 2 more Smart Citations

Posterior listhesis of a lumbar vertebra in spinal tuberculosis

Kirkman

Sridhar²

2010

Eur Spine J

View full text Add to dashboard Cite

The management of spinal tuberculosis, especially in children, is controversial. In children, vertebral destruction is more severe than adults because of the cartilaginous nature of their bone. Modern chemotherapy has significantly decreased mortality in spinal tuberculosis, but morbidity remains high. Without early surgery, patients can develop severe kyphosis leading to respiratory insufficiency, painful costopelvic impingement and paraplegia. Lumbar kyphosis results in early degenerative lumbar canal stenosis and is cosmetically unacceptable. We report a paediatric case of atypical spinal tuberculosis demonstrating the need for early surgical intervention to prevent significant spinal instability and neurologic deficit. A 12-year-old girl presented with increasing ambulatory difficulty and double incontinence 4 months after initiating treatment for pulmonary tuberculosis. There was no history of traumatic injury. Examination revealed severe lower limb neurologic deficit, with hypotonia, areflexia, marked sensory loss, and grade 0/5 power in both lower limbs. Plain radiographs and magnetic resonance imaging (MRI) demonstrated grade IV posterior listhesis of the L2 vertebral body over L3, cauda equina compression and bilateral psoas abscesses. Erosion of both the body and pedicle of L2 was observed. Both serology and pus drained from the psoas abscesses were negative for microorganisms. The patient underwent an L2 vertebrectomy via a left retroperitoneal approach. A titanium cage packed with autologous bone graft was inserted, and the spine was stabilized by fixation with screw and rods. Histopathology confirmed a diagnosis of tuberculosis. Eighteen months following the procedure, the patient has regained some power in her right leg and has completed her course of anti-tuberculous chemotherapy, but remains wheelchair-bound. To our knowledge, this is the first reported case of posterior listhesis secondary to spinal tuberculosis. Here, we discuss the possible management options in such a case, and the indications for surgery. As the global HIV/AIDS epidemic causes a resurgence in tuberculosis, increased awareness among the medical community regarding the atypical presentations of spinal tuberculosis is necessitated; both in the developing world where advanced clinical presentations are common, and in the developed world where spinal tuberculosis is an oftenneglected diagnosis.

show abstract