Spondylodiscitis: early diagnosis and management of patients

Khafizova, Irina F.; Фаритовна, Хафизова Ирина; Popova, N A; Анатольевна, Попова Наталия; Panyukhov, A G; Геннадьевич, Панюхов Александр; Gumerov, F R; Робертович, Гумеров Фарид

doi:10.17750/kmj2016-988

Cited by 6 publications

(2 citation statements)

References 6 publications

(30 reference statements)

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“…In the DWI sequence, epidural and paravertebral abscesses are characterized by reduced diff usion. Fat suppression technique improves diff erentiation between bone, soft tissue components and contiguous structures [7,[24][25][26][27][28].…”

Section: Methodsmentioning

confidence: 99%

Early Imaging and Course-of-Disease Control Markers of Pyogenic Vertebral Osteomyelitis

Bohdan¹,

Plakhtyr²,

Bohdan³

2021

PSSS MS

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Background. The diagnosis of early pyogenic vertebral osteomyelitis is essential for prompt determination of treatment strategy and prevention of suppurative-destructive complications, although the nonspecifi c clinical manifestation obstructs timely disease detection. Aim. To analyse the clinical accuracy of various radiological imaging methods for early detection and control over vertebral osteomyelitis course Materials and methods. A retrospective study of standardized clinical data of patients (N = 54) who underwent treatment at the Neurosurgery Department of the MМCC WR between 2010 and 2020 was carried out. Patients were observed for 12–36 months. Study fi ndings and discussion. Our study revealed that during radiological imaging, infl ammatory changes in the vertebrae specifi c to osteomyelitis were not found in any case, which signifi cantly delays the diagnosis. The study analysed and grouped radiological signs of the infl ammatory process spread in the vertebrae in case of spondylodiscitis by CT and MR stages. Spondylodiscitis was diagnosed by CT of the spine in the late third stage only in 29.0 % of patients. Nonspecifi c destructive changes of vertebrae were detected in 51.6% of persons, which required additional MRI examination to establish the diagnosis. In 19.4% of those examined in the presence of the fi rst MR stage, no specifi c CT signs of osteomyelitis were found. MRI scan of the spine is the main specifi c (93 %), accurate (94 %) and sensitive (97 %) method for early detection of pyogenic osteomyelitis. Although according to the world literature, MRI is not sensitive enough to assess the dynamics of the infl ammatory process in the spine, the progressive increase in signal intensity of vertebral cortex on T1-weighted images within aff ected vertebrae correlates well with infl ammation resolving and C-reactive protein (CRP) level normalization. We described this radiological sign as a «vertebral rim» phenomenon (VRP). In our study, a reliable correlation was found between CRP level and the «vertebral rim» phenomenon on MRI. Conclusions. For early detection of pyogenic vertebral osteomyelitis, MRI examination is the main specifi c and sensitive method. We suggest combining the CRP level and «vertebral rim» sign in practice as dynamics of spondylodiscitis markers and justifi cation of antibacterial therapy strategy.

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Section: Methodsmentioning

confidence: 99%

Early Imaging and Course-of-Disease Control Markers of Pyogenic Vertebral Osteomyelitis

Bohdan¹,

Plakhtyr²,

Bohdan³

2021

PSSS MS

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“…Спондилодисцит -це інфекційне ураження хребта [1][2][3], при якому запальний процес поширюється на міжхребцевий диск і суміжні з ним тіла хребців, що призводить до деструкції колоїдної структури хребців і порушення опорної функції хребта. Захворювання зазвичай перебігає на тлі дегенеративно-дистрофічного процесу хребта або формується після хірургічних втручань.…”

Section: клінічні випадкиunclassified

Experience in treating patients with a combination of the descending aorta saccular aneurysm and spondylodiscitis

Тончев¹,

Muzhevska²,

Bezkorovainyy³

et al. 2021

Ukr. ìnterv. nejroradìol. hìr.

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The article presents a clinical case of treatment of a patient with spondylodiscitis of two levels – thoracic and lumbar spine spondylodiscitis combined with the thoracic aorta aneurysm. A 68-year-old patient was hospitalized in the Neurosurgical Department of the M.V. Sklifosovsky Poltava Regional Clinical Hospital in August 2019 with complaints of pain and discomfort in the thoracic and lumbar spine, shoulder joints, severe weakness in the lower extremities. The multislice computed tomography with intravenous contrast revealed a sac-like aneurysm of the descending thoracic aorta at the level of vertebrae Th4-Th5 with invasion into the vertebral bodies, spondylodiscitis of vertebrae Th4-Th5 and Th11-Th12 with deformation of the spinal axis, the formation of absolute stenosis of the spinal canal at the level of vertebrae Th11-Th12. At the first stage of the surgery, the thoracic aortic arthroplasty was performed using TAA Stent Graft System (Ankura, China) 34 × 34 × 160 mm at the M.M. Amosov National Institute of Cardiovascular Surgery and the exclusion of the descending aorta aneurysm from the bloodstream was maintained. At the second stage, transpedicular stabilization of the spine at the level of vertebrae Th10-Th11-L2-L3 was performed at the M.V. Sklifosovsky Poltava Regional Clinical Hospital using Legacy system (Medtronic, USA) and spinal cord compression was eliminated. The treatment of spondylodiscitis at the level of the vertebrae Th4-Th5 was conservative with the use of osteotropic antibacterial drugs. The patient was mobilized in the early post-surgical period after stabilization of the spine. Regression of pain syndrome and lower paraparesis was noted. Further observation was performed on an outpatient basis. According to the modified Rankin Scale, which allows assessing the degree of independence of the patient in everyday life, the patient was evaluated with 3 points at discharge. A follow-up examination at 3, 12, and 24 months showed that the functioning of the stent-graft and transpedicular system were satisfactory. The result of 0 points according to the modified Rankin Scale.Patients with the thoracic spine spondylodiscitis require special attention and additional diagnostic procedures. The risk of additional combined pathology in the form of thoracic and abdominal aorta aneurysms should be considered when planning surgical treatment.

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Investigation of Bacterial and Viral Slow Intervertebral Disc Infections

Isroilov,

Shigapov,

Murasov

et al. 2023

Russian Journal of Infection and Immunity

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Objective. Currently, few publications have been available regarding an effect of level, type of intrusion, and viral infections on spinal disc degeneration. The study was aimed to evaluate an incidence of indolent bacterial and viral intervertebral disc infections in unstratified group of patients operated on for spinal degenerative pathologies. Material and methods. For the study, intraoperative disc samples were collected from patients who underwent discectomy and total spinal fusion surgery for degenerative pathologies between the years December, 2018 to January, 2020. 447 samples were examined obtained from 392 patients (189 women and 203 men) with a mean age of 58.1 years. The following epidemiological and clinical data were collected: gender, age, spinal segments affected, type of surgical approach, preoperative C-reactive protein (CRP; reference range 0.00.5 mg/dL), and preoperative as well as 6-month postoperative ODI and NDI, both expressed as a percentage. The incidence of postoperative infections within six months after surgery as well as MI for each operated segment was assessed. Only patients with ventral cervical or dorsal thoracic access were enrolled in the study. In the lumbar region, the ventral assess was chosen for anterior lumbar interbody fusion, the lateral approach for oblique or extreme lateral interbody fusion, and the dorsal approach in case of standard microdiscectomy of posterior transforaminal interbody fusion or transforaminal interbody fusion. A logistic regression analysis was performed to model a risk of positive microbiological culture and a risk of emerging modal changes by using a set of independent variables selected in a stepwise manner by using the Akaike information criterion as a measure of quality of select procedure. Results. MRI for modal analysis was available for all 447 segments. MRI revealed 45 type 1 SCs (10.07% of all segments), 118 type 2 SCs (26.4%), and 5 type 3 SCs (1.12%). Microbiological culture was available in 410 segments. In these 410 segments, 39 type 1 MCs, 113 type 2 MCs, and 5 type 3 MCs were found. A statistically significant relationship was found between SC type 2 and a positive microbiological result (p = 0.0127). In contrast, there were no statistically significant associations for type 1 and type 3 SCs (p=0.3052 and p=0.0767, respectively). Conclusion. A relation between disc degeneration and infections seems unlikely. Histopathological evidence of inflammation in degenerated discs is rare and unrelated to microbiological findings.

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Spondylodiscitis: early diagnosis and management of patients

Cited by 6 publications

References 6 publications

Early Imaging and Course-of-Disease Control Markers of Pyogenic Vertebral Osteomyelitis

Early Imaging and Course-of-Disease Control Markers of Pyogenic Vertebral Osteomyelitis

Experience in treating patients with a combination of the descending aorta saccular aneurysm and spondylodiscitis

Investigation of Bacterial and Viral Slow Intervertebral Disc Infections

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