Spondylodiscitis revisited

Mavrogenis, Andreas F.; Megaloikonomos, Panayiotis D.; Igoumenou, Vasileios G.; Panagopoulos, Georgios N.; Giannitsioti, Efthymia; Παπαδοπουλοσ, Αντωνιοσ; Papagelopoulos, Panayiotis J.

doi:10.1302/2058-5241.2.160062

Cited by 73 publications

(79 citation statements)

References 143 publications

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“…In our series mild-to-moderate intensity back pain was seen in 100% of cases. In the literature, age at presentation is in the 5th and 6th decades [13,14]. However, in our study, presentation was slightly earlier with a mean age of 45.6 years, possibly because most literature available is of acute cases.…”

Section: Discussioncontrasting

confidence: 53%

“…Other symptoms include nausea, vomiting, anorexia, weight loss, lethargy, and confusion. Predisposing factors include age, previous spine surgery, distant infectious focus, diabetes mellitus, advanced age, intravenous drug use, human immunodeficiency virus infection, immunosuppression, oncologic history, and renal failure [2,5,6,12,14]. On the basis of the duration of symptoms, infections can be classified as acute (<1 week), subacute (>2 weeks), and chronic.…”

Section: Introductionmentioning

confidence: 99%

“…Staphylococcus aureus is the most frequent causative microorganism, accounting for approximately half of the cases of bacterial spondylodiscitis and also is predominant in iatrogenic spondylodiscitis. In approximately one-third of patients with pyogenic spondylodiscitis, the infectious agent never is identified, which may increase up to 44% in iatrogenic cases by direct inoculation [5,13,14]. Due to the nonjudicious use of antibiotics in the Indian subcontinent, the low grade pyogenic spine infections may present in subacute or chronic phase as a nonrelieving backache.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Challenges in Diagnosis of Spontaneous Subacute Pyogenic Spondylodiscitis in Immunocompetent Patients: Experiences from a Tertiary Care Center

et al. 2019

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Study Design Prospective clinical study. Purpose We evaluated the challenges faced during diagnosis and management of patients with subacute pyogenic discitis and discussed various clues in clinical history, radiologic and hematologic parameters of these patients that helped in establishing their diagnosis. Overview of Literature Present literature available shows that in patients with subacute spondylodiscitis and infection with less virulent organisms, the clinical picture often is confusing and the initial radiologic and hematologic studies do not contribute much toward establishing the diagnosis. Methods Demographic pattern, predisposing factors, clinical presentation, comorbidities, microbiology, treatment, neurologic recovery, and complications of 11 patients were prospectively reviewed regarding their contribution toward the conformation of diagnosis of subacute pyogenic discitis. Results Mean age at presentation was 46.0 years with average preoperative Oswestry Disability Index and Visual Analog Scale scores of 83.4 and 7.18, respectively. Mean follow-up duration was 12.0 months. The most common site of infection was the lumbar spine, followed by the thoracic spine (n=1). Infective organisms were isolated in only 45% of cases. Staphylococcus aureus was the most common causative organism isolated. Conclusions Diagnosing subacute spondylodiscitis in a patient presenting with subacute low backache poses a diagnostic challenge. Clinical and radiologic picture are deceiving, and bacteriologic results often are negative, further complicating the picture. A detailed medical history along with clinical, radiologic, and biochemical parameters prevents missing the diagnosis. Serial serum Creactive protein and alkaline phosphatases were more reliable blood parameters in cases of subacute presentation.

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Section: Discussioncontrasting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of Challenges in Diagnosis of Spontaneous Subacute Pyogenic Spondylodiscitis in Immunocompetent Patients: Experiences from a Tertiary Care Center

et al. 2019

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“…Периоперационную (пред-и послеоперационную) антибактериальную терапию проводили в режимах, соответствующих современным рекомендациям по лечению специфических и неспецифических спондилитов [8,9]. Непосредственные результаты оце-нили у всех пациентов, отдаленные -у семи (туберкулезный спондилит -4, неспецифический спондилит и его последствия -3) c катамнезом, прослеженным в сроки более 6 мес.…”

Section: материал и методыunclassified

Anterior correction of angular kyphosis in children: description of the technique and analysis of clinical series

et al. 2018

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Objective. To describe the original technical surgical procedure simplifying the correction of kyphosis in children due to instrumental distraction of the anterior column of the spine, to analyze its effectiveness in the setting of clinical series. Level of evidence – IV. Material and Methods. The study included 9 patients aged 7 months to 14 years (median age: 4 years 8 months) with angular kyphosis (median magnitude 53°, min – 38°, max – 80°) associated with tuberculous (n = 4) and non-specific (n = 4) spondylitis and with a sequelae of spinal cord injury (n = 1). Deformity correction was achieved using temporary instrumental interbody distraction followed by anterior fusion with titanium mesh cage filled with autologous bone graft during a single-step two-stage reconstruction and stabilization surgery. Results. The duration of surgery was 3 hours 2 min ± 44 min, the volume of blood loss – 190 ml ± 39 ml. In all cases, the deformity was corrected by 75–85 % with restoration of physiological thoracic kyphosis and spinal profile. Conclusion. A safe and effective technique for intraoperative anterior instrumental distraction can be used to correct angular kyphosis in children, including infants.

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“…Proper diagnosis and individual therapy can improve clinical outcomes and decrease the likelihood of failure and promote the healing. Still, the percentage of failure reported in the literature goes from 6.2 to 32% (9, 16-22) and the complete recovery from both the neurological and the analgesia point of view is very variable from 50 to 91% of cases (9, 21-25).…”

Section: Introductionmentioning

confidence: 99%

Conservative Treatment of Spondylodiscitis: Possible Therapeutic Solution in Case of Failure of Standard Therapy

et al. 2019

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Introduction: Spondylodiscitis (SD) is an uncommon disease but not rare, because it represents around 3–5% of all cases of osteomyelitis. Late diagnosis and/or inadequate treatment often cause irreversible damage to cause neurological deficit. Most require only conservative treatment, sometimes a surgical approach is required. Aim: The purpose of this study is to propose a conservative protocol to treat spondylodiscitis when the standard conservative treatment has failed. This alternative treatment has been for a long time at the Codivilla-Putti Institute. Methods: We performed a prospective cohort study of 192 consecutive patients who underwent paravertebral intramuscular injections of antibiotic associated with standard treatment at our Center from January 2010 to December 2015 with SD. Of this 192 patients we selected 98 who had already undergone standard antibiotic therapy at another hospital without resolution of the disease. All patients have performed our protocol that provides a total of 3 cycles, each of 3 weeks, repeated at approximately 5 weeks apart. For each patient we evaluated Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), White Blood Cells (WBC) indexes, SF36 and VAS Score at the beginning and at the end of the treatment. Results: At a mean follow up of 22 months (range 60-12), clinical healing was achieved in 87 patients (88,9%) of cases with significant reduction in back pain and functional limitation. The VAS Score and the SF36 were better at the end of treatment compared to previous “GOLD STANDARD” treatments in the previous hospitalization in another hospital. In most cases there were slightly reduced in inflammatory indexes. Conclusion: There are no studies in the literature demonstrating the effective efficacy of local infiltrative treatment with antibiotics, associated with standard treatment protocol. We believe that our protocol in treating SD, favors an early functional recovery, and be able to offer more chance of success than the standard treatment.

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Spondylodiscitis revisited

Cited by 73 publications

References 143 publications

Evaluation of Challenges in Diagnosis of Spontaneous Subacute Pyogenic Spondylodiscitis in Immunocompetent Patients: Experiences from a Tertiary Care Center

Evaluation of Challenges in Diagnosis of Spontaneous Subacute Pyogenic Spondylodiscitis in Immunocompetent Patients: Experiences from a Tertiary Care Center

Anterior correction of angular kyphosis in children: description of the technique and analysis of clinical series

Conservative Treatment of Spondylodiscitis: Possible Therapeutic Solution in Case of Failure of Standard Therapy

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