Suggestions for managing pyogenic (non-tuberculous) discitis in adults

Grados, Franck; Lescure, François Xavier; Senneville, É.; Flipo, R.M.; Schmit, J. L.; Fardellone, Patrice

doi:10.1016/j.jbspin.2006.11.002

Cited by 173 publications

(145 citation statements)

References 18 publications

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“…Surgery for lumbar spondylodiscitis is indicated for neurological deficits, instability, deformity, medically intractable pain, or disease progression [3,4]. The surgical goal in lumbar spondylodiscitis is the debridement of infection, identification and reduction of pathogens, stabilization of deformed and instable segments, and decompression of neural structures [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive spine surgery in lumbar spondylodiscitis: a retrospective single-center analysis of 67 cases

et al. 2017

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Background Minimally invasive surgical techniques have been developed to minimize tissue damage, reduce narcotic requirements, decrease blood loss, and, therefore, potentially avoid prolonged immobilization. Thus, the purpose of the present retrospective study was to assess the safety and efficacy of a minimally invasive posterior approach with transforaminal lumbar interbody debridement and fusion plus pedicle screw fixation in lumbar spondylodiscitis in comparison to an open surgical approach. Furthermore, treatment decisions based on the patients preoperative condition were analyzed. Methods 67 patients with lumbar spondylodiscitis treated at our department were included in this retrospective analysis. The patients were categorized into two groups based on the surgical procedure: group (MIS) minimally invasive lumbar spinal fusion (n = 19); group (OPEN) open lumbar spinal fusion (n = 48). Evaluation included radiological parameters on magnetic resonance imaging (MRI), laboratory values, and clinical outcome. Results Preoperative MRI showed higher rates of paraspinal abscess (35.5 vs. 5.6%; p = 0.016) and multilocular location in the OPEN group (20 vs. 0%, p = 0.014). Overall pain at discharge was less in the MIS group: NRS 2.4 ± 1 vs. NRS 1.6 ± 1 (p = 0.036). The duration of hospital stay was longer in the OPEN than the MIS group (19.1 ± 12 days vs. 13.7 ± 5 days, p = 0.018). Conclusion The open technique is effective in all varieties of spondylodiscitis inclusive in epidural abscess formation. MIS can be applied safely and effectively as well in selected cases, even with epidural abscess.

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Section: Introductionmentioning

confidence: 99%

Minimally invasive spine surgery in lumbar spondylodiscitis: a retrospective single-center analysis of 67 cases

et al. 2017

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“…In any case, results of blood cultures should not delay speedy antibiotic treatment [6]. A minimum of six weeks antibiotic regimen after dialysis treatment is the current choice [8,22]. Four weeks of intravenous administration can be followed by oral therapy [16].…”

Section: Discussionmentioning

confidence: 99%

Spondylodiscitis in patients under haemodyalisis

Cerván

Colmenero²,

Arco

et al. 2011

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to reach conclusions about the diagnosis and treatment of a series of patients with spondylodiscitis under haemodialysis treatment. Methods We collected and studied 23 patients included in a prospective database from two neighbouring hospitals. Descriptive statistical analysis was performed. Results The diagnosis was frequently made very late and early negative cultures were not uncommon; magnetic resonance images allowed for an early diagnosis with accurate anatomical information. Empirical antibiotic treatment with prompt surgery produced good results in patients under risk of, or having neurological problems. Surgical approaches did not differ from pyogenic or tuberculous spondylodiscitis. Age in our series was not a predictive issue. Conclusions Whenever a patient under haemodialysis has symptoms of spinal disease, particularly back pain with fever, they should undergo an MRI. If diagnosis of spondylodiscitis is made prompt empirical antibiotherapy should be instituted. Blood cultures should be performed and tissue samples taken for cultures; however, culture outcome must not delay therapy. Early surgical decompression leads to good results.

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“…Indications for operative treatment are large paraspinal abscesses, sepsis, deformities due to destruction of the endplates, progressive neurological impairment, and resistance to nonsurgical treatment for more than 6 weeks (Schinkel et al 2003). In all other patients a non-operative approach, including long-term antibiotic treatment after CT-guided specimen acquisition, and immobilization in a rigid brace should be tried (Grados et al 2007). Spondylodiscitis with multiple abscesses causing severe sepsis nevertheless requires early surgical intervention (Robinson et al 2007).…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of spondylodiscitis using titanium cages: A 3-year follow-up of 22 consecutive patients

et al. 2008

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Background and purpose The use of metal implants in large defects caused by spinal infection to support the anterior column is controversial, and relatively few results have been published to date. Despite the fact that there is bacterial adhesion to metal implants, the strong immunity of the highly vascularized spine because of rich muscle covering is unique. This possibly allows the use of metal implants, which have the advantage of high stability and reduced loss of correction. This is a retrospective study of patients with spondylodiscitis treated with metal implants.Patients and methods We retrospectively analyzed the outcome in 22 consecutive patients (mean age 69 (43-82) years, 15 men) with spondylodiscitis (20 lumbar and 12 thoracic discs) who had received an anterior titanium cage implantation. In 13 cases, the pathogen could be identified. Antibiotic treatment was continued for at least 12 weeks postoperatively.Results The mean follow-up was 36 (32-47) months. Healing of inflammation was confirmed by clinical, radiographic, and laboratory parameters. The mean VAS improved from 9.1 (6-10) preoperatively to 2.6 (0-6) at the final follow-up, and the mean Oswestry disability index was 17 (0-76) at the final follow-up.Interpretation Our findings highlight the high healing rate and stability when titanium implants are used. Prerequisites are a radical debridement, correction of deformity, and additional bony fusion by bone grafting. The increased stability, with facilitated patient mobilization, and the relatively little loss of correction using anterior and posterior implants are of considerable

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Suggestions for managing pyogenic (non-tuberculous) discitis in adults

Cited by 173 publications

References 18 publications

Minimally invasive spine surgery in lumbar spondylodiscitis: a retrospective single-center analysis of 67 cases

Minimally invasive spine surgery in lumbar spondylodiscitis: a retrospective single-center analysis of 67 cases

Spondylodiscitis in patients under haemodyalisis

Successful treatment of spondylodiscitis using titanium cages: A 3-year follow-up of 22 consecutive patients

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