Therapeutic Outcomes of Hematogenous Vertebral Osteomyelitis With Instrumented Surgery

Park, Ki Ho; Cho, Oh-Hyun; Lee, Yu‐Mi; Moon, Chisook; Park, Seong Yeon; Moon, Song Mi; Lee, Jun Young; Park, Ji Seon; Ryu, Kyung Nam; Kim, Sung-Han; Lee, Sang‐Oh; Choi, Sang‐Ho; Lee, Mi Suk; Kim, Yang Soo; Woo, Jun Hee; Bae, In-Gyu

doi:10.1093/cid/civ066

Cited by 37 publications

(59 citation statements)

References 25 publications

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“…3–5,18–22 It even reaches 100% in case of postoperative spondylodiscitis. 18 This variation is probably due to the lack of consensual definition of the neurological impairment across studies.…”

Section: Discussionmentioning

confidence: 99%

“…Mc Henry in his large cohort of spontaneous and postoperative VO found 25% of motor deficit mainly caused by a compressive myelopathy, compressive radiculopathy, or cauda equina syndrome. 19 In a recent large neurosurgical population of 153 patients Park et al 3 showed 23.5% of “neurological deficit” but precisions about neurological examination were not given. Another recent study conducted by Bernard et al 5 found 16% of neurological signs at baseline, including 5% of motor deficit and 11% of sciatica.…”

Section: Discussionmentioning

confidence: 99%

“…Previous works have estimated that neurological complications occurred in 16% to 51% of the patients. 3–5 However, definition of neurological complications varied widely between series and some of these studies only included patients selected from surgical wards. Therefore, their frequency in a nonselected population of VO remains to be determined.…”

Section: Introductionmentioning

confidence: 99%

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Is There an Association Between Magnetic Resonance Imaging and Neurological Signs in Patients With Vertebral Osteomyelitis?

Bart¹,

Redon²,

Boutoille³

et al. 2016

Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is There an Association Between Magnetic Resonance Imaging and Neurological Signs in Patients With Vertebral Osteomyelitis?

Bart¹,

Redon²,

Boutoille³

et al. 2016

Medicine

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“…Primary failure was defined as patients who needed another episode of surgical debridement after surgical intervention before the completion of antibiotic treatment because of signs of uncontrolled infection. Recurrence was defined as patients with recurrent symptoms and signs after the completion of antibiotic therapy and who received a second course of parenteral antibiotic treatment12).…”

Section: Methodsmentioning

confidence: 99%

The Safety and Decision Making of Instrumented Surgery in Infectious Spondylitis

et al. 2016

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ObjectiveInfectious spondylitis is mostly managed by appropriate antibiotic treatment options, and some patients may require surgical interventions. However, surgical interventions that use spinal instrumentation to correct the mechanical instability may be associated with the risk of an increase in the recurrence rate. In this study, we investigated whether spinal instrumentation effects on recurrence of infectious spondylitis.MethodsThe study was conducted as a retrospective study by dividing the subjects into the noninstrumentation surgery and instrumentation surgery groups among a total of 95 patients who had received surgical interventions in infectious spondylitis from 2009 to 2014. The study investigated patient variables such as underlying illness, presumed source of infection, clinical data, laboratory and radiological data, and ultimate outcome, and compared them between the 2 groups.ResultsIn the 95 patients, instrumentation was not used in 21 patients but it was used in 74 patients. When the disease involved ≥3 vertebral bodies, lumbosacral level and epidural part, noninstrumentation surgery was mainly conducted, but when the disease involved the thoracic level and psoas muscle part, instrumentation surgery was mainly conducted. However, there were no differences between the 2 groups in terms of the recurrence rate and the incidence of primary failure.ConclusionThe use of instrumentation in treating infectious spondylitis was determined by the level of involvement and part of the infection, but the use of instrumentation did not cause any increases in the recurrence rate and the incidence of primary failure.

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“…2 Median patient age was 59 (interquartile range [IQR]: 49-67), and 25 (64%) patients were male. According to the Child-Pugh classes, 13% of patients were defined as grade A, 54% as grade B, and 33% as grade C. Back pain and fever were the most common symptoms.…”

mentioning

confidence: 99%

Clinical characteristics and outcomes of pyogenic vertebral osteomyelitis in patients with cirrhosis

Park

Cho

et al. 2015

Hepatology

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Pyogenic vertebral osteomyelitis (PVO) is uncommon, but its incidence is increasing.1 However, the clinical significance of PVO is unclear in the setting of cirrhosis. Herein, we report on the clinical characteristics of 39 patients with PVO and cirrhosis.Diagnosis of PVO was established by (1) compatible clinical picture, (2) consistent imaging findings on magnetic resonance imaging, and (3) isolation of pyogenic microorganisms in blood culture (in 36 patients) or samples obtained by computed tomography CT-guided bone biopsy (2 cases) or by open surgery (1 case) as described in our previous report.2 Median patient age was 59 (interquartile range [IQR]: 49-67), and 25 (64%) patients were male. According to the Child-Pugh classes, 13% of patients were defined as grade A, 54% as grade B, and 33% as grade C. Back pain and fever were the most common symptoms. Bacteremia was documented in 36 patients (92%). The responsible organisms were Staphylococcus aureus in 20 (54%; methicillin resistant in 9) cases, Streptococci spp., in 8 (21%), and Enterobacteriaceae in 8 (21%) cases. The most frequently prescribed intravenous antibiotics were a b-lactam agent (63%) and vancomycin (32%). Median antibiotic treatment duration was 56 days (IQR, 41-80). Twenty (51%) patients with PVO developed renal failure. Nine had hepatic encephalopathy and 10 had concomitant SBP during the hospitalization. Within a 90-day follow-up period, resolution of infection was achieved in 29 patients. Overall 90-day mortality rate was 38% (15 of 39).The most striking finding of our study is the high frequency of renal failure (51%), an incidence much higher than other reported infections.(3,4) Multivariate analysis revealed that concomitant SBP was an independent predictor of renal failure (odds ratio: 14.7; 95% confidence interval: 1.64-132.6; P 5 0.02).The 90-day mortality in the present study was higher than that observed for patients with cirrhosis and non-PVO infections.(3,4) PVO may be incite acute-on-chronic liver failure as can skin and soft tissue infection.(4) PVO usually presents insidiously and follows an indolent clinical course; thus, life expectancy may not be affected in the general population.(1) However, the same may not be true for patients with cirrhosis.

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Therapeutic Outcomes of Hematogenous Vertebral Osteomyelitis With Instrumented Surgery

Abstract: Spinal instrumentation in patients with HVO may be safe with pathogen-directed prolonged antibiotic therapy and should not be abandoned or delayed solely because of the risk of recurrence.

Cited by 37 publications

References 25 publications

Is There an Association Between Magnetic Resonance Imaging and Neurological Signs in Patients With Vertebral Osteomyelitis?

Is There an Association Between Magnetic Resonance Imaging and Neurological Signs in Patients With Vertebral Osteomyelitis?

The Safety and Decision Making of Instrumented Surgery in Infectious Spondylitis

Clinical characteristics and outcomes of pyogenic vertebral osteomyelitis in patients with cirrhosis

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