Vertebral Osteomyelitis in Paraplegia: Incidence, Risk Factors, Clinical Picture

Frisbie, J H; Gore, Robert L.; Strymish, Judith; Garshick, Eric

doi:10.1080/10790268.2000.11753503

Cited by 15 publications

(6 citation statements)

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“…Despite the small numbers of deaths, the elevated SMR values for bladder cancer and osteomyelitis are also consistent with past reports noting that subjects with SCI are at increased risk for these conditions. 20,21 Heart disease, diabetes, pulmonary function abnormalities, and cigarette smoking were predictors of mortality, and are also known to be determinants of mortality in the able-bodied. Heart disease is the leading cause of death in US men, accounting for approximately 30% of deaths, and diabetes is the sixth leading cause of death.…”

Section: Discussionmentioning

confidence: 99%

A prospective assessment of mortality in chronic spinal cord injury

et al. 2005

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Study design: Prospective mortality study. Objective: To assess the relationship between comorbid medical conditions and other healthrelated factors to mortality in chronic spinal cord injury (SCI). Setting: Boston, MA, USA. Methods: Between 1994 and 2000, 361 males X1 year after injury completed a respiratory health questionnaire and underwent pulmonary function testing. Cause-specific mortality was assessed over a median of 55.6 months (range 0.33-74.4 months) through 12/31/2000 using the National Death Index. Results: At entry, mean (7SD) age was 50.6715.0 years (range 23-87) and years since injury was 17.5712.8 years (range 1.0-56.5). Mortality was elevated (observed/expected deaths ¼ 37/ 25.1; SMR ¼ 1.47; 95% CI ¼ 1.04-2.03) compared to US rates. Risk factors for death were diabetes (RR ¼ 2.62; 95% CI ¼ 1.19-5.77), heart disease (RR ¼ 3.66; 95% CI ¼ 1.77-7.78), reduced pulmonary function, and smoking. The most common underlying and contributing causes of death were diseases of the circulatory system (ICD-9 390-459) in 40%, and of the respiratory system in 24% (ICD-9 460-519). Conclusions: These results suggest that much of the excess mortality in chronic SCI is related to potentially treatable factors. Recognition and treatment of cardiovascular disease, diabetes, and lung disease, together with smoking cessation may substantially reduce mortality in chronic SCI.Spinal Cord (2005) 43, 408-416.

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Section: Discussionmentioning

confidence: 99%

A prospective assessment of mortality in chronic spinal cord injury

et al. 2005

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“…1 Vertebral osteomyelitis often presented with back pain, fever, tenderness at the vertebral body and sometimes neurological symptoms related to spinal cord compression. 2 The above symptoms, except for fever, are mostly absent in the paraplegics.…”

Section: Discussionmentioning

confidence: 99%

“…1 Nevertheless, classic symptoms of vertebral osteomyelitis, such as back pain, neurological deficits and vertebral body tenderness, 2 are mostly absent in SCI and it challenges the early diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Delayed diagnosis of vertebral osteomyelitis in a paraplegic patient

Hsiao

Liang

2011

Spinal Cord

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Study design: Case report. Objective: Vertebral osteomyelitis, usually presented with back pain and local tenderness, can pose a great challenge of early diagnosis among spinal cord injury (SCI) patients who lost sensation below the injured level. We reported a paraplegic patient who had recurrent febrile episodes after being treated as urinary tract infection initially and was discovered later to have vertebral osteomyelitis. Case report: A 41-year-old man, completely paralyzed at the T11 level and with Foley catheterization for 9 years, was re-admitted within 2 weeks for recurrent fever, turbid urine, bacteriuria and bacteremia with Escherichia coli. Spine X-ray and renal, cardiac and abdominal ultrasonography showed no definite lesions related to infection in a previous admission. Intermittently febrile episodes continued despite treatment with antibiotics for 1 week. He had no pressure sores or other wounds. Computerized tomography and magnetic resonance imaging showed lumbosacral osteomyelitis and bilateral paravertebral abscess. The patient underwent debridement of paravertebral tissue. Fever subsided soon after surgery and the patient continued antibiotics and remained free of fever at a 1-year follow-up. Conclusion: It can be challenging to diagnose vertebral osteomyelitis below injury levels in SCI patients. Vertebral osteomyelitis should be considered in febrile SCI patients even with known infectious foci, as classic symptoms of osteomyelitis are lacking in this population.

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“…It is estimated that the incidence of spondylodiskitis in the general population is 1.8 cases per 10,000 hospital admissions, and the incidence of paraplegia represents 20.9 cases per 10,000 spinal cord injuries. 4 Common complications of spondylodiskitis are deformity, instability, and paravertebral or epidural abscess. The latter may result in back or neck pain, radiculopathy, paraparesis or paraplegia, severe morbidity, and mortality.…”

Section: Drs Korovessis and Repantis Are From The Orthopaedic Departmmentioning

confidence: 99%

Hematogenous Pyogenic Spinal Infection: Current Perceptions

Korovessis¹,

Repantis²,

Hadjipavlou³

2012

Orthopedics

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As a result of reading this article, physicians should be able to:1.Understand the importance of early diagnosis and treatment of spinal infection in an effort to avoid devastating and crippling complications such as paralysis, painful deformity, and death.2.Understand current perceptions in the ongoing debate of whether operative or conventional treatment should be preferred and in which cases.3.Understand the latest advances in the surgical treatment of spinal infection, their indications, and their effectiveness.4.Understand the change in the traditionally held belief that in the presence of infection, the use of metal implants or grafts is not indicated. Controversy exists regarding optimal treatment for pyogenic spinal infection. The authors systematically reviewed peer-reviewed published clinical trials in the English language through 2009 on the clinical presentation, complications, and conservative and operative treatments of pyogenic spinal infection. The cornerstone of therapy for uncomplicated spondylodiskitis is intravenous antibiotics followed by oral antibiotics and bracing. Surgery is effective in complicated cases and improves sagittal balance, restores neurological impairment, and relieves severe pain. In cases of delayed diagnosis or surgery, potential early devastating and late crippling complications may occur. To the authors' knowledge, no Level I studies compare operative vs conservative treatment of pyogenic spinal infection.

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Vertebral Osteomyelitis in Paraplegia: Incidence, Risk Factors, Clinical Picture

Cited by 15 publications

References 0 publications

A prospective assessment of mortality in chronic spinal cord injury

A prospective assessment of mortality in chronic spinal cord injury

Delayed diagnosis of vertebral osteomyelitis in a paraplegic patient

Hematogenous Pyogenic Spinal Infection: Current Perceptions

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