DOCSLIB.ORG

Infectious Spinal Pathology Mimicking Infections

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Infectious Spinal Pathology Mimicking Infections Kumar et al. BMC Musculoskeletal Disorders (2017) 18:244 DOI 10.1186/s12891-017-1608-z REVIEW Open Access Magnetic resonance imaging of bacterial and tuberculous spondylodiscitis with associated complications and non- infectious spinal pathology mimicking infections: a pictorial review Yogesh Kumar1, Nishant Gupta2, Avneesh Chhabra3, Takeshi Fukuda4, Neetu Soni5 and Daichi Hayashi1,6* Abstract Magnetic resonance (MR) imaging plays an important role in the evaluation of bacterial and tuberculous spondylodiscitis and associated complications. Owing to its high sensitivity and specificity, it is a powerful diagnostic tool in the early diagnosis of ongoing infections, and thus provides help in prompt initiation of appropriate, therapy which may be medical or surgical, by defining the extent of involvement and detection of complications such as epidural and paraspinal abscesses. More specifically, MR imaging helps in differentiating bacterial from tuberculous infections and enables follow up of progression or resolution after appropriate treatment. However, other non-infectious pathology can demonstrate similar MR imaging appearances and one should be aware of these potential mimickers when interpreting MR images. Radiologists and other clinicians need to be aware of these potential mimics, which include such pathologies as Modic type I degenerative changes, trauma, metastatic disease and amyloidosis. In this pictorial review, we will describe and illustrate imaging findings of bacterial and tuberculous spondylodiscitis, their complications and non-infectious pathologies that mimic these spinal infections. Keywords: Spine, Infection, Abscess, MRI, Spondylitis, Discitis Background be aware of these potential mimickers when interpreting Magnetic resonance (MR) imaging plays an important MR images [6–10]. Radiologists and referring clinicians role in the evaluation of bacterial and tuberculous spon- need to be aware of these potential mimics, which in- dylodiscitis. Owing to its high sensitivity and specificity clude such pathologies as Modic type I degenerative of up to 90% or greater [1–5], it is a powerful diagnostic changes, trauma, metastatic disease and amyloidosis. In tool in the early diagnosis of spondylodiscitis. MR im- this pictorial review, we describe and illustrate imaging aging thus provides help in prompt initiation of appro- findings of bacterial and tuberculous spondylodiscitis, priate therapy which may be medical or surgical, by their complications and non-infectious pathologies that defining the extent of involvement and detection of mimic these infections. complications such as epidural and paraspinal abscesses. However, other non-infectious pathology can demon- Epidemiology of bacterial and tuberculous strate similar MR imaging appearances and one should spondylodiscitis In bacterial spondylodiscitis, Staphylococcus aureus is * Correspondence: [email protected] the most commonly responsible organism, accounting 1Department of Radiology, Yale New Haven Health System at Bridgeport for up to >75% of cases [11–13]. Other organisms that Hospital, 267 Grant Street, Bridgeport 06610, CT, USA may cause bacterial spondylodiscitis include Escherichia 6Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston 02118, MA, USA coli in patients with concurrent urinary tract infections, Full list of author information is available at the end of the article Pseudomonas aeruginosa in patients with a history of © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Kumar et al. BMC Musculoskeletal Disorders (2017) 18:244 Page 2 of 10 intravenous drug abuse, Streptococcus pneumoniae in Clinical presentation and diagnostic work-up patients with diabetes, and Salmonella species in pa- Bacterial spondylodiscitis most commonly presents with tients with sickle cell disease or asplenia [14, 15]. acute to subacute onset of back pain and fever. In many Tuberculosis (TB) is one of the major causes of morbid- cases, fever of unknown origin is the main presenting ity and mortality in developing countries with a rising complaint. Progressively increasing pain at the surgical trend in the United States and other developed countries site is usually the first symptom of postsurgical infection. with a reported worldwide incidence of 10.4 million cases For tuberculous spondylitis, patients present with consti- in 2015 according to the World Health Organization glo- tutional symptoms such as malaise, loss of weight and bal report [16]. Spinal TB is a destructive form of TB night sweats while in chronic healed stage patients present affecting the spinal column in less than 1% of all TB cases, with back stiffness, deformity and neural deficits. causing neurological deficits, spinal deformities and para- Laboratory evaluation includes elevated inflammatory plegia which mandates early diagnosis and treatment to markers such as erythrocyte sedimentation rate (ESR) and avoid permanent damages [17]. According to an epi- C-reactive protein (CRP). These are very sensitive but demiological study in the United States with a 10-year ob- non-specific markers of active bacterial spondylodiscitis, servation period (2002–2011), the incidence of spinal TB and thus can only be used to exclude active infection. is actually decreasing from 0.07 cases per 100,000 persons Moreover, normal levels can also be seen in chronic infec- in 2002 to 0.05 cases per 100,000 in 2011 (p <0.001),cor- tions. Leukocytosis and positive blood cultures are seen in responding to 1 case per 2 million persons in the latter most cases, especially before the initiation of medical year [18]. The same study identified men aged approxi- treatment. Diagnosis of TB infection is usually based on mately 50 years were most commonly affected [18]. clinical features, cerebrospinal fluid (CSF) analysis, hist- ology and culture. However, combined use of MR imaging Pathogenesis of bacterial and tuberculous and GeneXpert, a test which detects DNA sequences spe- spondylodiscitis cific for Mycobacterium tuberculosis increases the sensitiv- Bacterial spondylodiscitis usually occurs due to ity to 97.9% for detection [17]. In doubtful cases, tissue hematogenous spread from a distant site, particularly biopsy is required to reach the diagnosis. from the lung or urinary tract. Bacterial spondylodiscitis The diagnosis is often made by a combination of clinical can also occur via direct extension, for instance from features and imaging findings in some cases of spinal in- spinal surgery, myelography, penetrating trauma, and fection to initiate early empirical treatment in order to re- from adjacent infections in the thorax or abdomen. Due duce the risk of complications, such as vertebral collapse to differences in vascular anatomy at different stages of and cord compression. However, a definitive diagnosis of life, discs are usually the first site of infection in the causative micro-organism is very difficult to establish pediatric patients followed by metaphyseal involvement, based on clinical features and imaging alone. Therefore, while in adult patients endplates are usually the first site image-guided percutaneous spinal biopsies are being in- of infection followed by disc involvement [19, 20]. creasingly performed to get sufficient tissue for culture Tuberculous spondylodiscitis, also known as Pott dis- and sensitivity of the causative organism [24]. However, ease, is caused by Mycobacterium tuberculosis, a slow- the biopsy diagnostic yield of percutaneous spinal biopsy growing gram positive acid fast bacillus which becomes for detecting infection ranges from 30 to 40% and aspir- lodged in the bone via Batson’s venous plexus and ation of > or = 2 mL of purulent fluid reported increases lymphatic from primarily infected lung, lymph nodes, the rate of positive cultures [24]. mediastinum and viscera, forming granulomatous in- flammation and caseation necrosis [17]. Primary or sec- Technical considerations for MR imaging ondary involvement of the posterior appendicular and Usually, MR imaging of the spine is performed with articular element along with paraspinal soft tissue can basic sequences including T1 and T2 weighted sagittal also be seen [17, 21]. Thoracolumbar region is the most and axial images. Additionally, fat-suppressed T2- commonly affected site while the cervical and sacrum weighted sequence or Short tau Inversion Recovery regions are less commonly involved. Usually more than (STIR) sequence is used to increase the conspicuity of one vertebra is affected because of its segmental arterial bone marrow edema and thus increasing the sensitivity distribution and subligamentous spread of the disease. [6]. If there is no bone marrow edema on fat suppressed The bacilli reach the disc space causing disc destruction, T2-weighted or STIR images, gadolinium contrast ad- spreads to adjacent vertebral bodies leading to vertebral ministration does not add any value and is not required collapse, anterior wedging,
Load more

Recommended publications
  • 18-0969: R.S. and DEPARTMENT of the ARMY, WALTER
    United States Department of Labor Employees’ Compensation Appeals Board __________________________________________ ) R.S., Appellant ) ) and ) Docket No. 18-0969 ) Issued: March 27, 2019 DEPARTMENT OF THE ARMY, WALTER ) REED NATIONAL MILITARY MEDICAL ) CENTER, Bethesda, MD, Employer ) _________________________________________ ) Appearances: Case Submitted on the Record Appellant, pro se Office of Solicitor, for the Director DECISION AND ORDER Before: CHRISTOPHER J. GODFREY, Chief Judge PATRICIA H. FITZGERALD, Deputy Chief Judge VALERIE D. EVANS-HARRELL, Alternate Judge JURISDICTION On April 10, 2018 appellant filed a timely appeal from a December 22, 2017 merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal Employees’ Compensation Act1 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction over the merits of this case.2 ISSUE The issue is whether appellant has met her burden of proof to establish lumbar and/or right shoulder conditions causally related to an April 7, 2016 employment incident. 1 5 U.S.C. § 8101 et seq. 2 The Board notes that following the December 22, 2017 decision, OWCP received additional evidence. However, the Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the case record that was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered by the Board for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this additional evidence for the first time on appeal. Id. FACTUAL HISTORY On April 15, 2016 appellant, then a 64-year-old radiology technology supervisor, filed a traumatic injury claim (Form CA-1) alleging that on April 7, 2016 she injured her lower back and right shoulder while in the performance of duty.
    [Show full text]
  • Brucellar Spondylodiscitis with Rapidly Progressive Spinal Epidural Abscess Showing Cauda Equina Syndrome
    Citation: Spinal Cord Series and Cases (2016) 2, 15030; doi:10.1038/scsandc.2015.30 © 2016 International Spinal Cord Society All rights reserved 2058-6124/16 www.nature.com/scsandc CASE REPORT Brucellar spondylodiscitis with rapidly progressive spinal epidural abscess showing cauda equina syndrome Tan Hu1,2,JiWu1,2, Chao Zheng1 and Di Wu1 Early diagnosis of Brucellosis is often difficult in the patient with only single non-specific symptom because of its rarity. We report a patient with Brucellar spondylodiscitis, in which the low back pain was the only symptom and the magnetic resonance imaging (MRI) showed not radiographic features about infection at initial stage. He was misdiagnosed as a lumbar disc herniation for inappropriate treatment in a long time. The delay in diagnosis and correct treatment led to rapid progression of the disease and severe complications. The patient was treated successfully with triple-antibiotic and surgical intervention in the end. Brucellar spondylodiscitis should always be suspended in the differential diagnosis specially when the patient comes from an endemic area or has consumed dairy products from animals in such an area and comprehensive examination should be done for the patent to rule out some important diseases like Brucellosis with sufficient reasons. Spinal Cord Series and Cases (2016) 2, 15030; doi:10.1038/scsandc.2015.30; published online 7 January 2016 Brucellosis is caused by small, non-motile, Gram-negative, aerobic post meridiem and intermittent left lower limb numbness for the and facultative intracellular coccobacilli of the genus Brucella recent weeks. One week before admission, the patient returned transmitted from infected animals to humans either by to the local clinic because his symptoms worsen.
    [Show full text]
  • Tuberculous Spondylitis, Pyogenic Spondylitis, X-Ray and Tomographic Features
    American Journal of Medicine and Medical Sciences 2021, 11(5): 398-401 DOI: 10.5923/j.ajmms.20211105.08 X-Ray and Tomographic Manifestations of Tuberculous Spondylitis Babоev Abduvakhob Sakhibnazarovich Bone and Joint Tuberculosis Department of Rebuplican Specialized Scientific Practical Medical Center of Phtiziology and Pulmonology, Tashkent, Uzbekistan Abstract X-ray and tomographic data of seventy-eight patients with spine disorders (31 patients with tuberculous spondylitis, 23 patients with pyogenic spondylitis, and 24 patients with degenerative spondylopathy) after clinical, laboratory, bacteriologic, and histologic verification of diagnosis was comparatively analyzed. Current X-ray and tomographic features of tuberculous spondylitis are relatively equal thoracic and lumbosacral spine segments localization, with more than two adjacent vertebrae involvement in 22,6±7,5% of cases, the collapse of the vertebra(s) in 35.5 ± 8.6% of cases, unclear or osteoporotic border of bone tissue around TB focus in 64.5 ± 8.6%, formation of abscesses in 74.2±7.9% and their subligamentous spread to more than two vertebrae in 25,8±7,9% of cases, intact intervertebral disc in 16.1 ± 6.6% of cases, and specific process in the lungs in 48.4 ± 9.0% of cases. Keywords Tuberculous spondylitis, Pyogenic spondylitis, X-ray and tomographic features identify differential diagnostic features of tuberculous 1. Introduction spondylitis (TS). X-ray and tomographic (MRI and CT) methods of examination play a leading role in the diagnosis of 3. Materials and Methods tuberculous (TB) lesions of the spine [1,2,3]. Features of radiological changes of spine TB depend on The study was conducted at the bone and joint TB the activity and duration of the specific process [1,2].
    [Show full text]
  • Master.Pmd 2
    The Effects of Tumor Necrosis Factor Inhibitors in a Particular Association of Psoriatic Arthritis and Behcet Disease ANCA EMANUELA MUSETESCU1#, ALESANDRA FLORESCU2*, ANA-MARIA BUMBEA3#, LUCIAN MIHAI FLORESCU4, PAULINA LUCIA CIUREA1, ANDREI BONDARI4, DAN NICOLAE FLORESCU5, SIMONA BONDARI4 1 University of Medicine and Pharmacy of Craiova,Department of Rheumatology, 2-4 Petru Rares Str., 200349, Craiova, Romania 2University of Medicine and Pharmacy of Craiova, 2-4 Petru Rares Str., 200349, Craiova, Romania 3University of Medicine and Pharmacy of Craiova, Department of Medical Rehabilitation, 2-4 Petru Rares Str., 200349, Craiova, Romania 4 University of Medicine and Pharmacy of Craiova, Department of Radiology and Medical Imaging, 2-4 Petru Rares Str., 200349, Craiova, Romania 5 University of Medicine and Pharmacy of Craiova, Department of Gastroenterology, 2-4 Petru Rares Str., 200349, Craiova, Romania The current case report presents a patient diagnosed with Behcet disease in concurrence with psoriatic arthritis, leading to a complex treatment, difficult management and challenging approach of both rheumatic disorders. After treatment with synthetic disease-modifying drugs and three different TNF inhibitors, the patient developed pulmonary tuberculosis, followed by tuberculosis spondylodiscitis, even after proper anti- tuberculosis therapy. Keywords: Behcet disease, psoriatic arthritis, tuberculosis spondylodiscitis, TNF inhibitors Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by the presence of both peripheral of uveitis in patients with BD, except for etanercept with joint and axial spine involvement, in concurrence with conflicting results [5]. psoriatic lesions and in the absence of rheumatoid factor. The term PsA comprises one of the five clinical forms: Experimental part symmetrical polyarthritis, asymmetrical oligoarthritis, distal Case report interphalangeal joint involvement, spondylitis and arthritis We present the case of a 34-year old male admitted in mutilans [1].
    [Show full text]
  • Case Report Surgical Management of L5-S1 Spondylodiscitis on Previously Documented Isthmic Spondylolisthesis: Case Report and Review of the Literature
    Hindawi Case Reports in Surgery Volume 2020, Article ID 1408701, 5 pages https://doi.org/10.1155/2020/1408701 Case Report Surgical Management of L5-S1 Spondylodiscitis on Previously Documented Isthmic Spondylolisthesis: Case Report and Review of the Literature Anthony Lubiato, Guillaume Baucher , Mikael Meyer, and Stéphane Fuentes Department of Adult Neurosurgery, La Timone University Hospital, APHM, Aix Marseille University, 264 Rue Saint Pierre, Marseille 13385, France Correspondence should be addressed to Guillaume Baucher; [email protected] Received 26 June 2019; Accepted 30 October 2019; Published 17 February 2020 Academic Editor: Mario Ganau Copyright © 2020 Anthony Lubiato et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Although lumbar isthmic spondylolisthesis is frequent in the Caucasian population, its association with spondylodiscitis is extremely rare. Case Description. The authors reported the case of a 44-year-old patient affected by pyogenic spondylodiscitis on previously documented isthmic spondylolisthesis at the L5-S1 level. The patient was surgically treated by circumferential arthrodesis combining anterior lumbar interbody fusion (ALIF), followed by L4-S1 percutaneous osteosynthesis using the same anesthesia. Appropriate antibiotherapy to methicillin-susceptible Staphylococcus aureus, found on the intraoperative samplings,
    [Show full text]
  • Neurological Impairment in a Patient with Concurrent Cervical Disc Herniation and POEMS Syndrome
    European Spine Journal (2019) 28 (Suppl 2):S51–S55 https://doi.org/10.1007/s00586-019-05914-5 CASE REPORT Neurological impairment in a patient with concurrent cervical disc herniation and POEMS syndrome Tingxian Ling1 · Limin Liu1 · Yueming Song1 · Shilian Zhou1 · Chunguang Zhou1 Received: 24 July 2018 / Revised: 16 December 2018 / Accepted: 9 February 2019 / Published online: 13 February 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Purpose POEMS syndrome is a rare clonal plasma cell disease characterized by polyneuropathy, organomegaly, endocrinopa- thy, M protein, and skin changes. We report a rare case of neurological impairment in patients with concurrent cervical disc herniation and POEMS syndrome. Methods A patient presented to a local hospital with C3/4 and C4/5 disc herniation, apparent spinal cord compression con- comitant with neurological signs, and concurrent POEMS syndrome. Anterior cervical discectomy and fusion was performed. Results The limb numbness was only slightly alleviated, and 10 days postoperatively the patient complained of muscle weak- ness of the extremities and was referred to our hospital. The patients exhibited non-typical neurological signs and an enlarged liver and spleen that could not be explained. Electroneuromyography and immunofxation electrophoresis produced abnormal results. We diagnosed concurrent POEMS syndrome, for which drug therapy was prescribed. The patient’s symptoms receded. Conclusion Patients presenting with cervical spondylopathy and non-typical neurological signs and symptoms or other systemic problems should be evaluated for the presence of concurrent disease and ruled out diferential diagnoses. Keywords Neurological impairment · POMES syndrome · Cervical disc herniation · Cervical spondylosis Introduction a chronic demyelinating autoimmune disease that has symp- toms similar to those associated with myelopathy: spasticity, Cervical disc herniation is a common spinal disorder that sensory disturbances, gait ataxia, weakness.
    [Show full text]
  • ICD-9 to ICD-10 Mapping Tool Courtesy Of: the Paperwork Project
    ICD-9 to ICD-10 Mapping Tool Courtesy of: The Paperwork Project Spinal Subluxation ICD-9 ICD-10 M99.00 Segmental and somatic dysfunction, Head region (occipito-cervical) 739.0 Segmental and somatic dysfunction, Head region (occipito-cervical) M99.10 Subluxation complex (vertebral), Head region M99.01 Segmental and somatic dysfunction, Cervical region 739.1 Segmental and somatic dysfunction, Cervical region M99.11 Subluxation complex (vertebral), Cervical region M99.02 Segmental and somatic dysfunction, Thoracic region 739.2 Segmental and somatic dysfunction, Thoracic region M99.12 Subluxation complex (vertebral), Thoracic region M99.03 Segmental and somatic dysfunction, Lumbar region 739.3 Segmental and somatic dysfunction, Lumbar region M99.13 Subluxation complex (vertebral), Lumbar region M99.04 Segmental and somatic dysfunction, Sacral region 739.4 Segmental and somatic dysfunction, Sacral region M99.14 Subluxation complex (vertebral), Sacral region M99.05 Segmental and somatic dysfunction, Sacroiliac, hip, pubic regions 739.5 Segmental and somatic dysfunction, Sacroiliac, hip, pubic regions M99.15 Subluxation complex (vertebral), Pelvic region 839.08 Closed dislocation, Multiple cervical vertebra (injury) S13.101_ Dislocation of unspecified cervical vertebra (injury) ** 839.20 Closed dislocation, Lumbar vertebra (injury) S33.101_ Dislocation of unspecified lumbar vertebra (injury) ** 839.21 Closed dislocation, Thoracic vertebra (injury) S23.101_ Dislocation of unspecified thoracic vertebra (injury) ** 839.42 Closed dislocation, Sacrum,
    [Show full text]
  • IN the UNITED STATES COURT of FEDERAL CLAIMS OFFICE of SPECIAL MASTERS No
    IN THE UNITED STATES COURT OF FEDERAL CLAIMS OFFICE OF SPECIAL MASTERS No. 10-565V Filed: June 11, 2014 For Publication * * * * * * * * * * * * * * * * * * * * * * * * * * * * MEGAN L. GODFREY, * HPV Vaccine; Gardasil; Juvenile * Ankylosing Spondylitis; JAS; Petitioner, * Causation-in-Fact; Expert; v. * Qualifications. * SECRETARY OF HEALTH * AND HUMAN SERVICES, * * Respondent. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Milton Clay Ragsdale, IV, Ragsdale LLC, Birmingham, AL, for petitioner. Jennifer Reynaud, U.S. Department of Justice, Washington, DC, for respondent. DECISION1 Vowell, Chief Special Master: On August 20, 2010, Megan Godfrey [“petitioner”] filed a petition for compensation under the National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 [the “Vaccine Act” or “Program”]. The petition alleged that the human papillomavirus [“HPV”] and meningococcal conjugate vaccines Ms. Godfrey received on August 22, 2007, caused her to develop juvenile rheumatoid arthritis. Petition at 1-2. 1 Because this decision contains a reasoned explanation for my action in this case, it will be posted on the United States Court of Federal Claims’ website, in accordance with the E-Government Act of 2002, Pub. L. No. 107-347, 116 Stat. 2899, 2913 (Dec. 17, 2002). As provided by Vaccine Rule 18(b), each party has 14 days within which to request redaction “of any information furnished by that party: (1) that is a trade secret or commercial or financial in substance and is privileged or confidential; or (2) that includes medical files or similar files, the disclosure of which would constitute a clearly unwarranted invasion of privacy.” Vaccine Rule 18(b). Otherwise, the entire decision will be available to the public. 2 National Childhood Vaccine Injury Act of 1986, Pub.
    [Show full text]
  • Surgical Treatment of Spondylodiscitis of the Thoracic and Lumbar Spine
    Open Access Austin Neurosurgery: Open Access Research Article Surgical Treatment of Spondylodiscitis of the Thoracic and Lumbar Spine Aleksey Eroshkin1*, Nikolai Rainov2, Dmytro Romanukha1 Abstract 1 Department of Neurosurgery of Central Hospital of Background: The incidence of spondylodiscitis (SD) of different origin is Ministry of Internal Affairs of Ukraine (Central Police increasing in the last decades and its treatment may be difficult and prolonged. Hospital), Kyiv, Ukraine 2MVZ Wirbelsäulenzentrum Taufkirchen, Munich, Methods: All patients presented with SD of different origin and with different Germany degrees of pain and/or neurological deficits. All of them underwent standard posterior transpedicular fixation with debridement and decompression of neural *Corresponding author: Aleksey Eroshkin, Head structures in the spinal canal. In some cases with significant segmental instability, of Department of Neurosurgery of Central Hospital of intervertebral PLIF cages were used in addition to dorsal transpedicular fixation. Ministry of Internal Affairs of Ukraine (Central Police Clinical outcomes were assessed using functional outcome criteria (ASIA and Hospital), 1 Berdychivs’ka Street, Kyiv, 04116, Ukraine VAS scales). The sagittal alignment of the affected segments was evaluated Received: August 05, 2020; Accepted: September 04, preoperatively and postoperatively by measuring the Cobb angle. 2020; Published: September 11, 2020 Results: 47 patients with SD of different origin underwent posterior transpedicular fixation. PLIF cages were used in addition in 12 cases (26%). 31 (66%) of the patients were males and 16 (34%) females. The average age of the male population was 62.3 ± 4.8 years, and of the female population 58.2 ± 5.1 years. 42 of these patients completed follow-up at 12 months (89.4%).
    [Show full text]
  • Dutch Multidisciplinary Guideline for Invasive Treatment of Pain Syndromes of the Lumbosacral Spine
    ORIGINAL ARTICLE Dutch Multidisciplinary Guideline for Invasive Treatment of Pain Syndromes of the Lumbosacral Spine Coen J. Itz, MD*,†; Paul C. Willems, MD, PhD‡; Dick J. Zeilstra, MD, PhD§; Frank J. Huygen, MD, PhD, FIPP¶ *Department of Anesthesiology, Erasmus Medical Center, Rotterdam; †Health Insurance Company VGZ Eindhoven, Eindhoven; ‡Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht; §Neurosurgery, Nedspine Ede and Bergman Clinics Naarden, Ede and Naarden; ¶Department of Anesthesiology, Centre of Pain Medicine, Erasmus Medical Center, Rotterdam, the Netherlands & Abstract Evaluation system. For the evaluation of invasive treatment options, the guideline committee decided that the outcome Objectives: When conservative therapies such as pain med- measures of pain, function, and quality of life were most ication or exercise therapy fail, invasive treatment may be important. indicated for patients with lumbosacral spinal pain. The Results: The definition, epidemiology, pathophysiological Dutch Society of Anesthesiologists, in collaboration with the mechanism, diagnostics, and recommendations for invasive Dutch Orthopedic Association and the Dutch Neurosurgical therapy for each of the spinal back pain syndromes are Society, has taken the initiative to develop the guideline reported. “Spinal low back pain,” which describes the evidence Discussion: The guideline committee concluded that the regarding diagnostics and invasive treatment of the most categorization of low back pain into merely specific or common spinal low back pain syndromes, that is, facet joint nonspecific gives insufficient insight into the low back pain pain, sacroiliac joint pain, coccygodynia, pain originating problem and does not adequately reflect which therapy is from the intervertebral disk, and failed back surgery syn- effective for the underlying disorder of a pain syndrome.
    [Show full text]
  • Characteristics, Management and Outcomes of Spondylodiscitis in Children: a Systematic Review
    antibiotics Review Characteristics, Management and Outcomes of Spondylodiscitis in Children: A Systematic Review Irene Ferri 1, Gabriele Ristori 2, Catiuscia Lisi 1, Luisa Galli 1 and Elena Chiappini 1,* 1 Paediatric Infectious Disease Unit, Meyer Children’s University Hospital, Department of Health Sciences, University of Florence, 50139 Florence, Italy; [email protected]fi.it (I.F.); [email protected] (C.L.); luisa.galli@unifi.it (L.G.) 2 Paediatric Orthopaedic and Traumatology Department, Meyer Children’s University Hospital, Department of Health Sciences, University of Florence, 50139 Florence, Italy; [email protected] * Correspondence: elena.chiappini@unifi.it; Tel.: +39-0-555-662-480 Abstract: Spondylodiscitis (SD) is the concurrent infection of the intervertebral disc and the adjacent vertebral bodies. Currently, there is a substantial lack of structured reviews about this topic. The aim of this study was to systematically review the available literature in order to determine the main features of pediatric SD. A systematic search of MEDLINE database was performed, according to the PRISMA guideline recommendations. Clinical features, laboratory data, radiological signs, treatments strategies, and outcomes were summarized. Studies’ quality assessments were performed using the JBI Critical Appraisal Checklists. A total of 35 retrospective studies were analyzed and 340 children were identified. The most frequently affected age class was 0.5–4 years. The most affected site was the lumbar spine. The most commonly reported symptoms were back pain (37.97%) and refusal to walk/to stand/to sit (49.79%). The most frequently identified pathogen was Staphylococcus aureus (n = 33). The most used antibiotics were third generation cephalosporins.
    [Show full text]
  • Spondt (Spondylodiscitis Diagnosis and Treatment): Spondylodiscitis Scoring System Lars Homagk1,4* , Daniel Marmelstein2, Nadine Homagk2 and Gunther O
    Homagk et al. Journal of Orthopaedic Surgery and Research (2019) 14:100 https://doi.org/10.1186/s13018-019-1134-9 RESEARCH ARTICLE Open Access SponDT (Spondylodiscitis Diagnosis and Treatment): spondylodiscitis scoring system Lars Homagk1,4* , Daniel Marmelstein2, Nadine Homagk2 and Gunther O. Hofmann3 Abstract Background: Spondylodiscitis is a chameleon among infectious diseases due to the lack of specific symptoms with which it is associated. It is nevertheless a serious infection, with 7% mortality of hospitalized patients, in large part because of delayed diagnosis. The aim of this study was to develop a diagnosis and course-of-disease index to optimize its treatment. Material and methods: Through analysis of 296 patients between January 1998 and December 2013, we developed a scoring system for spondylodiscitis, which we term SponDT (Spondylodiscitis Diagnosis and Treatment) based on three traits: (1) the inflammatory marker C-reactive protein (CRP) (mg/dl), (2) pain according to a numeric rating scale (NRS) and (3) magnetic resonance imaging (MRI), to monitor its progression following treatment. Results: The number of patients receiving treatment increased over the past 15 years of our study. We also found an increasing age of patients at the point of diagnosis across the study, with an average age of 67.7 years. In 34% of patients, spondylodiscitis developed spontaneously. Almost 70% of them did not receive treatment until the first diagnosis using SponDT. Following treatment against spondylodiscitis, pain intensity decreased from 6.0 to 3.1 NRS. The inflammatory markers also decreased (CRP from 119.2 to 46.7 mg/dl). Similarly, MRI revealed a regression in inflammation following treatment.
    [Show full text]