Supplemental antibiotic injections into the disc eradicate. The impact factor measures the average number of citations received in a particular year by. This article is from clinics in orthopedic surgery, volume 4. Vertebral spondylodiscitis or osteomyelitis is a relatively uncommon condition in general, and only 6. After 2 weeks, the percentage of correct and possible diagnosis of pyogenic spondylodiscitis is reported to be 76% and 20%, respectively. Diagnosis is difficult and often delayed or missed due to the. According to the results of our study, early diagnosis of spondylodiscitis continues to be a challenge, despite the technological advances in complementary tests. In infectious spondylodiscitis, with early treatment and management, preservation of disc height can be achieved, in addition to healing with ankylosis 8, 14. Fungal respiratory conditions associated with disasters include coccidioidomycosis, and fungi are among several organisms that can cause neardrowning pneumonia. The impact factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years. Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion. Spontaneous infectious spondylodiscitis is a rare, but serious disease with the risk of progressive neurological impairment.
Cases occurring in neonates or younger infants are usually the most severe and are frequently associated with sepsis and multiple infectious foci. Spondylodiscitis is the most common complication of sepsis or local infection, usually in the form of an abscess. Conversely, patients with well established infectious endocarditis diagnosis who present with backache. Fusobacterium is an unusual cause of infectious spondylodiscitis but responds well to medicalsurgical therapy with no deaths recorded in the reported patients. Spondylodiscitis is an important differential diagnosis of lower back, flank, groin, and buttock pain. Postinfectious ankylosis of the cervical spine in an army. Jun 28, 2016 spondylodiskitis spondylodiscitis, infectious spondylitis is an infection that involves 1 or more of the extradural components of the spine. To the best of our knowledge, no study has compared gramnegative bacillary hematogenous pyogenic spondylodiscitis gnbhps with grampositive coccal hematogenous pyogenic spondylodiscitis gpchps regarding their clinical characteristics and outcomes. Spondylodiscitis, a term encompassing vertebral osteomyelitis, spondylitis and discitis, is the main manifestation of haematogenous osteomyelitis in patients aged over 50 years. Escherichia coli infectious spondylodiscitis of l34 in a patient with a past history of colon cancer a. The infectious spondylodiscitis was observed in 226 97 men and 129 women of 461 patients 49% and infectious arthritis among the 235 118 men and 117 women others 51%. The surgical approach to spontaneous infectious spondylodiscitis is in most cases an anterior debridement and fusion, often in staged surgeries. Current diagnosis and treatment of spondylodiscitis.
Moreover, spinal stabilization, which is assisted by the infectious process even in the absence of bone graft, allows early mobilization. Diagnostics of spondylodiscitis and its most frequent. Spontaneous spondylodiscitis epidemiology, clinical. With modern surgical and antibiotic treatment, a relapse of spondylodiscitis is unlikely to occur. As such, infectious spondylodiskitis can virtually be excluded by a negative scan. Spondylodiscitis can characterize in its early stages by rather. In all of them, the clinical, biological and laboratory criteria crp and esr, also ruled out an infectious origin.
Mri is the diagnostic modality of choice for detecting spondylodiscitis. Staphylococcus aureus is the predominant pathogen, accounting for about half of nontuberculous cases. Reveille, in clinical immunology fourth edition, 20. Infectious spondylodiscitis is an infection of the intervertebral disc and the adjacent vertebral bodies due to the introduction of a pyogen, usually by the haematogenous route. The mean age of patients with infectious spondylodiscitis was 39. The association between comorbidities and the presence of infectious spondylodiscitis is welldocumented in the literature. Summary infectious spondylodiscitis v ertebral ost eomy elitis vo is an infection of the intervertebr al disc with a possible extension to adjacent vertebr ae. Prevalence and risk factors of infectious spondylodiscitis. Failure modes in conservative and surgical management of.
Infectious spondylodiscitis is usually secondary to spinal surgery. Ebscohost serves thousands of libraries with premium essays, articles and other content including infectious spondylodiscitis. Aagaard t, roed c, dragsted c, skinhoj p 20 microbiological and therapeutic challenges in infectious spondylodiscitis. The clinical presentation of spondylodiscitis are manifold. Case report a 74yearold caucasian man presented to hospital with a week history of lower back and neck pain. Spondylodiscitis when confirmed requires conservative treatment to get rid of the problem. Although it affects a small proportion 27% of all patients with osteomyelitis, it is important because of its potential morbidity and mortality. Plain film radiography which is usually normal in the early stages shows blurring of the vertebral endplates and a loss of disc height that progresses quickly. Fusobacterium species are unusual causes for anaerobic. Table invasive fungal infections after natural disasters. Human immunodeficiency virus can affect the semiology of. Spondylodiskitis spondylodiscitis, infectious spondylitis is an infection that involves 1 or more of the extradural components of the spine. We present the experience based on 10year period, from 2000 to.
The vertebrae can be severely damaged and sometimes entirely destroyed, leading to kyphosis. Tuberculous spondylodiscitis ts is a rare but serious clinical condition which may lead to severe deformity and early or late neurological complications. Infectious spondylodiscitis a case series analysis. If diagnosis is delayed, ankylosis remains a late complication and sequela that may be encountered 15,16,17. Failure modes in conservative and surgical management of infectious spondylodiscitis. From october 2006 to march 2014, a total of 41 patients with infectious spondylodiscitis underwent percutaneous endoscopic surgery under local anesthesia, and lesions.
Traditional spondylodiscitis is observed to be contained to the an. Diskitis differential diagnoses medscape reference. Jun 27, 2019 spondylodiscitis when confirmed requires conservative treatment to get rid of the problem. Fluorine18 fluorodeoxyglucose positron emission tomographyct 18 ffdgpetct is a procedure well known in oncology and infectious diseases and appears to be playing an increasingly important role in the diagnosis of spondylodiscitis 18, 19, 34. From january 2003 to january 20, 54 patients who underwent combined antibiotic and surgical therapy in the treatment of hematogenous.
Kappel, catherine peterson, parthasarathi chamiraju, gary b. For these reasons, it is recommended that the start of the antimicrobial therapy in case of infectious spondylodiscitis should be delayed until a microbial diagnosis is established10. Here, we present a case of spondylodiscitis caused by sdse, highlighting the pathogenic potential of group g streptococci in healthy adults. We describe the radiological semiology in detail, emphasizing the imaging findings and clinical data that were helpful in making an accurate diagnosis. Microbiological and immunological diagnosis of tuberculous. Nonoperative management results in spontaneous interbody fusion in 36100% of cases 18,19,20,21. Thanks to precise monitoring of conservative treatments and primarily stable surgical techniques, prolonged immobilization of the patient is no longer necessary nowadays. The css mortality rate remains high owing to its frequently insidious.
Overall the quality of life seems to be more favourable in patients following surgical treatment of spondylodiscitis. With this paper, we share our knowledge on the management of infectious spondylodiscitis. Treatment of infectious spondylodiscitis in children, geriatric patients, and patients with multiple risk factors can be very challenging and gives cause for intense discussions 10, 19. The annual incidence of spondylodiscitis varies from 0. Dec 12, 2016 spontaneous infectious spondylodiscitis is a rare, but serious disease with the risk of progressive neurological impairment. Petct represents a good alternative particularly in the case of contraindications to contrast. Disc space was narrowing with nearby destructed endplates on l34 level.
As for pyogenic spondylodiscitis, tss can result from arterial haematogenous seeding of the m. Cervical spine spondylodiscitis after esophageal dilation. The diagnosis of infectious spondylodiscitis was established by a combination of clinical history, physical examination, results of the tests of inflammatory markers, radiological assessment, and mri if available children with another form of spondylodiscitis were not included in the study. Mri appears to give the correct diagnosis or suggest pyogenic spondylodiscitis as a possible diagnosis in 55% and 36% of cases, respectively in patients who present with less than 2 weeks of symptoms. In order to treat spondylodiscitis, the mode of treatment is an extensive course of antibiotics to get rid of the infection causing the disease and then a course of the immobilization of the vertebral bodies to allow them to get back to their normal shape. Here we report a case of singlestage posterior debridement and posterior instrumented fusion in combination with an. Conclusions although prolonged and specific antibiotic therapy remains the mainstay of treatment in spontaneous spondylodiscitis, surgery provides samples for microbiological confirmation and histopathologic study, allows debridement of the infectious foci. Nov 01, 2010 spondylodiscitis, a term encompassing vertebral osteomyelitis, spondylitis and discitis, is the main manifestation of haematogenous osteomyelitis in patients aged over 50 years. The initial field narrative did describe spondylodiscitis with observation of fusion of multiple segments of the cervical spine upon discharge 17 months later. Prevalence and risk factors of infectious spondylodiscitis in. Lebanon b division of neurosurgery and spinal program, the toronto hospital, university of toronto, canada c division of infectious diseases, department of internal medicine, american university of beirut medical center, lebanon. Spontaneous infectious spondylodiscitis sis, caused by the hematogenous spread of bacteria, is a relatively rare disease.
Spontaneous spondylodiscitis is a rare but serious infectious disease which is a combination of an inflammatory process, involving one or more adjacent vertebral bodies spondylitis, the intervertebral discs discitis and finally the neighboring neural structures. Spondylodiscitis caused by streptococcus dysgalactiae. This material can then be examined at the cellular level under a microscope. The effect of hd on infectious spondylodiscitis is elucidated. Diabetes and high blood pressure hbp were the most common. To determine the prevalence and risk factor of infectious spondylodiscitis in children in benin. A 59 yearold patient presented with a history of thoracic spondylodiscitis resistant to antibiotic treatment for 6 weeks, progressive severe back pain, and a new. Epidemiology and outcomes of infectious spondylodiscitis in.
Clinical manifestations of infectious spondylodiscitis can significantly vary 2 17 18. It is important to identify and treat spondylodiscitis as early as possible. Spondylodiscitis caused by fusobacterium species is rare. Outcome of conservative and surgical treatment of pyogenic. Infectious discitis and spondylodiscitis in children. Many patients are elderly or immunosuppressed, and associated medical illnesses are frequent. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do. Spondylodiscitis frequently develops in immunocompromised individuals, such as by a cancer, infection, or by. The standard treatment is intravenous iv antibiotic with external immobilization of the spine. Any information contained in this pdf file is automatically generated from digital material submitted to epos by third parties in the form of scientific presentations. Nonoperative management results in spontaneous interbody fusion in. Fatal outcome after insufficient spine fixation for. To discuss certain aspects of the approach to tss, focusing upon epidemiology, diagnosis, and treatment outcome. Distribution of time of first visit with percentage of visits vs.
The link between natural disasters and subsequent fungal infections in disasteraffected persons has been increasingly recognized. Original rticle original o infectious spondylodiscitis. Pyogenic spondylodiscitis represents a potentially lifethreatening condition. Clinical study a minimally invasive endoscopic surgery for infectious spondylodiscitis of the thoracic and upper lumbar spine in immunocompromised patients hsinchuan chen,1 tengle huang,2,3,4 yenjen chen,5,6 hsikai tsou,7,8 weiching lin,6,9 chihhung hung,5,10 chunhao tsai,5,6 horng. Sensitivity and specificity of mri and fdgpetct in. Singleapproach vertebral osteosynthesis in the treatment of. Comparison of gramnegative and grampositive hematogenous. In this article, we will discuss the diagnosis, treatment and outcome of spontaneous as well as postoperative bacterial pyogenic spondylodiscitis. Mri allowed the differentiation between tuberculous and pyogenic spondylodiscitis in the chronic stage. Retrospective study including patients diagnosed with spondylodiscitis over a period of 4 years 20062009 at. Infectious spondylodiscitis is a rare but potentially. Mar 07, 2008 spondylodiscitis should be borne in mind in cases of diffuse back pain and nonspecific symptoms.
The main causative organisms are staphylococci and mycobacterium tuberculosis, but potential organisms include a large number of bacteria, fungi, zoonoses. Retrospective study including patients diagnosed with spondylodiscitis over a period of 4 years 20062009 at the rabat military teaching hospital. However, a rise in the incidence of sis has recently been noticed due to increasing life expectancy, use of endovascular devices, diabetes mellitus. This study evaluates the safety and effectiveness of computed tomography ct assisted endoscopic surgery in the treatment of infectious spondylodiscitis of the thoracic and upper lumbar spine in immunocompromised patients. Wound contamination with organic matter can lead to postdisaster skin and soft tissue fungal. Infectious spondylodiscitis due to eikenella corrodens. Singleapproach vertebral osteosynthesis in the treatment. Cervical spondylodiscitis caused by candida albicans in a non. Pdf infectious spondylodiscitis presents a diagnostic conundrum, and establishing the diagnosis often requires expensive testing and workup. Spondylodiscitis should be borne in mind in cases of diffuse back pain and nonspecific symptoms. No clear infection of the facet joint was described at the time.
Bacterial spondylodiscitis verterbral osteomyelitis is an infection of the intervertebral disc and the adjacent vertebral bodies. Pyogenic spondylodiscitis is the infectious process that affects the vertebral body and the intervertebral disc. Anaerobic spondylodiscitis due to fusobacterium species. Infective spondylodiscitis usually occurs in patients of older age, immunocompromisation, comorbidity, and individuals suffering from an overall poor general condition unable to undergo reconstructive anterior and posterior surgeries. Blood, disc tissue, or psoas abscess cultures in our patients often required 72 hours of incubation before there was sufficient growth to identify a pathogen. If spondylodiscitis is suspected, tissue material from the suspected vertebral segment can be obtained by fine needle aspiration or punch biopsies. But because of the potentially irreversible neurologic. Infectious spondylodiscitis presents a diagnostic conundrum, and establishing the diagnosis often requires expensive testing and workup. The medical literature was searched using pubmed, employing the key words discitis, disc space infection, infectious spondylodiscitis, pyogenic discitis, septic discitis and postoperative discitis. Bacteriological features of infectious spondylodiscitis at. L45 inflammatory process involving the vertebral end plates with associated destruction of the veps, marginal osteophytes with enhancement in post contrast images and extension of the enhancement to the paraspinal region. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a pdf plugin installed and enabled in your browser. If diagnosis is delayed, ankylosis remains a late complication and sequela that may be encountered 1517.
An uncommon but wellrecognized complication of as is spondylodiscitis, a destructive discovertebral lesion also called andersson lesion. A twentyyear experience from a single tertiary referral center article pdf available in egyptian rheumatologist 4 july 2018 with 103 reads how we measure reads. A total of 1,402 patients were identified over a year period. Escherichia coli is the most common gramnegative organism causing spondylodiscitis. This commonly leads to a several months from initial symptoms to final diagnosis. A minimally invasive endoscopic surgery for infectious. Cervical spondylodiscitis caused by candida albicans in a nonimmunocompromised patient. It usually starts at the interface of the disc and the vertebra. Due to the low incidence, evidencebased surgical recommendations in the literature are equivocal, and the treatment modalities remain controversial.
Dual imaging with petct may thus become the imaging modality of choice, especially in patients with prior surgery andor implants, where mri is contraindicated or hampered by artifact 811. In literature the relapse rate of 07% has been recorded. Instrumented osteosynthesis should be preferred for spondylodiscitis with osteolysis and spinal instability because it allows early mobilization and rehabilitation whenever necessary. Most cases of spontaneous spondylodiscitis are caused by staphylococcus aureus and most postoperative cases are caused by staphylococcus aureus or coagulasenegative staphylococci. The most common site of spondylodiscitis is the lumbar spine 60%, followed by the breast 30% and the cervical spine 10% 3,5,7.