• Title/Summary/Keyword: Pyogenic spondylodiscitis

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Pyogenic Spondylodiscitis after Percutaneous Endoscopic Lumbar Discectomy

  • Choi, Kyeong-Bo;Lee, Choon-Dae;Lee, Sang-Ho
    • Journal of Korean Neurosurgical Society
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    • v.48 no.5
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    • pp.455-460
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    • 2010
  • We reviewed 9 cases of pyogenic spondylodiscitis following percutaneous endoscopic lumbar discectomy (PELD). Microbiologic cultures revealed 6 causative organisms. Five patients were managed conservatively and four were treated surgically. The mean follow-up period was 20.6 months and the average length of hospitalization was 24 days. Radiological evidence of spinal fusion was noted and infection was resolved in all patients. Although PELD is a safe and effective procedure, the possibility of pyogenic spondylodiscitis should always be considered.

Spondylodiscitis Misdiagnosed as Spinal Stenosis and Compression Fracture -A report of two cases- (요척주관 협착증과 압박 골절로 오인된 척추 추간판염 2예 -증례보고-)

  • Hong, Ji Hee;Kim, Sae-Young;Han, Sung Ho
    • The Korean Journal of Pain
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    • v.22 no.2
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    • pp.176-180
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    • 2009
  • Cases of pyogenic spondylodiscitis are relatively rare diseases that concern 2-7% of total cases of osteomyelitis. Owing to the low frequency and initial nonspecific nature of signs and symptoms, diagnosis is often delayed up to 2-6 months. If the proper treatment is not established due to a diagnostic delay, there is a possibility of a serious neurologic deficit and spinal instability. We report two cases of infectious spondylodiscitis which were misdiagnosed as compression fracture and spinal stenosis respectively. They could be correctly diagnosed after MRI and laboratory test and under the recovery state after an antifungal and antibiotic medication. Special careful attention during the diagnostic procedure is a really important step considering the diagnostic delay and its resultant unsatisfactory outcome.

Anterior Interbody Grafting and Instrumentation for Advanced Spondylodiscitis

  • Lim, Jae-Kwan;Kim, Sung-Min;Jo, Dae-Jean;Lee, Tae-One
    • Journal of Korean Neurosurgical Society
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    • v.43 no.1
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    • pp.5-10
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    • 2008
  • Objective : To evaluate the surgical outcomes of ventral interbody grafting and anterior or posterior spinal instrumentation for the treatment of advanced spondylodiscitis with patients who had failed medical management. Methods : A total of 28 patients were evaluated for associated medical illness, detected pathogen, level of involved spine, and perioperative complications. Radiological evaluation including the rate of bony union, segmental Cobb angle, graft- and instrumentation-related complications, and clinical outcomes by mean Frankel scale and VAS score were performed. Results : There are 14 pyogenic spondylodiscitis, 6 postoperative spondylodiscitis, and 8 tuberculous spondylodiscitis. There were 21 males and 7 females. Mean age was 51 years, with a range from 18 to 77. Mean follow-up period was 10.9 months. Associated medical illnesses were 6 diabetes, 3 pulmonary tuberculosis, and 4 chronic liver diseases. Staphylococcus was the most common pathogen isolated (25%), and Mycobacterium tuberculosis was found in 18% of the patients. Operative approaches, either anterior or posterior spinal instrumentation, were done simultaneously or delayed after anterior aggressive debridement, neural decompression, and structural interbody bone grafting. All patients with neurological deficits improved after operation, except only one who died from aggravation as military tuberculosis. Mean Frankel scale was changed from $3.78{\pm}0.78$ preoperatively to $4.78{\pm}0.35$ at final follow up and mean VAS score was improved from $7.43{\pm}0.54$ to $2.07{\pm}1.12$. Solid bone fusion was obtained in all patients except only one patient who died. There was no need for prolongation of duration of antibiotics and no evidence of secondary infection owing to spinal instrumentations. Conclusion : According to these results, debridement and anterior column reconstruction with ventral interbody grafting and instrumentation is effective and safe in patients who had failed medical management and neurological deficits in advanced spondylodiscitis.

Candida Parapsilosis Spondylodiscitis after Lumbar Discectomy

  • Cho, Kyun-Gil;Lee, Sun-Ho;Kim, Eun-Sang;Eoh, Whan
    • Journal of Korean Neurosurgical Society
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    • v.47 no.4
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    • pp.295-297
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    • 2010
  • Candida is a relatively rare cause of spinal infections that commonly affects immunocompromised patients. A 70-year-old woman, who underwent a lumbar discectomy on L5-S1 two months earlier, was admitted to our department complaining of persistent back and leg pain. Magnetic resonance imaging showed irregular enhancing mass lesion in L5-S1 intervertebral space, suggest of pyogenic discitis with epidural abscess. The surgery was performed via retroperitoneal approach and the infected material at L5-S1 intervertebral space was removed. The histological examination of the specimen revealed chronic inflammation involving the bone and soft tissue, and a culture of the excised material was positive for Candida parapsilosis. The patient received intravenous fluconazole for 4 weeks after surgery and oral fluconazole 400 mg/day for 3 months after surgery. The patient made a full recovery with no symptoms 6 months after surgery. We present a rare case of spondylodiscitis after a lumbar discectomy due to Candida parapsilosis and discuss treatment option with a review of the literatures.

Is It Appropriate to Insert Pedicle Screws at an Infected Vertebral Body in the Treatment of Lumbar Pyogenic Spondylodiscitis? (요추부 화농성 척추염의 수술적 치료: 이환된 추체에 척추경 나사 고정이 타당한가?)

  • Na, Hwa-Yeop;Jung, Yu-Hun;Lee, Joo-Young;Kim, Hyung-Do
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.5
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    • pp.419-426
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    • 2021
  • Purpose: In the surgical treatment of pyogenic lumbar spondylodiscitis, screw insertion at the affected vertebra has been avoided because of biofilm formation, and the risk of infection recurrence. The authors analyzed the success rate of infection treatment while minimizing the number of instrumented segments by inserting pedicle screws into the affected vertebrae. Therefore, this study examined the usefulness of this technique. Materials and Methods: From January 2000 to June 2018, among patients with pyogenic lumbar spondylodiscitis treated surgically, group A consisted of patients with pedicle screws inserted directly at the affected vertebrae (28 cases), and group B underwent fusion by inserting screws at the adjacent normal vertebrae due to bone destruction of the affected vertebral pedicle (20 cases). The classified clinical results were analyzed retrospectively. All patients were treated via the posterior-only approach, so the affected disc and sequestrum were removed. Posterior interbody fusion was performed with an autogenous strut bone graft, and the segments were then stabilized with pedicle screw systems. The hospitalization period, operation time, amount of blood loss, EQ-5D index, duration of intravenous antibiotics, and the clinical and radiological results were analyzed. Results: In group A, the number of instrumented segments, operation time, blood loss, and EQ-5D index at one month postoperatively showed significant improvement compared to group B. There were no significant differences in the duration of antibiotic use, hospitalization, radiological bone union time, sagittal angle correction rate, and recurrence rate. Conclusion: Minimal segmental fixation, in which pedicle screws were inserted directly into the affected vertebrae through the posterior approach, reduced the surgery time and blood loss, preserved the lumbar motion by minimizing fixed segments and showed rapid recovery without spreading or recurrence of infection. Therefore, this procedure recommended for the surgical treatment of lumbar pyogenic spondyodiscitis.

Comparative Analysis of Spontaneous Infectious Spondylitis : Pyogenic versus Tuberculous

  • Lee, Yangwon;Kim, Bum-Joon;Kim, Se-Hoon;Lee, Seung-Hwan;Kim, Won-Hyung;Jin, Sung-Won
    • Journal of Korean Neurosurgical Society
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    • v.61 no.1
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    • pp.81-88
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    • 2018
  • Objective : Spondylitis is often chemotherapy resistant and requires long-term treatment. Without adequate chemotherapy, the outcome can be fatal or result in severe neurologic damage. Therefore, differentiating the etiology of spondylitis is very important, particularly in spontaneous cases. As the prevalence of tuberculosis in Korea has decreased in recent years, updated clinical research about spondylitis is warranted. Methods : From April 2010 to March 2016, data from spondylitis patients were collected retrospectively. In total, 69 patients (51 with pyogenic spondylitis and 18 with tuberculous spondylitis) were included. Clinical data, laboratory findings including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, measurements of Cobb angles at the initial and final follow-up, and radiologic features on magnetic resonance imaging (MRI) scans were evaluated. To test differences between the pyogenic and tuberculous groups, numerical data were compared using the student's t-test and Mann-Whitney U test, and categorical data were compared using the chi-square test and Fisher's exact test. Results : The patients' mean age was 60.0 years. Male sex was slightly predominant (56.5%). There was no difference in mean age and sex between the two groups. The pyogenic group had a relatively higher proportion of immunocompromised patients. The peak CRP value was higher in the pyogenic group than in the tuberculous group (14.08 mg/dL and 8.50 mg/dL, respectively, p=0.009), whereas the ESR was not significantly different between the groups (81.5 mm/h and 75.6 mm/h, respectively, p=0.442). Radiologically, the presence of disc space sparing and vertebral body collapse differed between the groups. In the tuberculous group, the disc was more commonly preserved on contrast-enhanced MRI (50% and 23.5%, respectively, p=0.044), and vertebral body collapse was more common (66.6% and 15.7%, respectively, p<0.001). The mean length of hospitalization was longer in the pyogenic group (56.5 days and 41.2 days, respectively, p=0.001). Four mortality cases were observed only in the pyogenic group. The most commonly isolated microorganism in the pyogenic group was Staphylococcus aureus(S. aureus) (methicillin susceptible S. aureus and methicillin resistant S. aureus [MRSA] in 8 and 4 cases, respectively). Conclusion : The clinical and radiological manifestations of spontaneous spondylitis differ based on the causative organism. Pyogenic spondylitis patients tend to have a higher CRP level and a more severe clinical course, whereas tuberculous spondylitis patients present with destruction of the vertebral body with disc sparing more frequently. The presence of MRSA is increasing in community-acquired spondylitis cases.

No more tears from surgical site infections in interventional pain management

  • Seungjin Lim;Yeong-Min Yoo;Kyung-Hoon Kim
    • The Korean Journal of Pain
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    • v.36 no.1
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    • pp.11-50
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    • 2023
  • As the field of interventional pain management (IPM) grows, the risk of surgical site infections (SSIs) is increasing. SSI is defined as an infection of the incision or organ/space that occurs within one month after operation or three months after implantation. It is also common to find patients with suspected infection in an outpatient clinic. The most frequent IPM procedures are performed in the spine. Even though primary pyogenic spondylodiscitis via hematogenous spread is the most common type among spinal infections, secondary spinal infections from direct inoculation should be monitored after IPM procedures. Various preventive guidelines for SSI have been published. Cefazolin, followed by vancomycin, is the most commonly used surgical antibiotic prophylaxis in IPM. Diagnosis of SSI is confirmed by purulent discharge, isolation of causative organisms, pain/tenderness, swelling, redness, or heat, or diagnosis by a surgeon or attending physician. Inflammatory markers include traditional (C-reactive protein, erythrocyte sedimentation rate, and white blood cell count) and novel (procalcitonin, serum amyloid A, and presepsin) markers. Empirical antibiotic therapy is defined as the initial administration of antibiotics within at least 24 hours prior to the results of blood culture and antibiotic susceptibility testing. Definitive antibiotic therapy is initiated based on the above culture and testing. Combination antibiotic therapy for multidrug-resistant Gram-negative bacteria infections appears to be superior to monotherapy in mortality with the risk of increasing antibiotic resistance rates. The never-ending war between bacterial resistance and new antibiotics is continuing. This article reviews prevention, diagnosis, and treatment of infection in pain medicine.

Late-Onset Candida Vertebral Osteomyelitis in Two Young Patients Who Underwent Heart Transplant Surgery (심장 이식술을 받은 젊은 환자에서 발생한 2예의 지연성 칸디다 척추 골수염)

  • Kang, Min Seok;Son, In Seok;Kim, Tae Hoon;Lee, Suk Ha
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.1
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    • pp.72-77
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    • 2019
  • Candida vertebral osteomyelitis (CVO) is a rare disease that is a complication of intravenous drug use, but recently it has been recognized as mostly an opportunistic infection. Because CVO appears to mimic pyogenic spondylodiscitis in terms of the clinical and radiologic presentations, it is often neglected in a usual clinical setting. The clinical, radiological, and biological characteristics of CVO are often used to make a differential diagnosis with vertebral osteomyelitis from other etiologies. Once an initial proper diagnosis was performed, the treatment relies on the prompt initiation of appropriate pharmacotherapy and serial monitoring of the clinical progress. This paper report late-onset CVO in two young patients who underwent a heart transplant surgery and had postoperative systemic candidiasis. These two cases are a good reminder of the potential of CVO in immunosuppressive patients treated with anti-fungal agents. This paper presents these two cases with a review of the relevant literature.