• Journal of Korean Neurosurgical Society
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• 제48권5호
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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.

• The Korean Journal of Pain
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• 제22권2호
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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.

• Journal of Korean Neurosurgical Society
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• 제43권1호
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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.

• Journal of Korean Neurosurgical Society
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• 제47권4호
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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.

• 대한정형외과학회지
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• 제56권5호
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• pp.419-426
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• 2021

목적: 화농성 요추부 추체 감염의 수술적 치료 시 이환된 추체에 척추경 나사를 삽입하는 수술법은 균막의 형성 및 감염 치료 실패의 위험성으로 기피되었다. 저자들은 이환된 추체에 척추경 나사를 삽입하여 고정 분절수를 최소화하면서도 감염 치료에 성공하였는바, 이를 분석하여 해당 술식의 유용성에 대하여 알아보고자 하였다. 대상 및 방법: 2000년 1월부터 2018년 6월까지 본원 척추센터에서 제1저자에 의해 수술적으로 치료한 화농성 요추부 척추 감염 환자 중, 이환된 추체에 직접 척추경 나사를 삽입하여 유합술을 시행한 환자군을 그룹 A, 이환된 추체 척추경의 골파괴 소견으로 인접 정상 추체에 척추경 나사를 삽입하여 유합술을 시행한 환자군을 그룹B로 분류하여 임상적 결과를 후향적으로 연구하였다. 모든 환자들은 후방 접근법으로 수술하였으며, 이환된 추간판을 제거하고 부골화된 추체의 소파술 및 추체 간 자가 지주골 이식술 후 척추경 나사 고정술을 시행한 48예(그룹A 28예, 그룹B 20예)를 대상으로 두 그룹 간의 입원 기간, 수술 시간, 출혈량 및 수술 후 1개월째 EQ-5D 지수, 주사 항생제 투여 기간, 혈액학적 결과, 임상적 결과, 방사선학적 결과를 종합적으로 분석하였다. 결과: 그룹 A에서 고정 분절 수, 수술 시간, 출혈량 및 술 후 1개월째 EQ-5D 지수에서 그룹 B에 비하여 통계적으로 유의하게 향상된 결과를 보였으며, 항생제 사용 기간, 입원 기간, 방사선학적 골유합의 시기, 시상각의 교정률 및 재발률에서는 유의한 차이를 보이지 않았다. 결론: 후방 도달법을 통한 이환된 추체에 직접 척추경 나사를 삽입하는 최소 분절 고정술은 수술 시간 및 출혈량이 줄어들고, 고정분절을 최소화하여 요추부의 운동성을 보전하면서도, 감염의 확산이나 재발 없이 빠른 회복을 보였기에, 요추부 화농성 척추염 환자의 수술적 치료 시 권장할 만한 술식으로 생각된다.

• Journal of Korean Neurosurgical Society
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• 제61권1호
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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.

• The Korean Journal of Pain
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• 제36권1호
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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.

• 대한정형외과학회지
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• 제54권1호
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• pp.72-77
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• 2019

칸디다 척추 골수염은 드문 질환으로서 과거에는 마약 등 정맥 내 주사제 사용자들에서 발생하는 합병증으로 알려져 왔으나 최근에는 대부분이 병원 내 기회 감염의 형태로 발생되고 있다. 칸디다 척추 골수염의 임상적 및 영상학적 특징이 화농성 척추 추간판염과 유사하기 때문에 일반적인 임상에서 간과되는 경우가 흔하다. 칸디다 척추 골수염에서 다른 원인에 의한 척추 골수염과의 감별진단은 임상적, 영상의학적 및 생물학적 특성에 의존한다. 칸디다 척추염의 치료는 초기의 정확한 진단과 이를 바탕으로 신속하고 적절한 약물 요법, 임상경과의 지속적인 추적관찰로 이루어진다. 본 증례에서 심장 이식술을 받은 젊은 환자에서 수술 후 전신성 진균증 치료 3개월 후 발생한 지연성 칸디다 척추 골수염을 항 진균제 단독요법으로 치료한 2예를 경험하였기에 이를 보고하고 문헌고찰을 통해 상기하고자 한다.