Abstract
BackgroundThe aim of this study was to evaluate the clinical outcome after radical surgical treatment of multifocal infections involving the spine.MethodsThe study demonstrates a retrospective chart review of seven patients who had more than three different abscesses in the musculoskeletal system and at least one of them in the area of the spinal column. All patients had a sepsis.ResultsBeside different musculoskeletal abscesses four patients had a spondylodiscitis in the cervical spine segments C4/5 or C5/6. Six patients had inflammatory processes in the lumbar spine with epidural abscesses, diffuse thoracolumbar paravertebral abscesses and a spondylodiscitis in different segments. In all cases we performed a radical surgical treatment of all related inflammatory focuses. Prompt radical surgical treatment of the spine included decompression, debridement and in the cases of spondylodiscitis a fusion of the involved segments. For more than one focus at the spine, a surgical one-step procedure was performed. An antibiotic therapy was administered for six to eight weeks. In follow up examinations no signs of ongoing inflammatory processes were seen in imaging studies or laboratory tests.ConclusionsIn the event of multiple abscesses of the musculoskeletal system involving the spine an early correct diagnosis and radical surgical treatment is recommended. We strongly favor a surgical single-stage procedure for treatment of multiple infections of the spine. In addition to a radical debridement and a sufficient decompression, the segmental fusion of affected areas in spondylodiscitis is essential. At the same time a surgical therapy of all other infected sites should be performed.
Highlights
The aim of this study was to evaluate the clinical outcome after radical surgical treatment of multifocal infections involving the spine
We present seven cases of multifocal infections of the musculoskeletal system involving the spine with sepsis
Three patients had an initial infection of a total knee prosthesis, one patient had an infection of a central venous port system and one patient had a purulent bacterial arthritis of the hip
Summary
The aim of this study was to evaluate the clinical outcome after radical surgical treatment of multifocal infections involving the spine. Treatment of sepsis resulting from multifocal infections involving the spinal column is a challenge. Patients with multiple inflammatory focuses have an immunodeficiency. This can be caused by a tumor disease or a metabolic disease [1,2]. Patients who are affected by rheumatism have a higher risk of developing multiple abscesses. In particular patients with total joint replacement and Pyogenic spondylodiscitis or spinal abscesses usually are caused by hematogenous spreading of pathogens from other infectious sites. Staphylococcus aureus followed by Streptococcus species and gram-negative bacteria are common pathogens [4]
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