Paravertebral Abscess Research Articles

Spondylodiscitis and Its Mimickers: A Pictorial Review

Spondylodiscitis is an infection of the intervertebral disc, the adjacent vertebral body, and/or contiguous structures due to the introduction of infectious agent, usually by the hematogenous route. Imaging is crucial in assessing bacterial and tubercular spondylodiscitis, as well as their associated complications. Magnetic resonance imaging in particular can clearly depict osteo-structural changes in the vertebral body and the associated disc, as well as any soft-tissue complications, such as paravertebral abscess and/or epidural abscess, improving disease characterization and helping to recognize the agent involved. Nevertheless, other non-infectious diseases may mimic imaging appearances of spondylodiscitis and one should be aware of these conditions when interpreting MR images, which include Modic type I degenerative changes, ankylosing spondylitis, acute Schmorl’s node, porotic fractures, and spinal neuropathy arthropathy. This pictorial review aims at describing imaging findings of bacterial and non-bacterial spondylodiscitis, complications, and those pathologies that mimic these infections.

Upper Thoracic Pyogenic Spondylitis With a Paravertebral Abscess Treated With a Combination of Cranked Minimally Invasive Spinal Instrumentation and Negative Pressure Wound Therapy: A Case Report

Upper Thoracic Pyogenic Spondylitis With a Paravertebral Abscess Treated With a Combination of Cranked Minimally Invasive Spinal Instrumentation and Negative Pressure Wound Therapy: A Case Report

A Retrospective Study on Endoscopic Surgery for the Treatment of Paravertebral Abscess in Spinal Tuberculosis Patients.

Spinal tuberculosis (TB) remains a significant global health concern, necessitating the development of innovative treatment strategies. This clinical study aimed to evaluate the efficacy and safety of endoscopic debridement as a minimally invasive approach for treating paravertebral abscesses in patients with spinal tuberculosis. A total of 52 patients diagnosed with paravertebral tuberculosis abscesses were enrolled in this retrospective study. Patients were assigned to two groups: the endoscopic debridement group (n = 30) and the conventional open surgery group (n = 22), based on the type of surgery they received. Clinical outcomes were assessed at baseline, post-treatment, and follow-up visits at regular intervals, including surgery time, intraoperative blood loss, total hospital stay duration, pain relief, and neurological improvement. The results of this study demonstrate that endoscopic debridement is a highly effective treatment for paravertebral abscesses in patients with spinal TB. Patients in the endoscopic debridement group experienced significant improvements in surgery time, intraoperative blood loss, total hospital stay duration, pain relief, and neurological improvement compared to those in the conventional open surgery group. Additionally, the endoscopic approach resulted in fewer complications, such as wound infections and postoperative instability, with no cases of recurrence observed during the follow-up period. Therefore, this clinical study highlights the potential of endoscopic debridement as a safe and effective treatment modality for spinal tuberculosis. The technique not only effectively eliminates infected tissue but also ensures faster patient recovery and reduces postoperative complications. Additional research and long-term follow-up studies are necessary to confirm the long-term effectiveness and safety of endoscopic debridement as the standard treatment for spinal tuberculosis.

Septic paravertebral abscess and inferior vena cava thrombosis complicated by uro-sepsis: Case report

Paravertebral abscess is an uncommon and potentially dangerous illness characterized by the buildup of pus in the anatomical area surrounding the spinal column. A 65-year-old female, who has diabetes and high blood pressure, came in with intense discomfort in her lower back that spreads to her lower limbs, making it difficult for her to move. She also has a high fever, excessive sweating, and has lost a large amount of weight. The blood tests indicate the following abnormalities: low Hb level of 9.6 g/dl, low MCV of 70 fl, elevated total white blood cell count of 15.8 × 109/L, elevated neutrophil count of 12.4 × 109/L, normal lymphocyte count of 2.8 × 109/L, high platelet count of 485 × 109/L, and elevated ESR of 110 mm/hr. The level of phosphatase was raised to 247 U/L, which is beyond the usual range of 40-150 U/L. The blood film reveals the presence of hypochromic microcytic red blood cells, which are indicative of iron deficiency anemia. There is also evidence of neutrophil leukocytosis in the white blood cells, with no immature cells observed. Additionally, an increase in platelets is observed in the film. The D-dimer level is 2009 ng/ml, which is within the normal range of less than 500 ng/ml. The CRP level is 48 gm/l, which is above the usual range of less than 6 gm/l. The bone marrow testing yielded normal results. The blood culture indicated the presence of Streptococcus epidermidis growth. Radiological tests revealed that a CE-MRI of the dorsal and lumbar spine indicated the presence of a para-aortic abscess together with septic thrombosis of the inferior vena cava. Paravertebral abscess is a critical emergent condition required a necessary therapy protocols to stabilize the patient status. The timing of intervention is crucial in cases of paravertebral abscess, as the existence of a mass can led to spinal cord compression.

MRI findings and classification of brucella spondylitis: a China multicenter study.

To propose a magnetic resonance imaging (MRI) classification of brucellosis spondylitis (BS) to determine a standard treatment method and a standard of post-treatment MRI follow-up. This is a multicenter retrospective cohort study. All patients diagnosed with BS at six hospitals for 12years, were included in the study. Data were collected retrospectively from the medical records of the patients. The classification of the cases was based on MRI. We analyzed MRI features of BS was categorized them into three types. Six hundred fifteen patients were included in the study, 78.9% of whom were males. The mean age was 53.05 ± 11.06years. Involvement of single vertebrae occurred in 6.2% of patients, while 72.7% involved two vertebrae and 21.1% involvement of more than two vertebrae. The most common of the lumbar spine was 64.6%. The main findings of MRI were affected vertebral endplate 2/3 above (60.7%), intervertebral space narrow (77.9%), intervertebral disc involvement (83.6%), paravertebral abscess (50.9%), disc abscess (49.6%), epidural abscess (43.3%), vertebra height change (22.1%), psoas abscess (22.0%), and abnormal vertebral accessory (10.2%). MR imaging of BS was categorized into three types. Type I: 57 (9.3%) patients; Type II: 526 (85.5%) patients, including IIa (26.5%), IIb (36.9%), and IIc (22.1%); Type IV: vertebral appendage type, 63 (10.2%) cases; Type III: 32 (5.2%) patients. MRI features of multicenter data can provide theoretical support for diagnosing BS. MRI classification of BS can afford better help for clinical treatment and follow-up after clinical treatment.

A simple scoring algorithm predicting paravertebral and/or iliopsoas abscess among adults with community-onset bloodstream infections: matters of PVL-producing Staphylococcus aureus

A simple scoring algorithm predicting paravertebral and/or iliopsoas abscess among adults with community-onset bloodstream infections: matters of PVL-producing Staphylococcus aureus

Meta-genomic next-generation sequencing in the diagnosis of brucellosis: Five cases from a non-endemic area.

Metagenomic next-generation sequencing (mNGS) in diagnosis of human brucellosis is comparatively unexplored. This report details five human brucellosis cases diagnosed using mNGS based on Illumina sequencing platform, comprising three females and two males, four with epidemiological exposure. In cases 1 and 2, plasma mNGS results showed one positive and one negative for Brucella melitensis, and subsequent blood cultures were both positive. Cases 3, 4 and 5 involved spinal brucellosis, some with paravertebral abscesses. mNGS from infectious tissue samples successfully detected Brucella, with read counts ranging between 30 and 1314, yet cultures were negative in cases 4 and 5. Following antibiotic and surgical treatments, all patients showed clinical improvement. This report shows mNGS testing enhances the detection sensitivity of brucellosis diagnosis.

A Comparative Factor Analysis and New Magnetic Resonance Imaging Scoring System for Differentiating Pyogenic Versus Tuberculous Spondylodiscitis.

This study aimed to compare and analyze differences in clinical and magnetic resonance imaging (MRI) findings between tuberculous spondylodiscitis (TbS) and pyogenic spondylodiscitis (PyS), and to develop and validate a simplified multiparameter MRIbased scoring system for differentiating TbS from PyS. We compared predisposing factors in 190 patients: 123 with TbS and 67 with PyS, confirmed by laboratory tests, culture, or pathology. Data encompassing patient demographics, clinical characteristics, laboratory results, and MRI findings were collected between 2015 and 2020. Data were analyzed using logistic regression methods, and selected coefficients were transformed into an MRI-based scoring system. Internal validation was performed using bootstrapping method. Univariate analysis revealed that the significant risk factors associated with TbS included thoracic lesions, vertebral destruction > 50%, intraosseous abscess, thin-walled abscess, well-defined paravertebral abscess, subligamentous spreading, and epidural abscess. Multivariate analysis revealed that only thoracic lesions, absence of epidural phlegmon, subligamentous spreading, intraosseous abscesses, well-defined paravertebral abscesses, epidural abscesses, and absence of facet joint arthritis were independent predictive factors for TbS (all p < 0.05). These potential predictors were used to derive an MRI scoring system. Total scores ≥ 14/29 points significantly predicted the probability of TbS, with a sensitivity of 97.58%, specificity of 92.54%, and an area under the curve of 0.96 (95% confidence interval, 125.40-3,257.95). This simplified MRI-based scoring system for differentiating TbS from PyS helps guide appropriate treatment when the causative organism is not identified.

Clinical characteristic, management, and outcomes of cervical spinal brucellosis: a retrospective cohort study over 1-year postoperative follow-up

BackgroundThe incidence of cervical spinal brucellosis is low, only a few case reports have been published, and case series are not widely reported in the medical literature. Therefore, clinical features, management, and outcomes of cervical spinal brucellosis are relatively unknown. In this series, the authors report 15 cases of patients with cervical spinal brucellosis, including clinical characteristic, imaging findings, management plans, the institution’s experience, and outcomes at 1 year postoperatively.MethodsThe study reviewed the clinical and radiographic records of 15 patients who received antimicrobial pharmacotherapy, and anterior cervical debridement and fusion for cervical spinal brucellosis. The data collected included patient demographic characteristics, spinal level affected, abscess, neurology, pathological reports, duration and type of antimicrobial regimens, details of orthopedic management, and complications incurred during the procedure.ResultsNeck pain (100%) and limb paralysis (86.7%) were the most common clinical presentations, and the disease had a rapid progression. The C6-7 segment was the most commonly affected segment, followed by C4-5 and C5-6. Imaging commonly revealed epidural or paravertebral abscesses (80%). There was a significant improvement in the VAS, JOA, and NDI scores three months after surgery, and the scores continued to improve until the final follow-up. There was a statistically significant difference between the pre- and postoperative scores (P < 0.05). The ESR and CRP levels returned to normal within three months postoperatively, being 7.7 ± 4.5 mm/h and 7.55 ± 3.48 mg/L, respectively. There were statistically significant differences between the pre- and postoperative levels (P < 0.05). The positive rate of bacterial culture testing of pus or lesion tissues was only 40%, but blood cultures revealed an even lower positivity rate (33.3%). The average antimicrobial pharmacotherapy regimen duration was 6.1 ± 1.9 months. All patients achieved intervertebral bone fusion within 8 months (4.8 ± 1.4 months) after surgery and were cured with non-recurrence.ConclusionsSpinal brucellosis rarely affects the cervical region, but its impact is more dangerous due to potential complications such as paraplegia or tetraplegia arising from epidural abscesses that compress the spinal cord. Surgical debridement, along with essential antimicrobial therapy, is an effective strategy and can lead to satisfactory prognosis in managing cervical spinal brucellosis.

Epidemiology and diagnostic tools practice of spinal tuberculosis at Kariadi Hospital Semarang, Indonesia

Introduction: Spinal tuberculosis (TB) is one of the most common manifestations of extrapulmonary TB. In contrast to pulmonary TB, currently, there is no consensus for standard management of spinal TB particularly in diagnosis. This study aims to provide an overview of spinal TB from an epidemiological profile and diagnostic practice perspective at Kariadi Hospital, Semarang. Method: We collect spinal TB patient data retrospectively through medical records in Kariadi Hospital Semarang between the 2019 to 2022 period. The data regarding all demographic profile, clinical, imaging, and laboratory data. Result: A total of 40 patients were included in this study, 23 patients were diagnosed through histopathology, 32 patients were diagnosed using gene expert examination, and 17 patients by Acid Fast Bacillus Test. The highest age distribution was 37.5% in the 21-30-year age group, with thoracic level involvement in 70% of cases. The average age was 35.10 ± 14.10 with the main complaint being weakness of the limbs followed by complaints of back pain. The MRI images found were paravertebral abscess (67.5%), followed by vertebral body compression (27.5%), vertebral body destruction (20%), wedging compression and disc narrowing (20%), and kyphosis (12, 5%). Conclusion: Establishing the diagnosis of spinal TB at Kariadi Hospital is very diverse, so management is needed regarding the selection of spinal TB diagnostic tools to provide appropriate management.

Case of successful treatment of spinal infection in a patient with high comorbidity and septic manifestations

The study presents a clinical case of complex treatment of a patient with high comorbidity (Charlson comorbidity index = 6 points) who had severe sepsis (SOFA score = 8 points) with multiple foci of pyogenic infection (spinal epiduritis, paravertebral and subdural abscesses, purulent meningitis, bilateral lower lobe pneumonia). The syndrome-based approach with the use of minimally invasive approaches in the early stages (no later than 12 hours from the onset of clinical manifestations of the disease) ensured a favorable outcome. Based on the results of surgical treatment, a conclusion was made about the tactics of surgical treatment in patients with spinal infection against the background of sepsis.

Magnetic Resonance Imaging (MRI) Images in Tuberculosis Spondylitis Patients at the Central General Hospital Prof. Dr. I.G.N.G. Ngoerah Year 2021-2023

Background: Tuberculous spondylitis is extrapulmonary tuberculosis that attacks the spine. The incidence of tuberculosis has decreased. However, the prevalence of deaths due to tuberculosis is still high, so it requires appropriate management. Method: This study used a cross-sectional descriptive method, the research population was tuberculous spondylitis patients diagnosed at RSUP Prof. Dr. I.G.N.G Ngoerah 2021-2023. The research data source is PACS MRI data, with a sample size of 25. This research uses a consecutive sampling technique. Data analysis uses univariate analysis. Result: The research results showed that 25 samples met the inclusion criteria. Patients in the largest age group were 19 – 39 (36%) years and 40 – 59 years (36%) and the largest sex was female (56%). The most common location of vertebral MR Imaging was found in the thoracic (36%), intervertebral disc involvement was (52%) with normal discs and (48%) with disc destruction, there was endplate defect and paravertebral abscess in all samples (100%), the presence of gibbus deformity As many as (88%) of the sample, spinal cord compression was (96%), the most destruction of the corpus vertebral was on the anterior side (64%), and the most change in intensity of the interverbal disc was without contrast enhancement (60%). Conclusion: There are more women than men. The largest age groups are 19 - 39 years and 40 - 59 years with the most MR Imaging, namely in the thoracic location, normal intervertebral discs, endplatedefect, and paravertebral abscesses in all samples, gibbus deformity, spinal cord compression, anterior corpus vertebral destruction, and changes in intensity, intervertebral disc without contrast enhancement. Keywords: Tuberculous spondylitis, MRI, Bali

Spondylodiscitis: Understanding pathophysiology, surgical strategies, and postoperative management - A single-center study.

Spondylodiscitis (SD) is an inflammatory condition affecting the intervertebral discs and adjacent structures, often leading to serious complications, including epidural abscesses. This study aimed to differentiate postoperative SD from spontaneous cases caused by osteoporotic defects and associated pathologies, evaluating the frequency of SD in spinal diseases at a single center. A retrospective observational study involving 25 patients was conducted, analyzing variations between postoperative revisions in SD patients and spontaneous SD due to concurrent pathology and osteoporotic defects. The effects of postoperative wound healing following transforaminal lumbar interbody fusion and decompressive hemilaminectomy with pedicle screws were also investigated. Ethical guidelines were strictly followed during the study, conducted from January 2023 to September 2023 at Moscow City Clinical Hospital No. 68, Demikhova V.P. Among the 25 patients with spontaneous SD, 15 females and 10 males were included, with only two undergoing surgical revision. Predominant purulent inflammatory foci were observed at specific spinal levels, and demographics revealed prevalent comorbidities such as arterial hypertension (80%) and type 2 diabetes mellitus (60%). Postoperative complications included paravertebral abscesses and wound-related issues. Structural observations indicated vertebral destruction, joint gaps, and localized spinal canal narrowing, revealing complexities in SD cases. Surgical intervention remains crucial for addressing SD-related vertebral complications, while antimicrobial therapy tailored to specific pathogens is pivotal. Concurrent conditions necessitate comprehensive management, often involving cardiological interventions. Postoperatively, a combined approach of conservative therapy and calcium phosphate adjuncts is recommended, especially considering the observed low bone density, aiming to optimize patient recovery and spinal stability.

Bilateral Endoscopic Debridement Combined with Local Antituberculosis Drugs for Thoracic Tuberculosis with Large Paravertebral Abscess: A Multicenter Study with 4-year Follow-Up

BackgroundParavertebral abscess represents a prevalent manifestation of thoracic tuberculosis, often necessitating surgical intervention. In this study, we introduced a novel approach by employing bilateral endoscopic debridement to address large Paravertebral abscesses associated with thoracic tuberculosis, a method not previously proposed in the literature. The clinical efficacy was examined through a comprehensive 4-year follow-up. MethodsWe conducted a retrospective analysis on patients diagnosed with thoracic tuberculosis and paravertebral abscess (TB-PA) who underwent bilateral endoscopic debridement combined with local antituberculosis drugs (BED+LAD) between February 2015 and February 2019. A total of 29 eligible patients (12 males and 17 females) with a median (interquartile ranges, IQR) of 59.0(16.5) years were included in the study. All patients received the BED+LAD treatment. After the surgery, the patients were treated with a 4-drug antituberculosis therapy (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol). All relevant indicators were meticulously recorded and analyzed. ResultsThe surgical procedures were successfully completed for all subjects, with an average intraoperative bleeding volume of (25.2 ± 8.9) ml, an average surgical time of (68.4 ± 14.0) minutes, an average fluoroscopy frequency of (21.7 ± 8.2) times, an average hospital stay of (14.2 ± 4.3) days, and an average medication period of (42.1 ± 9.6) weeks. All subjects completed at least a 4-year follow-up period. At the final follow-up, ESR and CRP levels returned to normal, and there was no significant increase in the Cobb angle (P>0.05). ConclusionThe application of BED+LAD in the treatment of TB-PA proved to be a safe, effective, and feasible approach.

Case Report: 14 Years-Old Boy with Paraplegia and Aneurysmal Bone Cysts of Neck who Responded to Anti-Tuberculosis Treatment

This article discusses a rare case of Aneurysmal Bone Cyst (ABC) affecting the cervical spine, presenting with neck pain and progressive weakness in all extremities. A 14-year-old boy experienced these symptoms for three years without any history of trauma. Physical examination revealed weakness and tenderness in the cervical vertebrae. MRI showed cervical compression, paravertebral abscess, spinal nerve swelling, and canal stenosis, suggestive of tuberculosis spondylitis. The surgical intervention involved laminectomy and tumor debulking, confirming the diagnosis of a aneurysmal bone cyst. Despite initial motor deficits, anti-tuberculosis treatment significantly improves motor function and neck mobility over several weeks. This case underscores the rarity of cervical spine involvement in aneurysmal bone cyst and highlights the importance of prompt diagnosis and treatment to prevent neurological complications and achieve favorable outcomes. The study emphasizes considering aneurysmal bone cyst as a potential differential diagnosis for lytic lesions involving the spine in young patients, emphasizing the need for vigilance in clinical practice.

Incidence and warning signs for complications of human brucellosis: a multi-center observational study from China

BackgroundBrucellosis is a severe zoonotic disease that is often overlooked, particularly in impoverished countries. Timely identification of focal complications in brucellosis is crucial for improving treatment outcomes. However, there is currently a lack of established indicators or biomarkers for diagnosing these complications. Therefore, this study aimed to investigate potential warning signs of focal complications in human brucellosis, with the goal of providing practical parameters for clinicians to aid in the diagnosis and management of patients.MethodsA multi-center cross-sectional study was conducted in China from December 2019 to August 2021. The study aimed to investigate the clinical characteristics and complications of patients with brucellosis using a questionnaire survey and medical record system. The presence of warning signs for complications was assessed using univariate and multivariate logistic regression models. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used for variable screening and model evaluation.ResultsA total of 880 participants diagnosed with human brucellosis were enrolled. The median age of the patients was 50 years [interquartile range (IQR): 41.5–58.0], and 54.8% had complications. The most common organ system affected by complications was the osteoarticular system (43.1%), with peripheral arthritis (30.0%), spondylitis (16.6%), paravertebral abscess (5.0%), and sacroiliitis (2.7%) being the most prevalent. Complications in other organ systems included the genitourinary system (4.7%), respiratory system (4.7%), and hematologic system (4.6%). Several factors were found to be associated with focal brucellosis. These factors included a long delay in diagnosis [odds ratio (OR) = 3.963, 95% confidence interval (CI) 1.906–8.238 for > 90 days], the presence of underlying disease (OR = 1.675, 95% CI 1.176–2.384), arthralgia (OR = 3.197, 95% CI 1.986–5.148), eye bulging pain (OR = 3.482, 95% CI 1.349–8.988), C-reactive protein (CRP) > 10 mg/L (OR = 1.910, 95% CI 1.310–2.784) and erythrocyte sedimentation rate (ESR) elevation (OR = 1.663, 95% CI 1.145–2.415). The optimal cutoff value in ROC analysis was > 5.4 mg/L for CRP (sensitivity 73.4% and specificity 51.9%) and > 25 mm/h for ESR (sensitivity 47.9% and specificity 71.1%).ConclusionsMore than 50% of patients with brucellosis experienced complications. Factors such as diagnostic delay, underlying disease, arthralgia, eye pain, and elevated levels of CRP and ESR were identified as significant markers for the development of complications. Therefore, patients presenting with these conditions should be closely monitored for potential complications, regardless of their culture results and standard tube agglutination test titers.

Role of magnetic resonance imaging in differentiating tuberculous spondylitis from pyogenic spondylitis in a TB endemic area

Background: Infectious spondylitis is an infection by a specific organism of one or more components of spine, namely the vertebra, intervertebral discs, paraspinal soft tissues, and epidural space. Magnetic resonance imaging (MRI) of the spine is gold standard in imaging to assess anatomical abnormalities of the spine and surrounding structures. Methods: This cross-sectional observational study was conducted in the Department of Radiology Narayan Medical College and Hospital Sasaram, Bihar (India), where tuberculosis is endemic from July 2022 to September 2023. It included 40 patients, purposively sampled, adhering to strict inclusion and exclusion criteria. Sensitivity, specificity and accuracy of MRI in discriminating tuberculous spondylitis from pyogenic spondylitis were compared against histopathological diagnosis and differences in MRI findings between these conditions were obtained. Results: In this study, 93% patients with tuberculous spondylitis had an enhanced signal with well-defined margins. Meanwhile, pyogenic spondylitis provided an ill-defined margins in 72.7% patients. Most of the patients 82.7% with tuberculous spondylitis showed thin and smooth wall paravertebral abscesses, while pyogenic spondylitis showed an irregular and thick wall paravertebral abscesses in 45% patients. A total of 72.4% patients with tuberculous spondylitis indicated involvement of ≥3 vertebral bodies. 100% patients with pyogenic spondylitis showed an abnormal contrast enhancement of the intervertebral discs. It was identified that tuberculous spondylitis had sensitivity, specificity, and accuracy values of 100%, 84.6%, and 95.2% respectively. For pyogenic spondylitis, the corresponding values were 84.6%, 96.6%, and 93%. Conclusions: MRI was accurate for differentiation of tuberculous spondylitis from pyogenic spondylitis. A well-defined paraspinal abnormal signal, a thin and smooth abscess wall, subligamentous spread to three or more vertebral levels, and less likely involvement of intervertebral discs were more suggestive of tuberculous spondylitis than pyogenic spondylitis.

Evaluation of diagnostic criteria and choice of treatment tactics for patients with infectious spondylodiscitis based on a case series

Objective. To present a brief description of a series of clinical cases of infectious spondylodiscitis with an assessment of the used diagnostic criteria in terms of their influence on the choice of sanifying treatment tactics.Material and Methods. A continuous retrospective study of 39 cases of spondylodiscitis was carried out. Level of evidence is IIIC. The level of ESR, serum C-reactive protein, the results of the study of biopsy materials, and CT and MRI data were evaluated. Criteria of neurological deficit, instability of the spinal motion segment, and recommendations for assessing the clinical and radiological severity of the disease were used to select the treatment tactics. Treatment success was defined as primary wound healing, absence of recurrent infection and/or death, and satisfaction with treatment according to the EQ-5D and EQ-VAS scales at a follow-up period of 22.5 months.Results. The average age of patients was 57.4 years. Primary spondylodiscitis accounted for 82 %, the predominant localization of the pathological focus was the lumbar spine (56.4 %), and staphylococci were predominant etiologic agents (59.1 %). On average, the increase in ESR was 45 mm/h, C-reactive protein – 57 ng/l, and D-dimer – 1235 pg/ml. The level of pain before sanation according to the VAS scale was 6.79 points, after the operation it was 2.3 points (p &lt; 0.05). Instability of the spinal motion segment according to the SINS scale was revealed in 36 cases, paravertebral abscess according to MRI – in 51.3 % of cases, and neurological deficit – in 38.5 % of cases. Severe spondylodiscitis according to the SponDT scale was noted in 53.8 %, moderate – in 43.6 %, and mild – in 2.6 % of patients. According to the clinical and radiological classification of infectious spondylodiscitis severity (SSC), grade I was present in 2 patients, grade II – in 21, and grade III – in 6. Compliance of the chosen treatment tactics with current recommendations was noted in 94,9 % of cases. Recurrence of infection was observed in 7.7 %; lethal outcome – in 5.1 %. Satisfaction with the quality of life according to EQ-5D was 0.74 points, and according to EQ-VAS – 73.88 points.Conclusions. The integrated use of criteria for neurological deficit, instability of spinal motion segments, and severity of the disease according to the SponDT classification with the account of Pola’s recommendations on treatment tactics made it possible to choose the optimal treatment tactics and achieve satisfactory results in the sanation of patients with infectious spondylodiscitis.

Case report: Uncommon presentation of Salmonella Dublin infection as a large paravertebral abscess

Case report: Uncommon presentation of Salmonella Dublin infection as a large paravertebral abscess

Microbial spectrum, patient-specific factors, and diagnostics in implant-related postoperative spondylodiscitis

AimsImplant-related postoperative spondylodiscitis (IPOS) is a severe complication in spine surgery and is associated with high morbidity and mortality. With growing knowledge in the field of periprosthetic joint infection (PJI), equivalent investigations towards the management of implant-related infections of the spine are indispensable. To our knowledge, this study provides the largest description of cases of IPOS to date.MethodsPatients treated for IPOS from January 2006 to December 2020 were included. Patient demographics, parameters upon admission and discharge, radiological imaging, and microbiological results were retrieved from medical records. CT and MRI were analyzed for epidural, paravertebral, and intervertebral abscess formation, vertebral destruction, and endplate involvement. Pathogens were identified by CT-guided or intraoperative biopsy, intraoperative tissue sampling, or implant sonication.ResultsA total of 32 cases of IPOS with a mean patient age of 68.7 years (37.6 to 84.1) were included. Diabetes, age &gt; 60 years, and history of infection were identified as risk factors. Patient presentation upon admission included a mean body temperature of 36.7°C (36.1 to 38.0), back pain at rest (mean visual analogue scale (VAS) mean 5/10) and when mobile (mean VAS 6/10), as well as elevated levels of CRP (mean 76.8 mg/l (0.4 to 202.9)) and white blood cell count (mean 9.2 units/nl (2.6 to 32.8)). Pathogens were identified by CT-guided or conventional biopsy, intraoperative tissue sampling, or sonication, and Gram-positive cocci presented as the most common among them. Antibiotic therapy was established in all cases with pathogen-specific treatment in 23 (71.9%) subjects. Overall 27 (84.4%) patients received treatment by debridement, decompression, and fusion of the affected segment.ConclusionCases of IPOS are rare and share similarities with spontaneous spondylodiscitis. While procedures such as CT-guided biopsy and sonication are valuable tools in the diagnosis of IPOS, MRI and intraoperative tissue sampling remain the gold standard. Research on known principles of PJI such as implant retention versus implant exchange need to be expanded to the field of spine surgery.Cite this article: Bone Jt Open 2023;4(11):832–838.