Osteomyelitis Of Spine Research Articles

Spinal osteomyelitis

Experience in diagnosis and treatment of 112 patients with spine osteomyelitis is presented. In 8 patients cervical spine, in 23 patients thoracic spine and in 81 patients lumbar spine was involved. Neurological deficit was observed in 45 (40.2%) patients. Forty seven (42%) patients underwent conservative and 65(58%) surgical treatment. Conservative treatment included intraarterial injection of antibacterial drugs. Surgical treatment consisted of radical resection of the osteomyelitis focus followed by stabilization of the spine with autografts. Long-term results were evaluated in terms from 1 to 20 years. In all patients the formation of bone block and regression of neurological symptoms was observed.

CORRELAÇÃO DA INFECÇÃO PÓS OPERATÓRIA COM A ETIOLOGIA DA DOENÇA NA CIRURGIA DE COLUNA INSTRUMENTADA

ABSTRACT Objective: To evaluate the epidemiological characteristics of postoperative infection in surgeries of the spine with instrumentation in our service, and whether there is a correlation between the rate of postoperative infection and the etiology of the indication for the primary surgical procedure. Methodology: A retrospective search through medical records of patients who underwent spinal surgery with instrumentation in our hospital between 2015 and 2019 was performed, and the ones that evolved with acute or chronic postoperative infection with need for surgical cleaning to resolve it were selected. Cases of non-instrumented surgery, primary infection of the spine (osteomyelitis and spondylodiscitis) and superficial infection of the surgical wound without the need for surgical cleaning were excluded. Results: The rate of postoperative infection was 11.6%. In this group of patients who evolved with this complication, most were submitted to surgery primarily for trauma (38.9%), followed by degenerative disease (30.8%), neoplasm (19.2%), and deformity (15, 4%). However, when we analyzed these patients comparing them with the total number of cases of spinal surgery with instrumentation performed in the period, we obtained a higher prevalence of infection in patients operated for deformity (17.6%), followed by degenerative disease (13%), neoplasm (11.4%) and trauma (9.9%). This difference did not prove to be statistically significant (p = 0.79), nor the correlation with sex and age. Conclusion: In our study, proportionally, there was a difference in the prevalence of postoperative infection according to the etiological indication, being higher in cases operated for deformity, mainly due to neuromuscular disease. Level of evidence IV; A case series therapeutic study.

Osteomyelitis of the spine: treatments and future directions.

Background:Osteomyelitis of the spine is a serious condition that has been increasing with the intravenous drug pandemic and aging population. Multiple different organisms can cause osteomyelitis and mainstay of treatment is early recognition and antibiotics. The course can sometimes be indolent leading to delayed presentations. Once suspected, comprehensive workup and initiation of management should be employed. In rare circumstances, surgical evacuation or deformity correction is indicated. Continued antibiotic treatment should be considered post-operatively.Methods:Emerging treatment solutions are being developed to help target osteomyelitis in a more effective manner. In this review, we highlight the epidemiology and pathophysiology of spinal osteomyelitis. We overview the diagnostic workup and treatment options. Finally, we present new options that are currently being investigated and are on the near horizon.Conclusion:This review offers a user friendly resource for clinicians and researchers regarding osteomyelitis of the spine and will serve as a catalyst for further discovery.

793. Rifabutin Use in Staphylococcal Prosthetic Material Infections: A Case Series

BackgroundBacterial biofilm formation is of clinical concern among patients with staphylococcal infections involving prosthetic material. While rifampin has in-vitro, animal and clinical data to support its adjunctive role in these types of infections, its potent induction of multiple cytochrome P450 enzymes and P-glycoprotein transport system proteins can pose significant drug-drug interactions. Rifabutin has comparable in-vitro anti-staphylococcal activity but less drug-drug interaction potential than rifampin. However, minimal clinical data exists to support rifabutin use as adjunctive treatment of prosthetic infections.MethodsThis case series describes 7 patients who received adjunctive rifabutin for staphylococcal prosthetic material infections between February 2018 and January 2021 at Massachusetts General Hospital. The primary outcome of infection recurrence was defined as need for surgical intervention for suspected or proven recurrence infection within 6 months after starting rifabutin therapy. Incidence of adverse effects was the main secondary outcome.ResultsMost patients (6/7) had methicillin-sensitive S. aureus (MSSA) and one patient had S. epidermidis infection. Three patients had spinal fusion hardware infection, one patient had hardware-associated spinal osteomyelitis/ diskitis with epidural abscess, two patients had prosthetic joint infection, and one patient had MSSA bacteremia with left ventricular assistance device involvement. All patients except one underwent surgical management prior to starting rifabutin. Infection recurrence was noted in one of seven patients who required surgical washout. Adverse events were uncommon (n=1 treatment-related nausea, n=1 leukopenia).ConclusionThis small case series suggests favorable outcomes with use of rifabutin instead of rifampin for staphylococcal infections with prosthetic material involvement.Disclosures Sandra B. Nelson, MD, UpToDate (Other Financial or Material Support, author)

Retropharyngeal Abscess and Pott’s Disease Due to Tuberculosis: A Case Report

Introduction: Extrapulmonary mycobacterial infection can lead to vertebral spondylitis and osteomyelitis (Pott’s disease). Retropharyngeal abscess with concurrent spinal osteomyelitis is a rare presentation of tuberculosis in the US. Chart review on a patient was completed, and the relevant published literature was reviewed. Case Presentation: A previously healthy 34-year-old male originally from Sudan presented to an outside hospital with a 2-month history of neck pain, sore throat, odynophagia, fevers, and chills. MRI showed a retropharyngeal abscess and suspected cervical spine osteomyelitis. Acid-fast bacillus (AFB) smear was positive from a neck drain specimen, but sputum was negative. Chest imaging did not show findings consistent with pulmonary tuberculosis. He was treated with rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) along with moxifloxacin and linezolid due to concern for possible multidrug resistant tuberculosis and transferred to our center for further care. Culture isolated Mycobacterium tuberculosis. CT neck showed vertebral tuberculous osteomyelitis (Pott’s disease) of C1-C3 with a multiloculated retropharyngeal and prevertebral abscess (Figure 1). The patient was taken to the OR for posterior spinal fusion from occiput to C4 and transoral incision and drainage of the abscess. The post-operative course was uneventful, and moxifloxacin and linezolid were discontinued when Xpert MTB/RIF test revealed rifampin susceptibility. At follow-up the patient’s symptoms had resolved. Patient consent was obtained to utilize this case for educational purposes. Conclusions: This report presents the multidisciplinary treatment of this patient requiring infection control measures and antibiotic therapy by infectious disease, posterior spine fusion by orthopedic surgery, and retropharyngeal abscess drainage by otolaryngology.

An Unusual and Near-Fatal Result of Acupuncture for Right Shoulder Girdle Pain Syndrome: Staphylococcal Aureus Cervical Spine Osteomyelitis with Paravertebral and Epidural Abscess

An Unusual and Near-Fatal Result of Acupuncture for Right Shoulder Girdle Pain Syndrome: Staphylococcal Aureus Cervical Spine Osteomyelitis with Paravertebral and Epidural Abscess

Management of spinal osteomyelitis-associated deformity

Spinal osteomyelitis predominantly affects the anterior vertebral column. Pyogenic infection seldom results in significant deformity but rather the more insidious causes such as tuberculosis. The typical deformity is a single plane kyphosis, other than when the infection affects the more mobile and more loaded lumbar spine where facet subluxation may result in a three-dimensional torsional deformity. Management is dictated by whether the disease process is active versus healed disease, the skeletal maturity of the patient and whether there is ongoing spinal growth expected and associated neurological deficit. Surgical strategies may be anterior only, such as in the sub-axial cervical and thoracic active disease, combined anterior and posterior procedures at the cervico-thoracic and thoracic‐lumbar junctions, but the posterior circumferential vertebral column resection (VCR) is increasingly utilized for rigid healed disease, especially with late presenters and in those patients who have associated neurological impairment.

Cerebrocortical necrosis causes multiple deaths in Scottish ewes and lambs.

Cerebrocortical necrosis causes multiple deaths in Scottish ewes and lambs.

Efficacy and safety with the use of Antibiotic-impregnated Poly-methyl methacrylate (AI-PMMA) for thoracolumbar spinal reconstruction in pyogenic Spondylodiscitis: Retrospective cohort study

BackgroundSurgical treatment of spinal osteomyelitis and discitis remains challenging due to the risk of implant colonization. We sought to demonstrate the safety and efficacy of using antibiotic-impregnated poly-methyl methacrylate (AI-PMMA) in spinal reconstruction for pyogenic spondylodiscitis. MethodWe retrospectively analyzed prospective data on consecutive patients who underwent AI-PMMA interbody fusion for thoracolumbar pyogenic spondylodiscitis from December 2011 to October 2016 at a single institution with multiple surgeons. We included consecutive patients who underwent AI-PMMA spinal reconstruction and fusion and were older than 18 years of age. All patients were included in the analysis regardless of their follow-up status who had previous spine surgery in the same area were excluded. Vancomycin powder was mixed with PMMA and tobramycin. The AIPMMA was introduced into the disc space as 5–10 mm beads, then contoured to fit. The primary outcome was fusion using CT or X-ray. Secondary outcomes were recurrent infection, PMMA-related complications, and VAS results. Descriptive statistics and univariate analyses were used. ResultsSixty-two patients were included in the study. The mean follow-up interval was 18.6 months (3–66 months). Sixty-six AI-PMMA levels demonstrated a fusion rate of 100% (95% CI: 94.9%–100%). There was no cement extravasation or embolism. One patient (1.6%) developed a recurrent infection at the same level requiring revision surgery. Five patients (8%) died on long-term follow-up due to non-PMMA/infection-related causes. VAS back showed significant improvement in pain (7.8 vs. 3.5; 95% CI 2.8–5.8; p = 0.00). ConclusionWe demonstrated that the application of AI-PMMA for spinal reconstruction in pyogenic spondylodiscitis is safe and efficacious. The study is limited by its retrospective design. Prospective studies are warranted.

Upper cervical spine instability due to pyogenic infection successfully treated by one stage posterior debridement and stabilization: Case Report and literature review

Pyogenic osteomyelitis of the upper cervical spine is a rare condition associated with different clinical symptoms and signs. Previous studies have stressed the difficulties in making the diagnosis due to its unusual location and relatively rare occurrence. We hereby describe a case of a 65-year-old man with pyogenic infection of the craniocervical junction up to the axis with severe instability managed by posterior fusion from occiput to C6, an open biopsy from C1–C2 lesions and irrigation and debridement. On follow-up visit at two years, our patient had recovered completely. We present this case to show that the posterior approach without the anterior transoral approach is a valid surgical option in such cases. Additionally, we emphasize the importance of stabilization to successfully treat spine osteomyelitis and summarize the literature available discussing upper cervical spine infection treatment options.

Updated Experience of Mycobacterium chimaera Infection: Diagnosis and Management in a Tertiary Care Center.

BackgroundDespite safety communications from the Food and Drug Administration (FDA) regarding the outbreak of Mycobacterium chimaera infections (MCIs) from contaminated heater-cooler devices, new cases continue to be identified.MethodsWe retrospectively reviewed confirmed cases of MCI that were managed at Mayo Clinic sites (Arizona, Florida, and Minnesota) from 09/2015 to 01/2021. Clinical histories including prior cardiovascular surgery were recorded. Diagnostic workup including ophthalmologic examination, imaging, and laboratory testing was reviewed. Treatment and survival outcomes on follow-up were obtained.ResultsTwelve patients with MCI were included. All patients had aortic valve or graft replacement. Five patients had their surgical procedures following the 10/15/2015 FDA safety communication. The mean time from surgery to symptom onset (range) was 32 (13–73) months. Ten of 11 patients who underwent ophthalmologic examination had chorioretinal abnormalities. Three patients who underwent microbial cell-free deoxyribonucleic acid sequencing tested positive for M. chimaera, which was subsequently confirmed with blood culture growth. Echocardiography and positron emission tomography/computed tomography (PET/CT) revealed evidence of prosthetic valve/graft infection in 7/12 (58.3%) and 6/10 (60.0%) of cases, respectively. Seven patients (58.3%) underwent redo cardiovascular surgery. Of these, 1 patient died 2 days postdischarge, 1 experienced spinal osteomyelitis relapse, and another had interval prosthetic valve fluorodeoxyglucose (FDG) uptake on PET/CT suspicious for recurrent infection. Among 4 patients on medical therapy only, 3 expired or transitioned to hospice during follow-up.ConclusionsMCI continues to occur despite the FDA communications. Incorporation of ophthalmologic examination and use of advanced tools may improve MCI diagnosis. The mortality in these patients is high even with aggressive surgical/medical management.

Disease surveillance in England and Wales, April 2021

Disease surveillance in England and Wales, April 2021

Streptococcus gallolyticus bacteraemia requiring 12-step desensitisation for penicillin

A 65-year-old Tongan man with significant comorbidities and anaphylaxis to penicillin developed infective endocarditis and spinal osteomyelitis as a consequence of recurrent Streptococcus gallolyticus bacteraemia. He was commenced on 12-step drug desensitization for penicillin. This case report discusses the process of 12-step drug desensitization and the background of Streptococcus gallolyticus (previously known as Streptococcus bovis) bacteraemia.

Two Co(II) coordination polymers: application values on spinal osteomyelitis by reducing the inflammatory response in the paravertebral soft tissue

In the present research, two novel coordination polymers (CPs) containing Co(II) ions as nodes have been prepared by solvent thermal reaction between free organic ligands of HL and Co(NO3)2·6H2O in distinct solvent systems, and their chemical formulae are [Co(L)2]·CH3CN (1, (HL = 6-aminonicotinic acid) and [Co(L)2] (2). Their treatment activity on the spinal osteomyelitis was assessed. Meanwhile, the specific mechanism was investigated. First, the inflammatory cytokines content released into the paravertebral soft tissue was detected through the enzyme-linked immunosorbent assay (ELISA) detection kit. In addition to this, the reactive oxygen species (ROS) levels in the paravertebral soft tissue were also determined with flow cytometry.

Mycobacterium xenopi osteomyelitis of the spine: a case report

ABSTRACT BACKGROUND: Mycobacterium xenopi (M. xenopi) osteomyelitis is an uncommon infection which is found in immunosuppressed patients. It is reported to be a slow-growing, nonchromogenic or scotochromogenic nontuberculous mycobacterium. The lungs constitute the most common site for infection and extrapulmonary manifestations, and disseminated forms of the disease are rare. Only a few cases of spontaneous spinal involvement have been reported. We report a case of M. xenopi vertebral osteomyelitis of the spine PATIENT AND METHODS: A 41-year-old female patient, HIV reactive on antiretroviral therapy with a low CD4 count of 183 cells/mm3, presented with clinical and radiological features in keeping with thoracic spinal tuberculosis, complicated with thoracic myelopathy. She was managed surgically with costo-transversectomy and drainage of the paraspinal cold abscess. The Ziehl-Neelsen staining was negative for acid-fast bacilli. However, the histology result revealed a necrotising granulomatous inflammation. A delayed result of polymerase chain reaction (PCR)/line probe assay for Mycobacterium genus testing revealed the presence of M. xenopi, as the cause for the spine osteomyelitis and thoracic myelopathy. However, no M. xenopi susceptibility testing, and no specific photoreactivity techniques for strain identification, were performed. Anti-tuberculosis therapy (ATT) consisting of a two-month initiation phase using rifampicin, isoniazid, ethambutol and pyrazinamide, followed by a seven-month continuation phase using rifampicin and isoniazid, was initiated according to national guidelines. She was fitted with a thoraco-lumbar-sacral orthosis, and underwent a spinal rehabilitation programme. Upon receipt of the PCR result, and considering the good clinical and radiological response to ATT, a consensus was reached with the Infectious Disease Unit (IDU) to continue with ATT until 18 months due to the atypical nature of the pathogen. RESULTS: The patient was successfully treated with the standard TB regimen, but for a period of 18 months, and made full clinical neurological recovery, without any back pain. Furthermore, her CD4 count had also improved to 707 cells/mm3 with a viral load reported lower than 1 000 copies/ml CONCLUSION: This case report emphasises the importance of biopsy in suspected spinal tuberculosis and highlights the concerns with laboratory testing and the prognostic and therapeutic implications of a positive strain identification Level of evidence: Level 5 Keywords: Mycobacterium xenopi osteomyelitis, tuberculosis, anti-tuberculosis treatment

Fewer-Angle SPECT/CT Blood Pool Imaging for Infection and Inflammation.

A new protocol for rapid SPECT/CT blood pool imaging consisting of fewer image-angle acquisitions (fewer-angle SPECT/CT, or FASpecT/CT) was evaluated for localization of focal sites of soft-tissue inflammation, infection, and osteomyelitis. Methods: Immediately after dynamic flow and standard planar blood pool imaging with 99mTc-methylene diphosphonate, FASpecT/CT was performed with a dual-head γ-camera consisting of 6 steps over 360°, 12 total images with 30° of separation between angles, and 30 s per image, requiring a total imaging time of approximately 3 min. Images were reconstructed using iterative ordered-subset expectation maximization. Before use in a patient-care setting, various FASpecT/CT acquisition protocols were modeled using a phantom to determine the minimum number of stops and the stop duration required to produce a reliable image. Results: FASpecT/CT images provided excellent 3-dimensional localization of spine osteomyelitis, soft-tissue infection of the foot, and tendonitis of the hand and foot using a 3-min image acquisition time. The FASpecT/CT acquisition protocol required 1.3-3.5 min, including camera movement time. This was a reduction of 72%-90% from the time required for the standard 60-angle, 20-s SPECT/CT acquisition. Conclusion: The ability of FASpecT/CT blood pool images to help localize focal sites of hyperemia and inflammation can increase exam sensitivity and specificity. Additionally, using a FASpecT/CT protocol decreases imaging time by up to 90%.

Utility of Percutaneous Image-guided Needle Biopsy for Suspected Spinal Vertebral Osteomyelitis

Chaudhry, Nauman S MD; Brunozzi, Denise MD; Behbahani, Mandana MD; Neckrysh, Sergey MD Author Information

Retained gastrostomy bumper resulting in esophageal fistula and spinal osteomyelitis

Abstract Background We report a case of spinal osteomyelitis and fistulous tract between the esophagus and prevertebral soft tissues secondary to an esophageal foreign body. This resulted from a retained gastrostomy bumper that broke on removal of the tube seven years earlier. Case presentation A 9-year-old male with Troyer Syndrome and developmental delay presented to his pediatrician with the refusal to bear weight and new onset torticollis, and was referred to our institution for further evaluation. He was admitted for further workup due to concern for a neurological process. Imaging revealed osteomyelitis of T3/T4 and inflammatory changes in the posterior mediastinum with possible communication with the esophagus. His gastrostomy tube (GT) was converted to a gastrojejunal tube (GJT) for post-pyloric feeding. He acutely worsened after this procedure, and further radiographic imaging revealed a retained foreign body in the esophagus. An upper endoscopy was subsequently performed with snare removal of the object, identified as the bumper of a previous gastrostomy tube. This esophageal foreign body caused esophageal erosion leading to creation of a fistulous tract with nidus for infection spread posteriorly. The patient underwent prolonged treatment for the infection, with improvement in his presenting symptoms, and eventually resumed gastrostomy feeding. Conclusion Retained foreign body following gastrostomy removal, while typically does not warrant further investigation, may present with significant sequelae if retained especially in children with developmental delay and feeding difficulties.

Antibiotic-impregnated polymethylmethacrylate strut graft as a treatment of spinal osteomyelitis: case series and description of novel technique.

The surgical treatment of osteomyelitis and discitis of the spine often represents a challenging clinical entity for a multitude of reasons, including progression of infection despite debridement, development of spinal deformity and instability, bony destruction, and seeding of hardware. Despite advancement in spinal hardware and implantation techniques, these aforementioned challenges not uncommonly result in treatment failure, especially in instances of heavy disease burden with enough bony endplate destruction as to not allow support of a modern titanium cage implant. While antibiotic-infused polymethylmethacrylate (aPMMA) has been used in orthopedic surgery in joints of the extremities, its use has not been extensively described in the spine literature. Herein, the authors describe for the first time a series of patients treated with a novel surgical technique for the treatment of spinal osteomyelitis and discitis using aPMMA strut grafts with posterior segmental fusion. Over the course of 3 years, all patients with spinal osteomyelitis and discitis at a single institution were identified and included in the retrospective cohort if they were surgically treated with spinal fusion and implantation of an aPMMA strut graft at the nidus of infection. Basic demographics, surgical techniques, levels treated, complications, and return to the operating room for removal of the aPMMA strut graft and placement of a traditional cage were examined. The surgical technique consisted of performing a discectomy and/or corpectomy at the level of osteomyelitis and discitis followed by placement of aPMMA impregnated with vancomycin and/or tobramycin into the cavity. Depending on the patient's condition during follow-up and other deciding clinical and radiographic factors, the patient may return to the operating room nonurgently for removal of the PMMA spacer and implantation of a permanent cage with allograft to ultimately promote fusion. Fifteen patients were identified who were treated with an aPMMA strut graft for spinal osteomyelitis and discitis. Of these, 9 patients returned to the operating room for aPMMA strut graft removal and insertion of a cage with allograft at an average of 19 weeks following the index procedure. The most common infections were methicillin-sensitive Staphylococcus aureus (n = 6) and methicillin-resistant S. aureus (n = 5). There were 13 lumbosacral infections and 1 each of cervical and thoracic infection. Eleven patients were cured of their infection, while 2 had recurrence of their infection; 2 patients were lost to follow-up. Three patients required unplanned return trips to the operating room, two of which were for wound complications, with the third being for recurrent infection. In cases of severe infection with considerable bony destruction, insertion of an aPMMA strut graft is a novel technique that should be considered in order to provide strong anterior-column support while directly delivering antibiotics to the infection bed. While the active infection is being treated medically, this structural aPMMA support bridges the time it takes for the patient to be converted from a catabolic to an anabolic state, when it is ultimately safe to perform a definitive, curative fusion surgery.

Diagnosing and treating native spinal and pelvic osteomyelitis in adolescents.

Retrospective case series. To describe how pediatric patients with spinal and pelvic osteomyelitis are diagnosed and treated and assess the diagnostic value of magnetic resonance imaging (MRI), needle aspiration biopsy (NAB), and blood cultures in this population. Spinal and pelvic osteomyelitis de novo are uncommon in children and minimal literature exists on the subject. Research has shown that NAB and blood cultures have variable diagnostic yield in adult native osteomyelitis. At our institution, there is no standard protocol for diagnosing and treating pediatric spinal and pelvic osteomyelitis de novo. All diagnoses of spinal and pelvic osteomyelitis at a pediatric tertiary care center from 2003 to 2017 were reviewed. Patients aged 0-21 at diagnosis were included. Patients with osteomyelitis resulting from prior spinal operations, wounds, or infections and those with chronic recurrent multifocal osteomyelitis were eliminated. All eligible patients' diagnoses were confirmed by MRI. 29 patients (18 men, 11 women) met the inclusion criteria. The median age at diagnosis was 11years old (range 1-18). More than half of all cases (17/29, 59%) affected the lumbar spine. The most common symptoms were back pain (20/29, 69%), fever (18/29, 62%), hip pain (11/29, 38%), and leg pain (8/29, 28%). The majority of NABs and blood cultures performed were negative, but of the positive tests Staphylococcus aureus was the most prevalent bacteria. 86% (25/29) had an MRI before a diagnosis was made and 72% (13/18) had an NAB performed post-diagnosis. MRI is a popular and helpful tool in diagnosing spinal osteomyelitis de novo. NAB cultures are often negative but can be useful in determining antibiotic treatment. Level IV.