Vertebral Infection Research Articles

Minimally invasive surgery for vertebral fracture and spinal infection

Minimally invasive surgery for vertebral fracture and spinal infection

Cat-scratch disease in Northern Italy: atypical clinical manifestations in humans and prevalence of Bartonella infection in cats

In this paper, we report an investigation on cat-scratch disease (CSD) in Northern Italy. Seventy-four cases of CSD were diagnosed at the San Matteo hospital, Pavia, during the period 2005-2010. Of these 74 patients, 18 (24.3 %) reported atypical clinical manifestations such as ocular papillitis, maculopapular eruptions, vertebral infection, pulmonary infiltrates, and granulomatous hepatitis. Contact with cats was documented for 61 patients (82.4 %), while cat-related trauma was reported for 49 patients (66.2 %). We subsequently investigated the presence of Bartonella infection in cats belonging to the above patients and in other domestic and stray cats from three provinces of Northern Italy. Among the 27 domestic cats tested, nine of the 11 belonging to the CSD patients and two of the remaining 16 were infected by B. henselae (81.8 % vs. 12.5 %). Out of over 1,300 stray cats examined, 23.1 % were seropositive for B. henselae; after culturing and genotyping, 17 % were found to be infected by B. henselae (15.5 %) or B. clarridgeiae (1.5 %).

Efficiency of Antibiotic-loaded Polymethylmethacrylate Rods for Treatment of the Implant-related Infections in Rat Spine

A study of local treatment of the implant-related infections in animal spine. : This study aims to investigate the efficiency of antibiotic-loaded polymethylmethacrylate rods for treatment of the implant-related infections. Today's implant-related vertebral infections are challenging in spinal surgery. In addition to resolving this problem, systemic antibiotic treatment is necessary to study and develop the effectiveness of locally applied treatment methods. Twenty-four female white Sprague Dawley rats were randomized in 3 different groups, each consisting of 8 animals. Under general anesthesia, 3 mm titanium microscrew was implanted in the thoracic vertebra. All 3 groups were inoculated with the same concentration of Staphylococcus aureus (10 colony-forming units/10 μL). Group 1 was assigned as a control group and received no additional therapy, group 2 was given single intraperitoneal doses of vancomycin, and group 3 was implanted vancomycin buffered acrylic rods. The results were analyzed by Fischer exact test. The comparison between the groups revealed a significantly higher therapeutic effect (P<0.05) in the local therapy group and in the systematic treatment group compared with the control group. The success of the treatment in the systemic treatment group was statistically not significantly different (P>0.05) compared with the outcome of the locally treated group. This study shows the success of antibiotic-loaded polymethylmethacrylate rods for the treatment of the spinal implant infections. Further research involving clinical studies is required to increase the efficacy and the clinical applicability of the technique.

Management of infectious discitis. Outcome in one hundred and eight patients in a university hospital.

The optimal management of pyogenic discitis is not agreed on. We conducted a retrospective, cross-sectional, observational study in which all patients with discitis who attended Hospital San Carlos Madrid from January 1999 to January 2009 were included. We identified 108 consecutive adult patients with infectious discitis. There were 49 men and 59 women with an average age of 67,5 (+/- 16,89) years in the study group. Mean follow-up interval was 6,06 (12,5-2) years. 78 patients had spontaneous discitis and 30 patients had postoperative discitis. Inclusion criteria for the review were illness compatible with vertebral infection and / or evidence of spinal involvement on magnetic resonance imaging (MRI). In 56 percutaneous discal biopsy (52% patients) were positive in 28 cases. A single disc was infected in 100 patients. The segments involved were the cervical spine in four, the thoracic spine in 38 and the lumbar spine in 66. One or more comorbid diseases were present in 73 (68%) of 108 patients. Diabetes mellitus was the most common disease. Comorbid disease was rapidly fatal in four patients, ultimately fatal in seven patients, and nonfatal or not present in 97 patients (90 %). Early diagnosis is a major challenge. Heightened awareness and the prompt use of MRI are necessary to avoid diagnostic delay. Prolonged antimicrobial therapy and the judicious application of timely surgical intervention are essential for an optimal outcome.

Lateral Mass Screw Complications

Retrospective, consecutive patient series. To quantify the risks and the complications associated with screw fixation devices of the cervical spine. The usefulness of lateral mass internal fixation has been well documented in the clinical setting. However, there is a paucity of studies examining the complications associated with these devices in a degenerative clinical setting. From 1999 to 2007, 225 consecutive patients underwent posterior cervical fixation using a screw-plate and polyaxial screw-rod implant systems. There were 105 women and 120 men (age range: 45 to 84 y; mean, 68 y). In all patients, the surgical indication was cervical spondylosis with myelopathy. Mean follow-up interval was 18 months (range: 12 to 72 mo). Screw position was evaluated by computed tomography scanning postoperatively in all patients. Clinical and radiographic outcome was assessed at each visit after surgery. Intraoperative complications include fracture of lateral mass in 27 screws placement and nerve irritation in 3 bicortical screws. Early complications include hematoma formation in 2 cases and C5 root palsy in 5 cases after spinal canal decompression. Late complications include pseudarthrosis in 6 cases and screw pull-out in 3 cases. There were no cases of spinal cord or vertebral artery injury, infections, deaths, or adjacent segment disease. All patients had radiographic union, and no patient developed mechanical implant failure requiring removal of instrumentation. Reoperation was required in 14 (6.2%) cases because of nerve injury, hematoma formation, pseudarthrosis, and screw pull-out. Our clinical findings indicate that lateral mass fixation can be used safely with minimal complications and low rate of morbidity for cervical myelopathy treatment.

Computed tomography for the diagnosis of lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review

AimIn low back pain if serious pathology is suspected diagnostic imaging could be performed. One of the imaging techniques available for this purpose is computed tomography (CT), however, insight in the diagnostic performance of CT is unclear.MethodDiagnostic systematic review. Studies assessing the diagnostic accuracy of CT in adult patients suggested having low back pain caused by specific pathology were selected. Two review authors independently selected studies for inclusion, extracted data and assessed risk of bias. Pooled summary estimates of sensitivity and specificity with 95% CI were calculated.ResultsSeven studies were included, all describing the diagnostic accuracy of CT in identifying lumbar disc herniation. Six studies used surgical findings as the reference standard and were considered sufficiently homogenous to carry out a meta-analysis. The pooled summary estimate of sensitivity was 77.4% and specificity was 73.7%.ConclusionsWe found no studies evaluating the accuracy of CT for pathologies such as vertebral cancer, infection and fractures and this remains unclear. Our results should be interpreted with some caution. Sensitivity and specificity, regarding the detection of lumbar disc herniation, showed that a substantial part of the patients is still classified as false-negative and false-positive. In future, the diagnostic performance of CT must be assessed in high quality prospective cohort studies with an unselected population of patients with low back pain.

L5 vertebral osteomyelitis treated with L5 corpectomy and anterior instrumentation: case report

Study design: A case report.Objective: Pyogenic osteomyelitis is the most common form of vertebral infection and typically resolves following conservative treatment with antibiotics administered long term and immobilization. In cases of spinal instability, severe neurological deficit or disease refractory to medical management, neurosurgical intervention is warranted. Historically, these patients have undergone radical vertebral debridement and grafting with or without posterior instrumentation. We report the case of a 46-year-old female intravenous drug user presenting with L5 pyogenic osteomyelitis with L5 vertebral compression and cortex retropulsion following L2–L4 laminectomy for epidural abscess 8 weeks prior.Methods: The patient underwent an anterior approach single-stage L5 corpectomy, L4/5 and L5/S1 discectomies, expandable titanium-cage insertion and anterior plating from L4 to the sacrum.Results: The patient recovered without any complications. The infection was successfully eradicated and her fusion remains solid 18 months postoperatively.Conclusions: To our knowledge, this is the first case of L5 vertebral osteomyelitis treated with a single-stage corpectomy and anterior instrumentation.

Are intravertebral vacuum phenomena benign lesions?

We retrospectively reviewed plain radiographs from patients with four different diseases that can cause vertebral collapse: osteoporotic vertebral collapse, spinal infection, spinal metastasis, and multiple myeloma. The objective of the study was to find the percentages of intravertebral vacuum phenomena and vertebral collapse rates in the four groups. The vacuum phenomenon is often observed in osteoporotic compression fractures. However, these phenomena are rarely seen in spinal infection and malignant lesions. Whether the vacuum phenomenon is a benign indicator is not known. We retrospectively reviewed plain radiographs from four groups of patients, including 328 osteoporotic vertebral collapse patients, 317 spinal infection patients, 302 spinal metastasis patients, and 325 multiple myeloma patients. The pattern and occurrence rates of intravertebral vacuum phenomena and vertebral body collapse were analyzed. The occurrence rate of intravertebral vacuum phenomena in patients with osteoporotic vertebral collapse was approximately 18.9%. Only one case of intravertebral vacuum phenomena was observed in patients with spinal infection. Vacuum phenomena were not observed in patients with spinal metastasis. The occurrence rate of intravertebral vacuum phenomena in patients with multiple myeloma was 6.4%. The patterns of intravertebral vacuum phenomena were also analyzed. Intravertebral vacuum phenomena are common in patients with osteoporotic vertebral collapse. Most cases of intravertebral vacuum phenomena are of a benign nature. Moreover, intravertebral vacuum phenomena occur extremely rarely in patients with spinal infection. Such phenomena are also found in patients with multiple myeloma.

Pyogenic osteomyelitis of the vertebral arch in children

Vertebral infection represents 2% to 4% of all cases of osteomyelitis in children. Extension of vertebral osteomyelitis into the vertebral arch is rare; and exclusive pyogenic involvement is exceedingly rare, especially in children. A review of the literature revealed less than 25 combined cases, most of them reported in the beginning of the 20th century without cross-sectional imaging. The unusual location creates difficulties in distinguishing vertebral osteomyelitis from neoplasm and arthritic conditions. We present 2 cases of infection of the posterior vertebral elements. Most useful in identifying the presence and extent of infection were a sudden onset of nonspecific back pain, elevated inflammatory parameters, and magnetic resonance imaging. Antibiotic therapy with or without surgical intervention provided successful management. With the recurrence observed in 1 child, the most optimal treatment of this condition might still be unknown.

The clinical analysis of Posterior mini-incision surgery for the single segment of the lumbar disc herniation

Objective To explore the treatment and clinical characteristic of posterior mini-incision surgery for the single segment of the lumbar disc herniation.Methods Clinical data of 260 cases with single segment lumbar disc herniation were analyzed retrospectively.Results Follow-up for 6 months to 5 years,with an average of 24 months.According to Nakai effect criteria,109 cases of excellent,good in 132 cases,17 cases of fair,two cases of poor,12 cases of cerebrospinal fluid leakage,2 cases of wound hematoma,one case of vertebral space infection,resulting in 92.7%.Conclusion Advantages of posterior mini-incision surgery for the single segment of the lumbar disc herniation are small incision,less trauma,shorter operative time,less bleeding,quick recovery and low costs.Stressed the need to accuratel position preoperation. Key words: lumbar vertebrae; Surgical procedures; oper ative

Mycobacterium chelonae Vertebral Osteomyelitis

Mycobacterium chelonae is a rapidly growing mycobacterium (RGM) in Runyon group IV. This group includes all other nontuberculous mycobacterium (NTM) except the mycobacterium tuberculosis complex. The most commonly infected organ by RGM is the lung, usually in immunosuppressed patients or those with underlying lung disease. Vertebral infection is very rare. Osteomyelitis is rarely caused by M. chelonae, and only one other case of M. chelonae vertebral osteomyelitis has been reported. A case of M. chelonae vertebral osteomyelitis in a man with intravenous drug abuse is reported, and NTM osteomyelitis is reviewed with a focus on M. chelonae and appropriate treatment options for M. chelonae vertebral osteomyelitis.

Salmonella osteomyelitis of multiple ribs and thoracic vertebra with large psoas muscle abscesses

Backgroud context Salmonella vertebral osteomyelitis is a well-known complication of sickle cell disease. However, it has been infrequently reported in immunologically normal people or diabetic patients. Purpose To report a case of Salmonella vertebral osteomyelitis in a diabetic patient with multiple rib infections, large bilateral psoas muscle abscesses, and pleural effusion. Study design/setting Case report. Methods A case of Salmonella vertebral osteomyelitis is reported in a 42-year-old man with diabetes. The patient had multiple rib and T12 vertebral infections with pleural effusion and large bilateral psoas muscle abscesses. The adjacent discs were intact. Results Diagnosis was made by computed tomography–guided psoas muscle abscess drainage and aspirate culture. Appropriate antibiotic treatment resulted in a favorable outcome. The patient had mild back pain with a 38° residual kyphosis at his thoracolumbar junction after treatment. Conclusions Vertebral osteomyelitis caused by Salmonella is uncommon in diabetic patients. Salmonella can cause multiple bone infections and large abscesses of psoas muscles in patients without sickle cell disease. Correct diagnosis can be confirmed by blood, biopsy, or abscess culture. Appropriate antibiotic treatment was effective.

MRI manifestations and differentiated diagnosis of postoperative spinal complications

To analyze MR manifestations of postoperative spinal complications and investigate the value of MRI in the diagnosis and differentiated diagnosis, 114 cases of spinal postoperative complications were analyzed retrospectively and compared with the clinical data. The results showed that the main postoperative spinal complications included spinal stenosis (n=33, consisting of 21 cases of epidural fibrosis and 12 cases of epidural hematoma or epidural abscess), lack of spinal stability (n=43), infection (n=23, consisting of 7 cases of para-spinal soft-tissue infection, 5 cases of vertebral discitis, 4 cases of vertebral and appendix infection, 3 cases of epidural abscess, 2 cases of myelitis, 2 cases of spinal arachnoiditis), others (n=28, consisting of 12 cases of inner fixation failure, 9 cases of epidural hematoma, 7 cases of cerebrospinal fluid gusher). It is concluded that MRI can specifically display all kinds of postoperative spinal complications, and is of significant value in the diagnosis and differentiated diagnosis of postoperative spinal complications.

Vertebral infection

Представлен обзор литературы по этиологии, патогенезу, консервативному и оперативному лечению остеомиелита позвоночника.

Fungal postoperative spondylodiscitis due to Scedosporium prolificans

Background context Postoperative fungal spondylodiscitis is a rare infectious disease. Purpose We report the first case of postoperative spondylodiscitis because of Scedosporium prolificans and review postoperative vertebral infection caused by fungi. Study design/setting Medline search. Methods Case report and literature review. Results On reviewing the cases of postoperative fungal spondylodiscitis reported so far in the literature, we found eight were caused by mold, and five by yeast. Clinically, the disease presents similar to postoperative vertebral osteomyelitis caused by bacteria, and a high clinical index of suspicion may be required to perform appropriate cultures to establish a diagnosis. Our review revealed a significant number of cases that were cured after surgical debridement and/or antifungal therapy. Conclusions On the basis of this limited assessment, it appears that the clinical course and prognosis of postoperative fungal spondylodiscitis is similar to that reported for postoperative pyogenic spondylodiscitis.

Infection-Related Spinal Cord Injury: Etiologies and Outcomes

Individuals with infection-related spinal cord injury comprise a significant subset of nontraumatic SCI and SCI-related rehabilitation admissions. They tend to be older and have a greater incidence of paraplegic injuries (secondary to predominance of thoracolumbar locations) than their traumatic counterparts. Common causes and pathogens (vertebral osteomyelitis, epidural abscess, HIV-related infections, spinal tuberculosis, syphilis, and acute transverse myelitis) will be discussed along with clinical signs and presenting symptoms, laboratory and radiographic diagnostic testing, medical and surgical treatment, and rehabilitation.

Surgical treatment for delayed pyogenic spondylitis after percutaneous vertebroplasty and kyphoplasty

Only 6 cases of pyogenic spondylitis following vertebroplasty or kyphoplasty have been reported, and their causes remained unclear. The authors report on 4 cases of delayed pyogenic spondylitis (DPS) following vertebroplasty or kyphoplasty for osteoporotic compression fractures and metastatic disease. Four patients presented with DPS after vertebroplasty or kyphoplasty and underwent surgical treatment. Clinical history, laboratory examination, and MR imaging confirmed the diagnosis of DPS. Anterior debridement, reconstruction, and posterior instrumented fusion were performed. The mean interval for the delayed occurrence of pyogenic spondylitis after surgery was 12.3 months. The infections were primarily bacterial in origin, but most patients also suffered diverse medical comorbidities. Despite successful treatment of the infections, comorbidity was and is a factor that compromises good results. Medical comorbidities associated with compromised immunity may increase susceptibility to DPS after vertebroplasty or kyphoplasty. In cases of incapacitating back pain after a pain-free period following either of these surgeries, evaluation of the erythrocyte sedimentation rate and C-reactive protein level and examination of contrast-enhanced MR imaging studies are essential to rule out delayed vertebral infection. Surgical treatment requires cement removal and anterior reconstruction with or without additional posterior instrumented fusion.

Percutaneous inoculated rabbit model of intervertebral disc space infection: Magnetic resonance imaging features with pathological correlation

Objectives The aims of this study were to characterize MRI features in percutaneously inoculated spondylodiscitis rabbit models, to evaluate MRI for non-invasive diagnosis, and to assess the incremental information brought by the use of gadolinium-enhanced MR sequences. Methods Under fluoroscopic control, lumbar discs of 12 New Zealand White adult rabbits were injected with bacterial suspension. Five, 10 and 15 days after bacterial inoculation, T1 and T2 signal abnormalities and contrast enhancement of discs, vertebrae and epidural spaces were evaluated. Bacteriological and pathological analyses were realized after completion of imaging series. Results Disc space infections were present in all animals. MRI detected vertebral and discal abnormalities as soon as, respectively, 5 and 10 days after inoculation. Gadolinium-enhanced sequences allowed an earlier diagnosis, a more precise evaluation of the extent of the infection and the identification of epidural involvement. The signal of vertebrae was a more reliable criterion for infection evaluation that discal one. Conclusions MRI is a reliable tool for non-invasive diagnosis of vertebral infection in a rabbit model and can be useful to compare the efficiency of different antimicrobial therapy in animal series before human administration. Gadolinium-enhanced MR sequences allow an earlier and more precise determination of the presence and extent of infection. Modifications of vertebral signal are the more reliable criterion for the evaluation of disc spaces infection.

Scintigraphic Imaging of Vertebral Osteomyelitis With 111In-Biotin

Early diagnosis of vertebral infection (hematogenous or postsurgical) is necessary to choose a correct therapy and to minimize dramatic complications. All patients suspected to have vertebral infection underwent radiologic imaging and In-Biotin scintigraphy. Biotin is a growth factor used by many bacteria. The aim of our study is to use In-Biotin to diagnose vertebral infections. Magnetic resonance imaging, even if endowed with fairly good sensitivity and specificity, shows some limitations in the study of the onset of pathology and in postsurgical conditions. Conventional scintigraphic imaging, like bone scintigraphy with Tc-MDP, Ga-citrate scintigraphy, or Positron Emission Tomography with [F]FDG, are limited by relatively low specificity; the use of Streptavidin/In-Biotin scintigraphy, based on aspecific uptake of tracer in the site of infection, shows good results in term of sensibility and specificity but the use of heterologous protein might engender immunogenic reactions. All patients (pts) (n = 110) of the study underwent In-biotin scintigraphy 2 hours after intravenous injection of the tracer, 71 pts were suspected to have hematogenous vertebral infection (Group I) and 39 pts were suspected to have postsurgical infection (Group II). The reference for final diagnosis was either bacterial cultures, histopathologic analysis, and/or clinical/imaging follow-up for at least 1 year. In-biotin scintigraphy showed a sensitivity of 84% and specificity of 98% in Group I and a sensitivity of 100% and specificity of 84% in Group II. Our results showed that In-Biotin scintigraphy possess high diagnostic accuracy. This technique is easy to perform and requires short imaging time-point after intravenous tracer injection. Moreover if In-Biotin uptake is due only to high proliferation rate of bacteria presents in site of infection, it will be further investigated to discriminate definitely bacterial from sterile inflammation.

Current Diagnosis and Treatment of Spondylodiscitis

Infection of the spinal column is rare, and often recognized and treated too late. Spondylodiscitis is osteomyelitis of the spine and can cause severe symptoms. Hospital mortality is in the region of 2% to 17%. Selective literature review and results of the authors' own research. The incidence of pyogenic spondylodiscitis is around 1 : 250 000, which represents around 3% to 5% of osteomyelitis as a whole. 10% to 15% of all vertebral infections can be ascribed to exogenous spondylodiscitis, with Staphylococcus aureus as the commonest pathogen, 2% to 16% of which are reported to be MRSA (methicillin-resistant S. aureus). Catheter-related, nosocomial infection with MRSA is a key cause for spondylodiscitis. 50% of all skeletal tuberculoses are found in the spine. Spondylodiscitis should be borne in mind in cases of diffuse back pain and non-specific symptoms. MRI is the diagnostic modality of choice for detecting spondylodiscitis. Thanks to precise monitoring of conservative treatments and primarily stable surgical techniques, prolonged immobilization of the patient is no longer necessary nowadays.