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Pediatric Radiology May 2024Sonographic diagnosis of spondylodiscitis is described in a 21-month-old girl who presented with altered gait. Spondylodiscitis, also referred to as...
Sonographic diagnosis of spondylodiscitis is described in a 21-month-old girl who presented with altered gait. Spondylodiscitis, also referred to as discitis-osteomyelitis, is an infection of the intervertebral disc and adjacent vertebrae. The imaging modality of choice is spinal magnetic resonance imaging. Our case is the first description in the English language of the sonographic diagnosis of spondylodiscitis. Pediatric radiologists and sonographers should be acquainted with its features, for both incidental and intentional diagnosis.
Topics: Humans; Female; Discitis; Infant; Ultrasonography; Diagnosis, Differential; Lumbar Vertebrae
PubMed: 38592502
DOI: 10.1007/s00247-024-05920-w -
Journal of Clinical Medicine Mar 2024Postoperative discitis (POD) accounts for 20% to 30% of all cases of pyogenic spondylodiscitis, while POD may be mis-or-under-diagnosed, due to the vague related... (Review)
Review
Postoperative discitis (POD) accounts for 20% to 30% of all cases of pyogenic spondylodiscitis, while POD may be mis-or-under-diagnosed, due to the vague related symptomatology and the non-specific imaging findings. Most studies report infection rate of less than 1%, which increases with the addition of non-instrumented fusion to 2.4% to 6.2%. It remains controversial whether POD is caused by an aseptic or infectious process. Positive cultures are presented only in 42-73% of patients with species being the most common invading organisms, while is isolated in almost 50% of cases. The onset of POD symptoms usually occurs at 2-4 weeks after an apparently uneventful operation. Back pain and muscle spasms are usually refractory to bed rest and analgesics. Magnetic Resonance Imaging (MRI) is the most sensitive and specific imaging diagnostic technique. Antimicrobial therapy depends on the results of tissue cultures, and along with bracing represents the mainstay of management. Surgical intervention is necessary in patients failing conservative treatment. For the majority of cases, extensive surgical debridement, antibiotic therapy, and orthosis immobilization are effective in eliminating the infection. According to this, we recommend an Algorithmic approach for the management of POD. Postoperative infections after spinal surgery pose a certain clinical challenge, and in most cases can be treated conservatively. Nevertheless, disability may be persistent, and surgery could be necessary. The purpose of this concise review is to describe the manifestation of post-discectomy infection, its pathogenesis and particularly a rational approach for its management.
PubMed: 38592315
DOI: 10.3390/jcm13051478 -
Annals of Medicine and Surgery (2012) Apr 2024Brucellosis, the most common microbial zoonotic disease in the world, is endemic in both industrialized and underdeveloped countries. Between 2 and 53% of patients with...
INTRODUCTION AND IMPORTANCE
Brucellosis, the most common microbial zoonotic disease in the world, is endemic in both industrialized and underdeveloped countries. Between 2 and 53% of patients with brucellosis, patients develop spondylitis, and people between the ages of 50 and 60 are the most commonly affected. It mostly affects the lumbar vertebrae (L4 and L5 in particular) and the thoracic vertebrae.
CASE PRESENTATION
A 52-year-old patient was brought to the neurological clinic after complaining of lower back discomfort, reduced mobility, and lower extremity weakness for 6 weeks. Both the cervical and lumbar columns were the sites of the specific discomfort. MRI showed cervical and lumbar discitis.
CLINICAL DISCUSSION
A high titre of anti-brucella antibodies was found by serology testing. He was treated with oral doxycycline (100 mg, two times daily), rifampicin (900 mg) orally once daily, and gentamicin (400 mg) once daily. The patient had massive improvement after 3 months of treatment.
CONCLUSIONS
This case should serve as a reminder to healthcare providers to keep a high index of suspicion for uncommon infections, including Brucella species, in patients exhibiting discitis symptoms, especially when traditional microbiological gram stain and culture are negative.
PubMed: 38576911
DOI: 10.1097/MS9.0000000000001715 -
European Review For Medical and... Mar 2024Non-specific features of spondylodiscitis lead to a delay and challenge in the diagnosis/differential diagnosis/treatment processes, and thus, serious complications may...
OBJECTIVE
Non-specific features of spondylodiscitis lead to a delay and challenge in the diagnosis/differential diagnosis/treatment processes, and thus, serious complications may arise. This study aims to compare brucellar, pyogenic, and tuberculous types of spondylodiscitis, considering their demographic, clinical, and laboratory differences. This may provide more rapid management and good outcomes.
PATIENTS AND METHODS
A total of 131 patients with infectious spondylodiscitis were included in the study. The patients were divided into brucellar (n=63), pyogenic (n=53), and tuberculous (n=15) types of spondylodiscitis and compared for demographic, clinical, laboratory, and imaging features.
RESULTS
Tuberculous spondylodiscitis had higher scores for weight loss, painless palpation, thoracic spine involvement, and psoas abscess formation than other spondylodiscitis. Also, tuberculous spondylodiscitis had higher rates of neurologic deficit and lower rates of lumbar involvement than brucellar spondylodiscitis. Pyogenic spondylodiscitis is more likely to occur in patients who have a history of spine surgery compared to other forms of spondylodiscitis. Also, pyogenic spondylodiscitis had higher rates of fever, erythema, paraspinal abscess, white blood cell (WBC), and erythrocyte sedimentation rate (ESR) than brucellar spondylodiscitis. On the other hand, brucellar spondylodiscitis had higher rates of rural living and sweating than pyogenic spondylodiscitis.
CONCLUSIONS
Weight loss, painless palpation, involved thoracic spine, psoas abscess, and neurologic deficit are symptoms favoring tuberculous spondylodiscitis. History of spine surgery, high fever, skin erythema, and paraspinal abscess are findings in favor of pyogenic spondylodiscitis. Rural living, sweating, and involved lumbar spine are symptoms that indicate brucellar spondylodiscitis. These symptoms can be used to distinguish the types of spondylodiscitis.
Topics: Humans; Discitis; Brucella; Psoas Abscess; Tuberculosis; Lumbar Vertebrae; Erythema; Weight Loss; Retrospective Studies
PubMed: 38567614
DOI: 10.26355/eurrev_202403_35761 -
Cureus Mar 2024Pyogenic spinal infections (PSI) have an incidence of 0.5-2.2 cases per 100,000 population, though diagnosis can be delayed by up to three months. The incidence of...
Pyogenic spinal infections (PSI) have an incidence of 0.5-2.2 cases per 100,000 population, though diagnosis can be delayed by up to three months. The incidence of bacteremia is rare, occurring in 0.22-0.34 cases per 100,000 population, whilst its implication in spinal infections is rarer still. A man in his 60s with a background of chronic lower back pain presented to the emergency department with a two-week history of worsening back pain associated with fever and difficulty voiding. He was initially managed as pyelonephritis due to the recent history of urinary tract infection (UTI) with fever and flank pain. However, there were radiculopathy and bilateral pain on hip flexion with reduced power on the right side. The light-touch sensation was reduced over the right hallux and distal L4 dermatome. These neurological deficits associated with deranged infective markers made a diagnosis of discitis plausible. Discitis and native vertebral osteomyelitis (NVO) should be suspected in patients reporting a fever and back pain of recent onset or increasing in severity. Once discitis was confirmed, the patient was subsequently tested for tuberculosis (TB) using a T-SPOT, human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus, with no positive findings, but in the days following, blood cultures yielded . Guided by knowing the natural reservoirs in the body, establishing the source of could be achieved through head and neck imaging and investigating the gastrointestinal tract for malignant or inflammatory processes.
PubMed: 38562315
DOI: 10.7759/cureus.55306 -
Medical Science Monitor : International... Mar 2024Native vertebral osteomyelitis, also termed spondylodiscitis, is an antibiotic-resistant disease that requires long-term treatment. Without proper treatment, NVO can... (Review)
Review
Native vertebral osteomyelitis, also termed spondylodiscitis, is an antibiotic-resistant disease that requires long-term treatment. Without proper treatment, NVO can lead to severe nerve damage or even death. Therefore, it is important to accurately diagnose the cause of NVO, especially in spontaneous cases. Infectious NVO is characterized by the involvement of 2 adjacent vertebrae and intervertebral discs, and common infectious agents include Staphylococcus aureus, Mycobacterium tuberculosis, Brucella abortus, and fungi. Clinical symptoms are generally nonspecific, and early diagnosis and appropriate treatment can prevent irreversible sequelae. Advances in pathologic histologic imaging have led physicians to look more forward to being able to differentiate between tuberculous and septic spinal discitis. Therefore, research in identifying and differentiating the imaging features of these 4 common NVOs is essential. Due to the diagnostic difficulties, clinical and radiologic diagnosis is the mainstay of provisional diagnosis. With the advent of the big data era and the emergence of convolutional neural network algorithms for deep learning, the application of artificial intelligence (AI) technology in orthopedic imaging diagnosis has gradually increased. AI can assist physicians in imaging review, effectively reduce the workload of physicians, and improve diagnostic accuracy. Therefore, it is necessary to present the latest clinical research on NVO and the outlook for future AI applications.
Topics: Humans; Anti-Bacterial Agents; Artificial Intelligence; Discitis; Osteomyelitis; Spine
PubMed: 38555491
DOI: 10.12659/MSM.943168 -
Revista Da Sociedade Brasileira de... 2024
Topics: Humans; Burkholderia cepacia complex; Discitis; Anti-Bacterial Agents
PubMed: 38537005
DOI: 10.1590/0037-8682-0001-2024 -
Journal of Veterinary Internal Medicine 2024Vertebral infections, including vertebral osteomyelitis, septic physitis, and discospondylitis, are rarely reported in goats, and when reported, have been largely...
BACKGROUND
Vertebral infections, including vertebral osteomyelitis, septic physitis, and discospondylitis, are rarely reported in goats, and when reported, have been largely limited to necropsy case reports.
OBJECTIVE
Describe clinical findings and outcome in goats with vertebral infections evaluated by computed tomography (CT).
ANIMALS
Five goats with vertebral osteomyelitis, septic physitis, and discospondylitis evaluated by CT.
METHODS
Retrospective case series.
RESULTS
The most common presenting complaints were progressive weakness, paresis and recumbency. Three goats were tetraparetic and 2 goats had pelvic limb paraparesis. Clinicopathologic findings included leukocytosis, mature neutrophilia, and hyperfibrinogenemia. The most common vertebrae affected were C7-T1. All 5 goats had discospondylitis with or without vertebral osteomyelitis and septic physitis. Computed tomographic evidence of spinal cord compression was present in 4/5 goats. Medical management (antimicrobials, physical therapy, analgesia, supportive care) was attempted in 4 goats, and 1 goat was euthanized at the time of diagnosis. All 4 goats that were treated regained ambulatory ability and survived to hospital discharge.
CONCLUSIONS AND CLINICAL IMPORTANCE
Despite severity of CT imaging findings, goats with discospondylitis, septic physitis, and vertebral osteomyelitis can successfully return to ambulatory function. Additional studies are required to determine ideal treatment regimens.
Topics: Animals; Goats; Goat Diseases; Osteomyelitis; Retrospective Studies; Female; Tomography, X-Ray Computed; Male; Discitis; Spondylitis; Spinal Diseases
PubMed: 38483064
DOI: 10.1111/jvim.17035 -
Acta Ortopedica Mexicana 2023Patient with spondylodiscitis who presented kyphosis deformity with neurological compromise at the upper thoracic level, who was treated with a new right infraclavicular... (Review)
Review
Patient with spondylodiscitis who presented kyphosis deformity with neurological compromise at the upper thoracic level, who was treated with a new right infraclavicular anterior thoracic approach, as a new alternative surgical technique. 72-year-old male with kyphosis deformity secondary to T2-T3 ASIA "C" spondylodiscitis, treated with C5 to T6 posterior cervicothoracic instrumentation and right infraclavicular transthoracic anterior approach utilizing an expandable cylinder. Within the literature review carried out in the search engines, no similar techniques to the one described in this article were found. Given the complexity of the surgical approach, this new technique is described as a new way for accessing the upper thoracic spine, demonstrating that the right infraclavicular anterior thoracic approach is a new alternative to access the upper thoracic spine from T1 to T4.
Topics: Aged; Humans; Male; Discitis; Kyphosis; Spinal Fusion; Thoracic Vertebrae
PubMed: 38467461
DOI: No ID Found -
Cureus Feb 2024is commonly implicated in Infective Endocarditis (IE), resulting in remarkable morbidity and mortality. We present an unusual case documenting the clinical course and...
is commonly implicated in Infective Endocarditis (IE), resulting in remarkable morbidity and mortality. We present an unusual case documenting the clinical course and outcome of an elderly female patient who developed quadruple valve endocarditis due to infection. She presented with altered mental status, resulting in hospitalization, and was found to have bacteremia complicated by endocarditis, epidural abscess, discitis, and splenic infarction. Urinalysis was consistent with bacterial infection two days before being admitted to the hospital. Unfortunately, despite aggressive therapeutic regimens, the patient died. This is one of the few documented endocarditis cases involving all heart valves. It reviews the importance of maintaining a high index of clinical suspicion for assessing IE, with a low threshold for performing a transesophageal echocardiogram as a diagnostic tool.
PubMed: 38465066
DOI: 10.7759/cureus.53837