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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 -
Magnetic Resonance Imaging Clinics of... May 2024Spinal infections are a diverse group of diseases affecting different compartments of the spine with variable clinical and imaging presentations. Diagnosis of spinal... (Review)
Review
Spinal infections are a diverse group of diseases affecting different compartments of the spine with variable clinical and imaging presentations. Diagnosis of spinal infections is based on a combination of clinical features, laboratory markers, and imaging studies. Imaging plays a pivotal role in the diagnosis and management of spinal infections. The characteristic imaging manifestations of bacterial and viral infections in the spine are discussed with key teaching points emphasized.
Topics: Humans; Spondylitis; Magnetic Resonance Imaging; Spine; Virus Diseases; Communicable Diseases; Discitis
PubMed: 38555143
DOI: 10.1016/j.mric.2023.12.003 -
Revista Da Sociedade Brasileira de... 2024
Topics: Humans; Burkholderia cepacia complex; Discitis; Anti-Bacterial Agents
PubMed: 38537005
DOI: 10.1590/0037-8682-0001-2024 -
European Journal of Radiology Jun 2024To compare image quality, assess inter-reader variability, and evaluate the diagnostic efficacy of routine clinical lumbar spine sequences at 0.55T compared with those... (Comparative Study)
Comparative Study
PURPOSE
To compare image quality, assess inter-reader variability, and evaluate the diagnostic efficacy of routine clinical lumbar spine sequences at 0.55T compared with those collected at 1.5/3T to assess common spine pathology.
METHODS
665 image series across 70 studies, collected at 0.55T and 1.5/3T, were assessed by two neuroradiology fellows for overall imaging quality (OIQ), artifacts, and accurate visualization of anatomical features (intervertebral discs, neural foramina, spinal cord, bone marrow, and conus / cauda equina nerve roots) using a 4-point Likert scale (1 = non-diagnostic to 4 = excellent). For the 0.55T scans, the most appropriate diagnosis(es) from a picklist of common spine pathologies was selected. The mean ± SD of all scores for all features for each sequence and reader at 0.55T and 1.5/3T were calculated. Paired t-tests (p ≤ 0.05) were used to compare ratings between field strengths. The inter-reader agreement was calculated using linear-weighted Cohen's Kappa coefficient (p ≤ 0.05). Unpaired VCG analysis for OIQ was additionally employed to represent differences between 0.55T and 1.5/3T (95 % CI).
RESULTS
All sequences at 0.55T were rated as acceptable (≥2) for diagnostic use by both readers despite significantly lower scores for some compared to those at 1.5/3T. While there was low inter-reader agreement on individual scores, the agreement on the diagnosis was high, demonstrating the potential of this system for detecting routine spine pathology.
CONCLUSIONS
Clinical lumbar spine imaging at 0.55T produces diagnostic-quality images demonstrating the feasibility of its use in diagnosing spinal pathology, including osteomyelitis/discitis, post-surgical changes with complications, and metastatic disease.
Topics: Humans; Lumbar Vertebrae; Spinal Diseases; Magnetic Resonance Imaging; Male; Reproducibility of Results; Female; Middle Aged; Adult; Observer Variation; Artifacts; Sensitivity and Specificity; Aged
PubMed: 38490129
DOI: 10.1016/j.ejrad.2024.111406 -
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 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Dec 2023Spinal infection caused by () is a rare infection. The characteristic imageology includes spondylodiscitis, spondylitis, paravertebral abscess, and epidural abscess.... (Review)
Review
Spinal infection caused by () is a rare infection. The characteristic imageology includes spondylodiscitis, spondylitis, paravertebral abscess, and epidural abscess. One case of spondylodiscitis of lumbar complicated with spinal epidural abscess caused by was admitted to the Department of Spinal Surgery, Xiangya Hospital, Central South University on February, 2023. This case is a 60 years old man with lower back pain and left lower limb numbness. MRI showed spondylitis, spondylodiscitis, and epidural abscess. The patient underwent debridement, decompression and fusion surgery. The culture of surgical sample was negative. was detected by metagenomic next-generation sequencing (mNGS). The postoperative antibiotic treatment included intravenous infusion of linezolid and piperacillin for 1 week, then intravenous infusion of ceftazidime and oral metronidazole for 2 weeks, followed by oral metronidazole and nerofloxacin for 2 weeks. During the follow-up, the lower back pain and left lower limb numbness was complete remission. Spinal infection caused by is extremely rare, when the culture is negative, mNGS can help the final diagnosis.
Topics: Male; Humans; Middle Aged; Discitis; Epidural Abscess; Low Back Pain; Hypesthesia; Metronidazole; Spondylitis; Firmicutes
PubMed: 38448387
DOI: 10.11817/j.issn.1672-7347.2023.230139