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British Journal of Hospital Medicine... Oct 2022Spondylodiscitis is often diagnosed late in its course because its symptoms are vague. The incidence in adults increases with age, being seen most commonly in men in...
Spondylodiscitis is often diagnosed late in its course because its symptoms are vague. The incidence in adults increases with age, being seen most commonly in men in their 50s and 60s, so the presence of other medical conditions or infections can make it more difficult to identify spondylodiscitis. Diagnosis is made based on clinical suspicion, raised levels of inflammatory markers, a positive blood or tissue biopsy culture and radiological findings. Once a diagnosis is confirmed, treatment must be started promptly. The mainstay of treatment is medical management, with antibiotics tailored to the relevant organism, as well as immobilisation. Where surgery is indicated, the aims are debridement of infected tissue, tissue sampling, neural decompression and stabilisation. Spondylodiscitis is associated with high rates of mortality and morbidity and should be treated promptly to ensure the best outcome.
Topics: Adult; Male; Humans; Discitis; Treatment Outcome; Anti-Bacterial Agents; Biopsy; Debridement
PubMed: 36322436
DOI: 10.12968/hmed.2021.0448 -
Journal of Infection and Public Health 2010Although uncommon, spontaneous and postoperative pyogenic spondylodiscitis entail major morbidity and may be associated with serious long-term sequelae. A review of the... (Review)
Review
Although uncommon, spontaneous and postoperative pyogenic spondylodiscitis entail major morbidity and may be associated with serious long-term sequelae. A review of the literature was done to advance our understanding of the diagnosis, treatment, and outcome of these infections. The principles of conservative treatment are to establish an accurate microbiological diagnosis, treat with appropriate antibiotics, immobilize the spine, and closely monitor for spinal instability and neurological deterioration. The purpose of surgical treatment is to obtain multiple intraoperative cultures of bone and soft tissue, perform a thorough debridement of infected tissue and decompression of neural structures, and reconstruct the unstable spinal column with bone graft with or without concomitant instrumentation. Appropriate management requires aggressive medical treatment and, at times, surgical interventions. If recognized early and treated appropriately, a full recovery can often be expected. Therefore, clinicians should be aware of the clinical presentation of such infections to improve patient outcome.
Topics: Anti-Infective Agents; Back Pain; Bacterial Infections; Debridement; Decompression, Surgical; Diagnosis, Differential; Discitis; Humans; Postoperative Complications; Spine; Treatment Outcome
PubMed: 20701886
DOI: 10.1016/j.jiph.2010.01.001 -
The Pan African Medical Journal 2015
Topics: Biopsy; Candida albicans; Candidiasis; Discitis; Humans; Lumbar Vertebrae; Male; Middle Aged; Spondylitis
PubMed: 26664532
DOI: 10.11604/pamj.2015.22.31.7831 -
Arthritis and Rheumatism Dec 2012
Topics: Adult; Congenital Abnormalities; Diagnosis, Differential; Discitis; Female; Humans; Low Back Pain; Lumbar Vertebrae; Spinal Fractures; Tomography, X-Ray Computed
PubMed: 22833300
DOI: 10.1002/art.34630 -
BMC Musculoskeletal Disorders Aug 2022This retrospective study analyzed the clinical characteristics and outcomes of patients with anaerobic spondylodiscitis.
BACKGROUND
This retrospective study analyzed the clinical characteristics and outcomes of patients with anaerobic spondylodiscitis.
METHODS
From a total of 382 patients with infectious spondylodiscitis, nine patients (2.4%; two male and seven female with an average age of 67 years) with anaerobic spondylodiscitis between March 2003 and March 2017 were analyzed.
RESULTS
Most of the patients (77.8%) initially presented with afebrile back pain. Hematogenous spread occurred in seven patients and postoperative infection in two patients. Bacteroid fragilis was the most common pathogen isolated from three patients. Atypical radiographic characteristics, including a vertebral fracture with the preservation of disk height or coexisting spondylolytic spondylolisthesis, occurred in four patients with hematogenous anaerobic spondylodiscitis. The eradication rate of anaerobic infection was significantly higher in the patients with hematogenous infection than in those with postoperative infection (100% vs. 0%, p = 0.0476). Anaerobic spondylodiscitis accounted for 2.4% of cases of infectious spondylodiscitis and predominantly affected the female patients.
CONCLUSIONS
Diagnostic delay may occur because of atypical spinal radiographs if the patient reports only back pain but no fever. Anaerobic infection following elective spinal instrumentation has a higher recurrence rate.
Topics: Aged; Anaerobiosis; Back Pain; Delayed Diagnosis; Discitis; Female; Humans; Male; Retrospective Studies
PubMed: 35978349
DOI: 10.1186/s12891-022-05749-0 -
Turkish Neurosurgery 2015Postoperative spondylodiscitis is relatively uncommon. This complication is associated with increased cost, and long-term of inability to work, and even morbidity.... (Review)
Review
Postoperative spondylodiscitis is relatively uncommon. This complication is associated with increased cost, and long-term of inability to work, and even morbidity. Although the majority of postoperative spondylodiscitis cases can be well managed by conservative treatment, postoperative spondylodiscitis after internal fixation and those cases that are unresponsive to the conservative treatment present challenges to the surgeon. Here, a review was done to analyze the treatment of postoperative spondylodiscitis with/without internal fixation. This review article suggested that majority of postoperative spondylodiscitis without internal fixation could be cured by conservative treatment. Either posterior or anterior debridement can be used to treat postoperative spondylodiscitis without internal fixation when conservative treatment fails. In addition, minimally invasive debridement and drainage may also be an alternative treatment. In case of postoperative spondylodiscitis after internal fixation, surgical treatment was required. In the cervical spine, it can be well managed by anterior debridement, removal of internal fixation, and reconstruction of the spinal stability by using bone grafting/cage/anterior plate. Postoperative spondylodiscitis after internal fixation is successfully managed by combined anterior debridement, fusion with posterior approach and removal of pedicle screw or extension of pedicle screw beyond the lesion site, in the thoracic and lumbar spine.
Topics: Discitis; Humans; Internal Fixators; Postoperative Complications; Watchful Waiting
PubMed: 26242325
DOI: 10.5137/1019-5149.JTN.9008-13.1 -
BMJ Case Reports Jul 2017The authors present a case involving an 80-year-old man with infectious T10/T11 discitis on the background of a recent bacteraemia. This case report describes a case of...
The authors present a case involving an 80-year-old man with infectious T10/T11 discitis on the background of a recent bacteraemia. This case report describes a case of probable discitis as further investigations failed to identify any causative agents. He was treated with intravenous piperacillin/tazobactam to good effect, achieving favourable clinical outcome. Diagnosis of discitis/osteomyelitis can often be delayed and mismanaged due to its non-specific presentations. Timing of empirical antimicrobial therapy requires careful consideration based on haemodynamic stability and neurological function to maximise microbiological yield.
Topics: Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Clostridium Infections; Discitis; Humans; Male; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Treatment Outcome
PubMed: 28747416
DOI: 10.1136/bcr-2017-220646 -
International Orthopaedics Jan 2024Knowledge of Candida spondylodiscitis is limited to case reports and smaller case series. Controversy remains on the most effective diagnostical and therapeutical steps... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Knowledge of Candida spondylodiscitis is limited to case reports and smaller case series. Controversy remains on the most effective diagnostical and therapeutical steps once Candida is suspected. This systematic review summarized all cases of Candida spondylodiscitis reported to date concerning baseline demographics, symptoms, treatment, and prognostic factors.
METHODS
A PRISMA-based search of PubMed, Web of Science, Embase, Scopus, and OVID Medline was performed from database inception to November 30, 2022. Reported cases of Candida spondylodiscitis were included regardless of Candida strain or spinal levels involved. Based on these criteria, 656 studies were analyzed and 72 included for analysis. Kaplan-Meier curves, Fisher's exact, and Wilcoxon's rank sum tests were performed.
RESULTS
In total, 89 patients (67% males) treated for Candida spondylodiscitis were included. Median age was 61 years, 23% were immunocompromised, and 15% IV drug users. Median length of antifungal treatment was six months, and fluconazole (68%) most commonly used. Thirteen percent underwent debridement, 34% discectomy with and 21% without additional instrumentation. Median follow-up was 12 months. The two year survivorship free of death was 80%. The two year survivorship free of revision was 94%. Younger age (p = 0.042) and longer length of antifungal treatment (p = 0.061) were predictive of survival.
CONCLUSION
Most patients affected by Candida spondylodiscitis were males in their sixties, with one in four being immunocompromised. While one in five patients died within two years of diagnosis, younger age and prolonged antifungal treatment might play a protective role.
Topics: Male; Humans; Middle Aged; Female; Candida; Antifungal Agents; Discitis; Candidiasis; Immunocompromised Host
PubMed: 37792014
DOI: 10.1007/s00264-023-05989-2 -
Tidsskrift For Den Norske Laegeforening... Sep 2011
Topics: Aged; Discitis; Humans; Male; Osteomyelitis; Radiography; Risk Factors
PubMed: 21946597
DOI: 10.4045/tidsskr.11.0362 -
Ugeskrift For Laeger Sep 2016Spondylodiscitis, infection of the spine and intervertebral discs, is a rare condition with increasing incidence. Early diagnosis can be challenging due to the... (Review)
Review
Spondylodiscitis, infection of the spine and intervertebral discs, is a rare condition with increasing incidence. Early diagnosis can be challenging due to the non-specific symptoms such as back pain and fever. Diagnosis is verified by MRI. Microbial aetiology is pursued by blood cultures or surgical biopsy, however, some cases remain culture-negative. Long-term antibiotic treatment is standard of care. Some patients receive surgical treatment. One-year mortality is up to 20%. Recently, published data suggest that six weeks of antibiotics equals 12 weeks in culture-positive cases.
Topics: Anti-Bacterial Agents; Critical Pathways; Discitis; Humans; Magnetic Resonance Imaging
PubMed: 27697126
DOI: No ID Found