RESUMEN
BACKGROUND: In July 2023, our hospital confirmed one case of lumbar spine infected complicated by Mycobacterium tuberculosis and Cryptococcus neoformans. The patient was admitted due to lower back pain for 1 year and a hard lump for 3 months. Symptoms and signs: Dressing can be seen fixed on the lower back, with severe bleeding. When the dressing is removed, a hard and protruding lump with a size of 6 cm x 8 cm, a sinus tract can be seen near the mass, with a slightly red wound and a sinus depth of about 3 cm. Light red fluid can be seen flowing out. There are no symptoms such as redness, swelling, or heat in the rest of the lower back, and the patient has no other underlying diseases or surgical history. METHODS: Lumbar magnetic resonance imaging and lumbar CT examination; Percutaneous puncture lumbar vertebral biopsy was performed, and the biopsy tissue was subjected to pathological examination, mNGS (metagenomic next-generation sequencing), and acid-fast staining; Extract pus from the lump for fungal culture and ink staining, and identify the fungi through MALDI-TOF MS. RESULTS: Bone destruction and bone marrow edema in the L5 vertebral body, compression of the spinal canal at the L5 vertebral body level; The pathological results of the biopsy tissue indicate granulomatous lesions. The acid-fast staining of the tissue is positive, and the mNGS of the tissue indicates infection with Mycobacterium tuberculosis. A single fungus was cultured from pus and identified by MALDI-TOF MS as Cryptococcus neoformans. Clinically, isoniazid 0.3 g ivgtt + rifampicin 0.45 g qd po + ethambutol 0.25 g qd po + pyrazinamide 0.75 g qd po + fluconazole 0.3 g qd po was administered for treatment. After 11 days, there was slight pain at the incision site, and the original symptoms were significantly relieved. The wound dressing was fixed in place, dry and without obvious exudation. Improved and discharged, followed up for 3 months with no recurrence of the lesion. CONCLUSIONS: mNGS is an effective identification technique that can be used to accurately diagnose suspected infection cases. MALDI-TOF MS has significant advantages over traditional detection methods in shortening detection time. This case achieved satisfactory treatment results for patients through a reasonable treatment plan, which is of great significance for exploring the diagnosis and treatment of similar disease infections.
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Criptococosis , Cryptococcus neoformans , Vértebras Lumbares , Mycobacterium tuberculosis , Humanos , Cryptococcus neoformans/aislamiento & purificación , Vértebras Lumbares/microbiología , Mycobacterium tuberculosis/aislamiento & purificación , Criptococosis/diagnóstico , Criptococosis/microbiología , Criptococosis/tratamiento farmacológico , Masculino , Tuberculosis de la Columna Vertebral/diagnóstico , Tuberculosis de la Columna Vertebral/microbiología , Imagen por Resonancia Magnética , Antituberculosos/uso terapéutico , Antituberculosos/administración & dosificación , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Bacterial infection and Modic changes (MCs) as causes of low back pain (LBP) are debated. Results diverged between two randomised controlled trials examining the effect of amoxicillin with and without clavulanic acid versus placebo on patients with chronic LBP (cLBP) and MCs. Previous biopsy studies have been criticised with regard to methods, few patients and controls, and insufficient measures to minimise perioperative contamination. In this study, we minimise contamination risk, include a control group and optimise statistical power. The main aim is to compare bacterial growth between patients with and without MCs. METHODS AND ANALYSIS: This multicentre, case-control study examines disc and vertebral body biopsies of patients with cLBP. Cases have MCs at the level of tissue sampling, controls do not. Previously operated patients are included as a subgroup. Tissue is sampled before antibiotic prophylaxis with separate instruments. We will apply microbiological methods and histology on biopsies, and predefine criteria for significant bacterial growth, possible contamination and no growth. Microbiologists, surgeons and pathologist are blinded to allocation of case or control. Primary analysis assesses significant growth in MC1 versus controls and MC2 versus controls separately. Bacterial disc growth in previously operated patients, patients with large MCs and growth from the vertebral body in the fusion group are all considered exploratory analyses. ETHICS AND DISSEMINATION: The Regional Committees for Medical and Health Research Ethics in Norway (REC South East, reference number 2015/697) has approved the study. Study participation requires written informed consent. The study is registered at ClinicalTrials.gov (NCT03406624). Results will be disseminated in peer-reviewed journals, scientific conferences and patient fora. TRIAL REGISTRATION NUMBER: NCT03406624.
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Dolor de la Región Lumbar , Humanos , Dolor de la Región Lumbar/microbiología , Estudios de Casos y Controles , Biopsia , Disco Intervertebral/microbiología , Disco Intervertebral/patología , Vértebras Lumbares/microbiología , Antibacterianos/uso terapéutico , Infecciones Bacterianas/microbiología , Estudios Multicéntricos como Asunto , Profilaxis AntibióticaRESUMEN
BACKGROUND: Pyogenic spondylitis by methicillin-resistant Staphylococcus aureus (MRSA) is known to be intractable. In the past, the insertion of an implant into infected vertebra was considered contraindicated in affected patients because it may exacerbate the infection, but there are increasing numbers of reports indicating the usefulness of posterior fixation to correct instability and alleviate infection. Bone grafting is often required to repair large bone defect due to infection, but free grafts can exacerbate infection and are controversial. CASE PRESENTATION: We present the case of a 58-year-old Asian man with intractable pyogenic spondylitis who had repeated septic shocks due to MRSA. Back pain from repeated pyogenic spondylitis caused by a huge bone defect in L1-2 rendered him unable to sit. Posterior fixation by percutaneous pedicle screws (PPSs) without bone transplantation improved spinal stability and regenerated bone in the huge vertebral defect. He regained his activities of daily living, had no reoccurrence of pyogenic spondylitis nor bacteremia, and was completely cured of the infection without antibiotics after removal of all screws. CONCLUSIONS: For intractable MRSA pyogenic spondylitis with instability accompanied by a huge bone defect, posterior fixation using PPSs and administration of antibacterial agents stopped the infection, allowed the bone to regenerate, and recovered the patient's activities of daily living.
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Staphylococcus aureus Resistente a Meticilina , Tornillos Pediculares , Espondilitis , Masculino , Humanos , Persona de Mediana Edad , Actividades Cotidianas , Espondilitis/complicaciones , Espondilitis/diagnóstico por imagen , Espondilitis/cirugía , Antibacterianos/uso terapéutico , Vértebras Lumbares/microbiología , Regeneración ÓseaRESUMEN
BACKGROUND Pyogenic spondylitis comprises several clinical entities, including native vertebral osteomyelitis, septic discitis, pyogenic spondylodiscitis, and epidural abscess. The lumbar spine is most often infected, followed by the thoracic and cervical areas. It mainly develops (i) after spine surgery; (ii) from history of blunt trauma to the spinal column; (iii) from infections in adjacent structures (such as soft tissues); (iv) from iatrogenic inoculation after invasive procedures (such as lumbar puncture); and (v) from hematogenous bacterial spread to the vertebra (mainly through the venous route). Any delay in diagnosis and treatment can lead to significant spinal cord injury, permanent neurological damage, septicemia, and death. CASE REPORT We describe a 63-year-old man with no significant past medical history who presented with fever and an altered level of consciousness. Significant thoracic spine pain was also reported during the last 3 months. The final diagnosis was vertebral spondylodiscitis, contiguous spinal epidural abscess, and sepsis due to Bacteroides fragilis bacteremia. Clinical recovery was achieved after surgical decompressive therapy with abscess drainage combined with appropriate antibiotic therapy for 12 weeks. The primary focus of the infection was not clarified, despite all the investigations that were performed. CONCLUSIONS Spondylodiscitis, spinal epidural abscess, and sepsis as complications of Bacteroides fragilis bacteremia are rare in a patient without any previously known predisposing conditions and without an obvious primary focus. Early diagnosis and proper treatment of anaerobic spondylodiscitis, especially if epidural abscess and sepsis are present, are of great importance to reduce mortality and avoid long-term complications.
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Bacteriemia , Discitis , Absceso Epidural , Sepsis , Bacteriemia/complicaciones , Bacteriemia/diagnóstico , Bacteroides fragilis , Discitis/diagnóstico , Discitis/microbiología , Absceso Epidural/diagnóstico , Absceso Epidural/terapia , Humanos , Vértebras Lumbares/microbiología , Masculino , Persona de Mediana Edad , Sepsis/complicaciones , Sepsis/diagnósticoAsunto(s)
Ceftriaxona/uso terapéutico , Discitis/tratamiento farmacológico , Discitis/microbiología , Discitis/cirugía , Vértebras Lumbares/microbiología , Vértebras Lumbares/cirugía , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Humanos , Masculino , Neisseria meningitidis , Adulto JovenRESUMEN
BACKGROUND: Brucella spondylitis (BS) and tuberculous spondylitis (TS), caused initially by bacteremia, are the two leading types of granulomatous spinal infections. BS is easy to miss or may be misdiagnosed as TS. Our purpose aims to differentiate BS from TS in conventional MR imaging and MR T2 mapping. METHODS: We performed on 26 BS and 27 TS patients conventional MR imaging and MR T2 mapping. We analyzed the features in conventional MR imaging and measured T2 values of the lesion vertebrae (LV) and unaffected adjacent vertebrae (UAV) in BS and TS patients, respectively. RESULTS: There were no significant differences in sex, age, national between BS and TS. There was significantly lower severity of vertebral destruction, vertebral posterior convex deformity, dead bone, and abscess scope in BS when compared to TS (p < 0.001, p = 0.048, p < 0.001, p < 0.001, respectively). The vertebral hyperplasia was significantly higher in BS when compared to TS (p < 0.001). The T2 value of the LV with BS was markedly higher than that in the UAV with BS and that in the LV and UAV with TS (p < 0.001, p < 0.037, p < 0.001, respectively). The T2 value of the LV with TS was significantly higher than that of the UAV in TS and BS (p < 0.001, p < 0.001, respectively). There were no significant differences in the T2 value of the UAV between BS and TS (p = 0.568). CONCLUSIONS: The qualitative and quantitative evaluation may differentiate BS from TS. The conventional MR imaging helps to distinguish BS from TS by several distinctive features. MR T2 mapping has the additional potential to provide quantitative information between BS and TS.
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Brucella/aislamiento & purificación , Brucelosis/diagnóstico , Diagnóstico por Imagen/métodos , Imagen por Resonancia Magnética/métodos , Espondilitis/diagnóstico , Tuberculosis de la Columna Vertebral/diagnóstico , Adolescente , Adulto , Anciano , Brucelosis/microbiología , Diagnóstico Diferencial , Humanos , Vértebras Lumbares/microbiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Espondilitis/microbiología , Vértebras Torácicas/microbiología , Tuberculosis de la Columna Vertebral/microbiología , Adulto JovenRESUMEN
Vertebral discitis-osteomyelitis is an infection of the intervertebral disk and vertebral bodies that may extend to adjacent paraspinal and epidural soft tissues. Its incidence is increasing, likely because of improved treatments and increased life expectancy for patients with predisposing chronic disease and increased rates of IV drug use and intravascular intervention. Because blood cultures are frequently negative in patients with vertebral discitis-osteomyelitis, biopsy is often indicated to identify a causative microorganism for targeted antimicrobial therapy. The reported yield of CT-guided percutaneous sampling is 31-91%, which is lower than the reported yield of open biopsy of 76-91%. However, the less invasive approach may be favored given its relative safety and low cost. If paravertebral fluid collections are present, CT-guided aspiration should be performed. If aspiration is unsuccessful or no paravertebral fluid collections are present, CT-guided percutaneous biopsy should be performed, considering technical factors (e.g., anatomic approach, needle selection, and needle angulation) that may improve microbiologic yield. Although antimicrobial therapy should be withheld for 1-2 weeks before biopsy if clinically feasible, biopsy may still be performed without stopping antimicrobial therapy if needed. Because of the importance of targeted antimicrobial therapy, repeat biopsy should be considered after 72 hours if initial biopsy does not identify a pathogen.
Asunto(s)
Discitis/diagnóstico por imagen , Biopsia Guiada por Imagen/métodos , Vértebras Lumbares/diagnóstico por imagen , Osteomielitis/diagnóstico por imagen , Anciano , Antibacterianos/uso terapéutico , Discitis/tratamiento farmacológico , Discitis/microbiología , Discitis/patología , Humanos , Biopsia Guiada por Imagen/efectos adversos , Vértebras Lumbares/microbiología , Vértebras Lumbares/patología , Masculino , Osteomielitis/tratamiento farmacológico , Osteomielitis/microbiología , Osteomielitis/patología , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: The aim of this study was to explore the efficacy and safety of surgical treatment of lumbar brucella spondylitis with PEEK cages combined with one-stage posterior debridement and instrumentation. METHODS: We performed a retrospective study for adult patients with lumbar brucella spondylitis. Medical records, imaging studies and laboratory data were collected, back pain was measured by employing the visual analog scale (VAS) and the neurological status was evaluated by using the American Spinal Injury Association (ASIA) scale. RESULTS: A total of 61 consecutive patients (42 males and 19 females) were enrolled with the mean age at presentation of 56.33⯱â¯9.16 years old. L3-4 and L4-5 were the most infected levels with the ratios of 21.31 % and 19.67 % respectively. Moreover, 12 (19.67 %) patients suffered multiple-level infection and 5 (5/12, 41.67 %) of them had non-contiguous spondylitis. In addition, epidural masses were found in 26 (42.62 %) cases and psoas abscesses were found in 14 (22.95 %) cases. The number of operative segment depended on operation indications (failure of conservative measures, instability, kyphosis, intractable pain and/or neurological impairment). VAS scores were significantly improved at 6-weeks and the last follow-up. Among the 23 (37.70 %) patients with neurological deficits, 19 (19/23, 82.61 %) obtained a full recovery and 4 (4/23, 17.39 %) had been improved incompletely during the last follow-up. All patients exhibited satisfactory bone fusion during the last follow-up. Local infection of surgical site was identified in 6 (9.84 %) cases and no other surgery-related complications were found. CONCLUSION: Use of PEEK cages for interbody fusion is feasible and safe in patients suffering from lumbar brucella spondylitis.
Asunto(s)
Brucella/aislamiento & purificación , Brucelosis/cirugía , Desbridamiento/métodos , Fijadores Internos , Cetonas/administración & dosificación , Vértebras Lumbares/cirugía , Polietilenglicoles/administración & dosificación , Espondilitis/cirugía , Anciano , Benzofenonas , Materiales Biocompatibles/administración & dosificación , Brucelosis/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/microbiología , Masculino , Persona de Mediana Edad , Polímeros , Estudios Retrospectivos , Espondilitis/diagnóstico por imagen , Espondilitis/microbiologíaRESUMEN
Background: Disconnection of the tubing between the port and LAGB is a well-known complication in general surgery and accounts for up to 17% of LAGB complications. Typically, when this complication occurs patients present with abdominal or pelvic complaints. A complication of spinal infection due to trans-foraminal migration has not been previously reported. The aim of this study is to highlight an unusual infection of the thoracolumbar spine due to laparoscopic adjustable gastric band (LAGB) intragastric erosion, and migration into the lumbar spine causing epidural abscesses, discitis, and osteomyelitis. This case underscores the importance of a thorough surgical history, complete imaging, and multi-disciplinary approach in management of complex spine infections. Methods: We report a case of LAGB tubing migration into the spinal canal through the left L2/L3 neural foramen resulting in symptomatic epidural abscesses and osteomyelitis. Results: Although dislodgement and migration of LAGB tubing has been reported previously, this is the first report of trans-foraminal migration and erosion of lumbar vertebrae, causing osteomyelitis of the spine and epidural abscess formation, subsequent instability and neurologic deficit requiring urgent operative intervention. Conclusions: Dislodgement and migration of LAGB tubing is a known complication. While it most commonly leads to abdominal and pelvic sequelae, in rare circumstances it may acutely affect the spine. Careful history, imaging, and multidisciplinary approach are paramount for the successful management.Level of Evidence: V.
Asunto(s)
Migración de Cuerpo Extraño/complicaciones , Migración de Cuerpo Extraño/microbiología , Gastroplastia , Vértebras Lumbares/microbiología , Osteomielitis/microbiología , Antibacterianos/uso terapéutico , Migración de Cuerpo Extraño/cirugía , Humanos , Laparoscopía , Vértebras Lumbares/cirugía , Masculino , Staphylococcus aureus Resistente a Meticilina , Persona de Mediana Edad , Osteomielitis/tratamiento farmacológico , Osteomielitis/cirugíaAsunto(s)
Discitis/diagnóstico , Dolor de la Región Lumbar/etiología , Vértebras Lumbares , Tuberculosis de la Columna Vertebral/diagnóstico , Adolescente , Discitis/complicaciones , Discitis/microbiología , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/microbiología , Imagen por Resonancia Magnética , Tuberculosis de la Columna Vertebral/complicacionesRESUMEN
BACKGROUND: The aims of this study were to identify the predictive factors for microbiological diagnosis through disco-vertebral biopsy (DVB) in patients with pyogenic vertebral osteomyelitis (PVO) and negative blood cultures, and compare the performance of DVB under fluoroscopic versus scanographic guidance. METHODS: We performed a cohort study comparing positive and negative DVB among patients with PVO. All cases of PVO undergoing a DVB for microbiological diagnosis in our center were retrospectively reviewed. Infections due to Mycobacterium tuberculosis, infections on foreign device, and non-septic diseases were excluded. Anamnestic, clinical, biological, microbiological, as well as radiological data were collected from medical charts thanks to a standardized data set. RESULTS: A total of 111 patients were screened; 88 patients were included. Microbiological cultures were positive in 53/88 (60.2%) patients. A thickening of the paravertebral tissue ≥10 mm on magnetic resonance imaging (MRI) in axial MR scans was a predictive factor of DVB microbiological positivity (52.4% vs. 13.3%; p = 0.006; OR = 5.4). Overall, 51 DVB were performed under fluoroscopic guidance and 37 under scanographic guidance. Considering lumbar DVB, 25/36 (69.4%) of cases yielded positive results under fluoroscopic guidance versus 5/15 (33.3%) under scanographic guidance (p = 0.02; OR = 4.4). No adverse event linked to DVB was notified. CONCLUSION: Every patient with PVO and negative blood cultures should undergo a DVB. A thickening of the paravertebral tissue ≥10 mm on MRI is associated with a higher rate of positive DVB culture. A lumbar DVB under fluoroscopic guidance is more sensitive than under scanographic guidance to identify the micro-organism involved.
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Disco Intervertebral/patología , Vértebras Lumbares/patología , Osteomielitis/diagnóstico , Enfermedades de la Columna Vertebral/diagnóstico , Infecciones Estafilocócicas/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Absceso Epidural/diagnóstico , Absceso Epidural/patología , Femenino , Fluoroscopía/métodos , Humanos , Biopsia Guiada por Imagen/métodos , Disco Intervertebral/microbiología , Vértebras Lumbares/microbiología , Masculino , Persona de Mediana Edad , Osteomielitis/microbiología , Osteomielitis/patología , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Enfermedades de la Columna Vertebral/microbiología , Enfermedades de la Columna Vertebral/patología , Infecciones Estafilocócicas/patología , Tomografía Computarizada por Rayos X/métodos , Adulto JovenRESUMEN
Post-surgical implant-associated spinal infection is a devastating complication commonly caused by Staphylococcus aureus Biofilm formation is thought to reduce penetration of antibiotics and immune cells, contributing to chronic and difficult-to-treat infections. A rabbit model of a posterior-approach spinal surgery was created, in which bilateral titanium pedicle screws were interconnected by a plate at the level of lumbar vertebra L6 and inoculated with a methicillin-resistant S.aureus (MRSA) bioluminescent strain. In vivo whole-animal bioluminescence imaging (BLI) and ex vivo bacterial cultures demonstrated a peak in bacterial burden by day 14, when wound dehiscence occurred. Structures suggestive of biofilm, visualized by scanning electron microscopy, were evident up to 56â days following infection. Infection-induced inflammation and bone remodeling were also monitored using 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and computed tomography (CT). PET imaging signals were noted in the soft tissue and bone surrounding the implanted materials. CT imaging demonstrated marked bone remodeling and a decrease in dense bone at the infection sites. This rabbit model of implant-associated spinal infection provides a valuable preclinical in vivo approach to investigate the pathogenesis of implant-associated spinal infections and to evaluate novel therapeutics.
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Biopelículas/crecimiento & desarrollo , Placas Óseas/efectos adversos , Tornillos Óseos/efectos adversos , Vértebras Lumbares/cirugía , Procedimientos Ortopédicos/efectos adversos , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/crecimiento & desarrollo , Animales , Carga Bacteriana , Remodelación Ósea , Modelos Animales de Enfermedad , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/microbiología , Vértebras Lumbares/fisiopatología , Masculino , Microscopía Electroquímica de Rastreo , Procedimientos Ortopédicos/instrumentación , Tomografía Computarizada por Tomografía de Emisión de Positrones , Prueba de Estudio Conceptual , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/fisiopatología , Conejos , Infecciones Estafilocócicas/diagnóstico por imagen , Infecciones Estafilocócicas/fisiopatología , Staphylococcus aureus/ultraestructura , Factores de TiempoAsunto(s)
Dolor Abdominal/diagnóstico por imagen , Absceso/diagnóstico por imagen , Antibacterianos/administración & dosificación , Dolor de la Región Lumbar/diagnóstico por imagen , Vértebras Lumbares/diagnóstico por imagen , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Dolor Abdominal/tratamiento farmacológico , Dolor Abdominal/microbiología , Absceso/tratamiento farmacológico , Absceso/microbiología , Administración Intravenosa , Adulto , Dependencia de Heroína/complicaciones , Humanos , Dolor de la Región Lumbar/tratamiento farmacológico , Dolor de la Región Lumbar/microbiología , Vértebras Lumbares/microbiología , Vértebras Lumbares/patología , Imagen por Resonancia Magnética , Masculino , Sistemas de Atención de Punto , Enfermedades de la Columna Vertebral/tratamiento farmacológico , Enfermedades de la Columna Vertebral/microbiología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Muslo/patología , Resultado del Tratamiento , UltrasonografíaRESUMEN
The study is designed to contrast the clinical efficacy of one stage posterior debridement with iliac bone graft, titanium mesh bone graft or granular bone graft in the surgical treatment of single segment lumbar tuberculosis [1].
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Trasplante Óseo/métodos , Desbridamiento/métodos , Ilion/trasplante , Vértebras Lumbares/cirugía , Tuberculosis de la Columna Vertebral/cirugía , Adulto , Estudios de Factibilidad , Femenino , Humanos , Vértebras Lumbares/microbiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Mallas Quirúrgicas , Titanio , Resultado del TratamientoRESUMEN
BACKGROUND: Minimally invasive surgery (MIS) is a common treatment option for paravertebral or psoas abscesses (PAs) in patients with spinal tuberculosis (ST). However, its efficacy remains controversial. The aim of the study was to evaluate the efficacy of MIS for PA with ST combined with anti-tuberculous chemotherapy. METHODS: A total of 106 consecutive patients who underwent MIS for ST with PA from January 2002 to Oct 2012 were reviewed. The MIS involved computed tomography (CT)-guided percutaneous catheter drainage and percutaneous catheter infusion chemotherapy. Clinical outcomes were evaluated based on the changes observed on preoperative and postoperative physical examination, inflammatory marker testing, and magnetic resonance imaging (MRI). RESULTS: The mean follow-up period was 7.21 ± 3.15 years. All surgeries were successfully completed under CT-guidance without intraoperative complications and all patients experienced immediate relief of their symptoms, which included fever and back pain. The preoperatively elevated erythrocyte sedimentation rate and C-reactive protein values returned to normal at a mean period of 3 months postoperatively. Solid bony union was observed in 106 patients and no abscesses were found on MRI examination. CONCLUSION: MIS carries advantages in terms of less invasiveness, precise drainage, and enhanced local drug concentration. While the technique has not been fully characterized and clinically prove, its use in addition to conservative chemotherapy and open debridement and instrumental fixation may be recommended for patients with ST and PA.
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Antituberculosos/uso terapéutico , Procedimientos Quirúrgicos Mínimamente Invasivos , Absceso del Psoas/cirugía , Radiografía Intervencional , Tuberculosis de la Columna Vertebral/complicaciones , Beijing , Desbridamiento , Evaluación de la Discapacidad , Drenaje , Femenino , Humanos , Estudios Longitudinales , Vértebras Lumbares/microbiología , Vértebras Lumbares/cirugía , Imagen por Resonancia Magnética , Masculino , Absceso del Psoas/microbiología , Estudios Retrospectivos , Vértebras Torácicas/microbiología , Vértebras Torácicas/cirugía , Tomografía Computarizada por Rayos X , Tuberculosis de la Columna Vertebral/terapia , Escala Visual AnalógicaRESUMEN
BACKGROUND: This is a case of lateral recess stenosis secondary occurred the discal fungus infection treated with percutaneous transforaminal endoscopic discectomy (PTED). There has been no relevant reports before. CASE PRESENTATION: A 49-year-old patient who had taken itraconazole for 13 months for lateral recess stenosis secondary occurred the discal fungus infection complained of gradually worsening radiating pain and numbness in the back and inguinal and inner thigh region of right side. In order to relieve the radiating neuralgia and reduce the damage to spinal stability, the minimally invasive PTED was performed.The patient's prognosis was assessed using Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS). During the follow-up, the patient's ODI and VAS scores were decreased significantly. The radiating pain in the inguinal and inner thigh region of right side were significantly alleviated and the discomfort caused by lower back instability was improved by plaster vest. DISCUSSION AND CONCLUSION: PTED not only avoids further damage to the stability of the lumbar spine, but also effectively relieves the symptoms of leg neuroradialgia caused by lateral recess stenosis secondary occurred the discal fungus infection.
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Aspergillus flavus , Discectomía Percutánea/métodos , Disco Intervertebral/cirugía , Neuroaspergilosis/cirugía , Neuroendoscopía/métodos , Estenosis Espinal/cirugía , Aspergillus flavus/aislamiento & purificación , Humanos , Disco Intervertebral/diagnóstico por imagen , Disco Intervertebral/microbiología , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/microbiología , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Neuroaspergilosis/diagnóstico por imagen , Estenosis Espinal/diagnóstico por imagen , Estenosis Espinal/microbiología , Resultado del TratamientoRESUMEN
BACKGROUND: Vertebral osteomyelitis can be attributed to many factors including immunosuppression, diabetes, malignancy, collagen disease, periodontal disease, open fractures, and endoscopic procedures. Anaerobic bacteria, such as Veillonella species, are found in the oral cavity and are rarely implicated in the infection. This report describes vertebral osteomyelitis secondary to a dental abscess with positive Veillonella cultures. CASE DESCRIPTION: A 76-year-old man presented to the hospital due to back pain with a four-day history of fever and chills. CT scans revealed several abscesses in the lumbar region as well as indications of vertebral osteomyelitis. After a psoas drain, the patient began antibiotics with a combination of ampicillin-sulbactam, metronidazole, and levofloxacin, but due to the patient's penicillin allergy, he was initially desensitized to this antibiotic for a significant period of time. Laminectomies, foraminotomies, and facetectomies were performed, but the infection spread to vertebral levels. The patient was then switched to a combination of vancomycin, metronidazole, and levofloxacin which eliminated the infection. Final laminectomy was performed with posterior segmental instrumentation and arthrodesis. Post-operatively, there were no signs of infection. The patient recovered well and regained mobility. Deeper examination of the patient's medical history revealed a severe tooth abscess immediately before the onset of bacteremia. CONCLUSION: We believe that a delay in the onset of antibiotic treatment is what led to the initial bacteremia that ultimately took root in the lower lumbar vertebrae. To the best of our ability, we could identify only one other case that linked vertebral osteomyelitis to the oral cavity.
Asunto(s)
Absceso/tratamiento farmacológico , Bacteriemia/microbiología , Osteomielitis/etiología , Osteomielitis/terapia , Absceso Periodontal/complicaciones , Absceso/diagnóstico por imagen , Anciano , Antibacterianos/uso terapéutico , Dolor de Espalda/diagnóstico por imagen , Dolor de Espalda/tratamiento farmacológico , Bacteriemia/tratamiento farmacológico , Bacteriemia/etiología , Foraminotomía , Humanos , Laminectomía , Vértebras Lumbares/microbiología , Vértebras Lumbares/cirugía , Masculino , Osteomielitis/diagnóstico por imagen , Osteomielitis/microbiología , Absceso Periodontal/microbiología , Tomografía Computarizada por Rayos X , Veillonella/patogenicidadRESUMEN
PURPOSE: To access the feasibility and efficacy of percutaneous endoscopic debridement (PED) combined with percutaneous pedicle screw fixation (PPSF) in the treatment of lumbar pyogenic spondylodiscitis. METHODS: Forty-five patients diagnosed as pyogenic spondylodiscitis underwent PPSF followed by PED. A drainage catheter was left in place for negative pressure drainage. Adequate systematic antibiotics were administered empirically or based on bacterial culture results. Clinical outcomes were assessed by physical examination, regular serologic testing, visual analog scale (VAS), Oswestry Disability Index (ODI), and imaging studies. RESULTS: The mean operative time was 110.1 ± 21.2 minutes (range 80-165 minutes), with intra-operative blood loss 47.8 ± 21.0 ml (range 20-120 ml). All patients reported relief of back pain, able to sit up, and partially ambulate the next day. Causative pathogens were identified in 32 of 45 biopsy specimens, staphylococcal bacteria being the most prevalent strain. However, there were 13 patients with post-operative complications. During 6-12 months' follow-up, inflammatory markers showed infection controlled. VAS and ODI values were significantly improved. DISCUSSION: Satisfactory clinical and functional outcomes were achieved in our patients post-operatively. It is recommended that PED plus PPSF can be another alternative for spondylodiscitis. CONCLUSION: PED supplementing PPSF offers a valid option in treating spondylodiscitis, as it is minimally invasive, shortens hospital stay, and avoids prolonged bed rest with an optimistic outcome.
Asunto(s)
Artroscopía/métodos , Desbridamiento/métodos , Discitis/cirugía , Vértebras Lumbares/cirugía , Adulto , Anciano , Antibacterianos/uso terapéutico , Discitis/microbiología , Drenaje , Estudios de Factibilidad , Femenino , Humanos , Vértebras Lumbares/microbiología , Masculino , Persona de Mediana Edad , Tornillos Pediculares , Estudios Retrospectivos , Fusión Vertebral/instrumentación , Supuración , Resultado del TratamientoRESUMEN
BACKGROUND Emphysematous osteomyelitis of the spine is characterized by intravertebral or intraosseous air. Emphysematous pyelonephritis (EP) is the infection of the renal parenchyma and perirenal tissues caused by gas forming microorganisms and thus is characterized by gas formation. Prompt diagnosis and initiation of necessary treatment is crucial, as both entities are associated with high mortality rates. CASE REPORT A 57-year-old female with uncontrolled hyperglycemia presented to the emergency department with history of sudden onset of weakness, nausea, vomiting and diarrhea for 3 days and with a fall on the same level the previous day. Laboratory examinations revealed leukocytosis, lymphopenia, thrombocytopenia, deteriorated renal function, and hyperglycemic hyperosmolar non-ketotic state. She was placed on aggressive intravenous hydration and insulin infusion pump. Due to the deterioration of her medical condition, she underwent abdominal and pelvic CT scanning that revealed emphysematous osteomyelitis of the spine and emphysematous pyelonephritis. Despite vigorous fluid resuscitation and systemic broad-spectrum antibiotic therapy, the patient's condition deteriorated further and eventually led to death within 48 h. CONCLUSIONS This case of fatal emphysematous osteomyelitis of the spine and EP serves as a significant reminder of those rare life-threatening entities, which affect patients with comorbidities, such as diabetes mellitus and other etiologies causing immunosuppression. The aim of the present case report is to highlight the importance and contribution of computed tomography in diagnosing these conditions and to emphasize the rare coexistence of these 2 emphysematous entities.
Asunto(s)
Complicaciones de la Diabetes/diagnóstico por imagen , Enfisema/diagnóstico por imagen , Infecciones por Klebsiella/diagnóstico por imagen , Vértebras Lumbares/diagnóstico por imagen , Osteomielitis/diagnóstico por imagen , Pielonefritis/diagnóstico por imagen , Complicaciones de la Diabetes/microbiología , Diagnóstico Diferencial , Enfisema/microbiología , Resultado Fatal , Femenino , Humanos , Klebsiella pneumoniae , Vértebras Lumbares/microbiología , Persona de Mediana Edad , Osteomielitis/microbiología , Pielonefritis/microbiología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Actinomycosis is a chronic, slowly progressive infection caused by the Actinomyces species. Lumbar vertebral involvement of Actinomyces israelii is extremely rare; this is the first case report of lumbar vertebral osteomyelitis and psoas abscess caused by Actinomyces israelii after an operation under general anesthesia. CASE PRESENTATION: A 66-year-old Japanese man with end-stage renal disease was admitted to our hospital for an operation for cervical canal stenosis. After the operation under general anesthesia, during which tracheal intubation and nasogastric tube insertion were performed, he developed low back pain. During a second hospitalization, computed tomography revealed osteolysis of the lumbar endplates of L2 and L3, swelling of the intervertebral disk of L2/L3, and swelling of the left psoas major muscle. Percutaneous drainage of the intervertebral disc was performed, and the culture of the aspirate grew Actinomyces israelii. Based on the susceptibility, ampicillin was administered but his condition did not improve. We changed the antibiotics to ampicillin-sulbactam for coverage of unidentified oral commensals, and his symptoms and signs finally improved. CONCLUSION: Our patient's long-term end-stage renal disease had made the oral and gastrointestinal mucosal barriers very fragile. Under these conditions, even mildly invasive procedures such as tracheal intubation and nasogastric tube insertion could be the cause of infectious complication by oral commensals, including Actinomyces.