Blood culture bottles meet the operating room: enhancing the diagnostic accuracy of infectious spondylitis through open microsurgical biopsy and intraoperative inoculation.

PURPOSE: Infectious spondylitis is caused by hematogenous seeding or adjacent soft tissue infection. No study has provided evidence that incubating biopsy specimens in blood culture bottles could enhance detection rates, nor has any study compared this method with conventional culture techniques. We aimed to assess the diagnostic yield of open microsurgical biopsies for infectious spondylitis and the efficacy of various culture media in the presence and absence of pre-biopsy antibiotic therapy. METHODS: This retrospective study, which was conducted at a university-affiliated teaching hospital in Korea, enrolled 165 adult patients with suspected infectious spondylitis between February 2014 and September 2020. The diagnostic yield of open biopsy was compared among three culture media, namely, blood culture bottles, swab culture using transport media, and tissue culture using plain tubes, while considering preoperative antibiotic exposure. RESULTS: Causative bacteria were identified in 84.2% of all cases. Blood culture bottles had the highest positivity rate (83.5%), followed by swab cultures (64.4%) and tissue cultures (44.9%). The differences in positivity rates were significant (P < 0.001). Preoperative antibiotic therapy reduced detection rates across all media, particularly in tissue cultures. CONCLUSIONS: We established the high diagnostic yield of open microsurgical biopsy using blood culture bottles, suggesting that pre-biopsy antibiotic therapy significantly affects bacterial detection, thereby underscoring the importance of culture medium selection in the diagnosis of infectious spondylitis.

[One-stage posterior debridement and spinal internal fixation for the treatment of lumbar Brucellar spondylitis].

OBJECTIVE: To explore the clinical efficacy and safety of one-stage posterior lesion removal and internal spinal fixation in patients with lumbar Brucellosis spondylitis. METHODS: The clinical data of 24 patients admitted from October 2017 to October 2022 were retrospectively analyzed, 2 patients were lost to follow-up at 10 months after surgery, at the final 22 cases were included in the study, including 13 males and 9 females with an average age of (52.00±6.89) years old, were treated with one-stage posterior lesion removal and internal spinal fixation. The operation time, intraoperative bleeding, follow-up time, erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) before and after operation were recorded. The pain visual analogue scale(VAS), Oswestry disability index(ODI), the Japanese Orthopaedic Association(JOA) score for neurofunction, American Spinal Injury Association(ASIA) spinal cord injury grade and modified MacNab criteria were ussed to evaluate the efficacy. RESULTS: All patients were followed up from 12 to 30 months with an average of (17.41±4.45) months. The operation time was 70 to 155 min with an average of (116.59±24.32) min;the intraoperative bleeding volume was 120 to 520 ml with an average of (275.00±97.53) ml. CRP and ESR levels decreased more significantly at 1 week and at the final follow-up than preoperative levels(P<0.05). VAS, JOA score and ODI at 1 week and at the latest follow-up were more significantly improved than preoperative results(P<0.05). There was no significant difference between ASIA preoperative and 1 week after operation(P>0.05), and a significant difference between preoperative and last follow-up(P<0.05). In the final follow-up, 21 patients had excellent efficacy, 1 patient had fair, and there was no recurrence during the follow-up. CONCLUSION: One-stage transpedicular lesion removal and internal spinal fixation, with few incisions and short operation time, helps the recovery of neurological function, and the prognosis meets the clinical requirements, which can effectively control Brucella spondylitis.

Machine learning-enabled prediction of prolonged length of stay in hospital after surgery for tuberculosis spondylitis patients with unbalanced data: a novel approach using explainable artificial intelligence (XAI).

BACKGROUND: Tuberculosis spondylitis (TS), commonly known as Pott's disease, is a severe type of skeletal tuberculosis that typically requires surgical treatment. However, this treatment option has led to an increase in healthcare costs due to prolonged hospital stays (PLOS). Therefore, identifying risk factors associated with extended PLOS is necessary. In this research, we intended to develop an interpretable machine learning model that could predict extended PLOS, which can provide valuable insights for treatments and a web-based application was implemented. METHODS: We obtained patient data from the spine surgery department at our hospital. Extended postoperative length of stay (PLOS) refers to a hospitalization duration equal to or exceeding the 75th percentile following spine surgery. To identify relevant variables, we employed several approaches, such as the least absolute shrinkage and selection operator (LASSO), recursive feature elimination (RFE) based on support vector machine classification (SVC), correlation analysis, and permutation importance value. Several models using implemented and some of them are ensembled using soft voting techniques. Models were constructed using grid search with nested cross-validation. The performance of each algorithm was assessed through various metrics, including the AUC value (area under the curve of receiver operating characteristics) and the Brier Score. Model interpretation involved utilizing methods such as Shapley additive explanations (SHAP), the Gini Impurity Index, permutation importance, and local interpretable model-agnostic explanations (LIME). Furthermore, to facilitate the practical application of the model, a web-based interface was developed and deployed. RESULTS: The study included a cohort of 580 patients and 11 features include (CRP, transfusions, infusion volume, blood loss, X-ray bone bridge, X-ray osteophyte, CT-vertebral destruction, CT-paravertebral abscess, MRI-paravertebral abscess, MRI-epidural abscess, postoperative drainage) were selected. Most of the classifiers showed better performance, where the XGBoost model has a higher AUC value (0.86) and lower Brier Score (0.126). The XGBoost model was chosen as the optimal model. The results obtained from the calibration and decision curve analysis (DCA) plots demonstrate that XGBoost has achieved promising performance. After conducting tenfold cross-validation, the XGBoost model demonstrated a mean AUC of 0.85 ± 0.09. SHAP and LIME were used to display the variables' contributions to the predicted value. The stacked bar plots indicated that infusion volume was the primary contributor, as determined by Gini, permutation importance (PFI), and the LIME algorithm. CONCLUSIONS: Our methods not only effectively predicted extended PLOS but also identified risk factors that can be utilized for future treatments. The XGBoost model developed in this study is easily accessible through the deployed web application and can aid in clinical research.

Intraoperative Ultrasonography for the Surgical Treatment of Grisel Syndrome of the Adult: Management of A Rare Condition.

STUDY DESIGN: This is a narrative review and case report. OBJECTIVE: To review the literature concerning Grisel syndrome physiopathology, diagnosis, and surgical reports, highlighting the decision-making for treatment and its timing. We describe the role of intraoperative US in the management of 2 cases of GS of the adult. SUMMARY OF BACKGROUND DATA: GS is a rare nontraumatic post inflammatory C1-C2 rotatory instability usually affecting children; adult cases are even rarer, and the role of surgical treatment is not well defined. CASE DISCUSSION: Case 1: A 72-year-old man with upper cervical pain and no neurological deficit; radiologic examination revealed C1-C2 spondylitis and epidural abscess. After antibiotic therapy, the patient developed cervical instability. Hence, surgical decompression and C1-C2 stabilization were performed. Case 2: An 82-year-old woman with progressive right hemiparesis. CT and MRI showed C1-C2 spondylitis with retro-odontoid epidural abscess. Atlanto-axial rotatory instability was evident so surgery was achieved. In both cases, intraoperative US was useful for localizing retro-odontoid abscess and allowing safe puncture of the collection, leading to its remarkable radiologic reduction. CONCLUSION: GS in adults remains a challenge: Patients should be closely monitored concerning neurological and inflammatory status. We describe the successful use of intraoperative US for draining retro-odontoid abscess for the first time, with satisfactory postoperative outcome without need of circumferential approach.

Pedicle screw insertion into infected vertebrae reduces operative time and range of fixation in minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis: a multicenter retrospective cohort study.

BACKGROUND: Minimally invasive posterior fixation surgery for pyogenic spondylitis is known to reduce invasiveness and complication rates; however, the outcomes of concomitant insertion of pedicle screws (PS) into the infected vertebrae via the posterior approach are undetermined. This study aimed to assess the safety and efficacy of PS insertion into infected vertebrae in minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis. METHODS: This multicenter retrospective cohort study included 70 patients undergoing minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis across nine institutions. Patients were categorized into insertion and skip groups based on PS insertion into infected vertebrae, and surgical data and postoperative outcomes, particularly unplanned reoperations due to complications, were compared. RESULTS: The mean age of the 70 patients was 72.8 years. The insertion group (n = 36) had shorter operative times (146 versus 195 min, p = 0.032) and a reduced range of fixation (5.4 versus 6.9 vertebrae, p = 0.0009) compared to the skip group (n = 34). Unplanned reoperations occurred in 24% (n = 17) due to surgical site infections (SSI) or implant failure; the incidence was comparable between the groups. Poor infection control necessitating additional anterior surgery was reported in four patients in the skip group. CONCLUSIONS: PS insertion into infected vertebrae during minimally invasive posterior fixation reduces the operative time and range of fixation without increasing the occurrence of unplanned reoperations due to SSI or implant failure. Judicious PS insertion in patients with minimal bone destruction in thoracolumbar pyogenic spondylitis can minimize surgical invasiveness.

[Nonspecific craniovertebral spondylitis]. / Nespetsificheskie spondility kraniovertebral'noi oblasti.

OBJECTIVE: To analyze surgical strategy for nonspecific spondylitis of the craniovertebral region (CVR) taking into account clinical features and morphological signs of disease. MATERIAL AND METHODS: Eight patients with nonspecific spondylitis of CVR underwent surgery (4 women and 4 men aged 31-75 years). Three patients had pain syndrome, 5 ones - conduction disorders. Combined interventions were performed in 5 patients with neurological disorders. Of these, 3 patients underwent transoral decompression with subsequent occipitospondylodesis. In other cases, stages of surgical treatment were reverse. Four patients underwent simultaneous interventions, 1 patient - with 7-day interval. Patients with pain syndrome underwent occipitospondylodesis. RESULTS: In all patients, postoperative VAS score of pain syndrome decreased by 5-7 points (mean 5.5). Among 5 patients with conduction symptoms, regression of neurological disorders 1 year after surgery was achieved in 2 cases, and complete recovery was observed in 3 patients (Frankel E). In all cases, examination confirmed relief of inflammatory process and no compression of the spinal cord and medulla oblongata. One patient had a dehiscence of the wound edges of posterior pharyngeal wall, and another one had implant fracture in 3 years after surgery. CONCLUSION: Active surgical approach is reasonable for nonspecific spondylitis of CVR. Craniocervical fixation eliminates pain and risk of neurological complications following atlantoaxial instability. Conduction disorders require simultaneous transoral decompression and occipitospondylodesis in patients with nonspecific purulent craniovertebral lesions. Impaired head tilt complicates transoral stage. In this regard, it is more rational to carry out craniocervical fixation at the last stage.

Real-time polymerase chain reaction detection and surgical treatment of thoracic and lumbar spondylitis due to Brucella infection: two typical case reports.

Background: Spondylitis caused by Brucella infection is a rare but challenging condition, and its successful management depends on timely diagnosis and appropriate treatment. This study reports two typical cases of thoracic and lumbar brucellosis spondylitis, highlighting the pivotal roles of real-time polymerase chain reaction (real-time PCR) detection and surgical intervention. Case presentation: Case 1 involved a 49-year-old male shepherd who presented with a 6-month history of fever (40°C), severe chest and back pain, and 2-week limited lower limb movement with night-time exacerbation. Physical examination revealed tenderness and percussion pain over the T9 and T10 spinous processes, with grade 2 muscle strength in the lower limbs. CT showed bone destruction of the T9 and T10 vertebrae with narrowing of the intervertebral space, whereas MRI demonstrated abnormal signals in the T9-T10 vertebrae, a spinal canal abscess, and spinal cord compression. The Rose Bengal plate agglutination test was positive. Case 2 was a 59-year-old man who complained of severe thoracolumbar back pain with fever (39.0°C) and limited walking for 2 months. He had a 2.5 kg weight loss and a history of close contact with sheep. The Rose Bengal test was positive, and the MRI showed inflammatory changes in the L1 and L2 vertebrae. Diagnosis and treatment: real-time PCR confirmed Brucella infection in both cases. Preoperative antimicrobial therapy with doxycycline, rifampicin, and ceftazidime-sulbactam was administered for at least 2 weeks. Surgical management involved intervertebral foraminotomy-assisted debridement, decompression, internal fixation, and bone grafting under general anesthesia. Postoperative histopathological examination with HE and Gram staining further substantiated the diagnosis. Outcomes: both patients experienced significant pain relief and restored normal lower limb movement at the last follow-up (4-12 weeks) after the intervention. Conclusion: Real-time PCR detection offers valuable diagnostic insights for suspected cases of brucellosis spondylitis. Surgical treatment helps in infection control, decompression of the spinal cord, and restoration of stability, constituting a necessary and effective therapeutic approach. Prompt diagnosis and comprehensive management are crucial for favorable outcomes in such cases.

[Pyogenic spondylitis after Corynebacterium striatum blood stream infection following allogeneic hematopoietic stem cell transplantation for malignant lymphoma].

Patient 1 was a 70-year-old woman with refractory diffuse large B-cell lymphoma who received allogeneic peripheral blood stem cell transplantation from an HLA-haploidentical related donor. Upper back pain appeared on day63, and Th8-Th9 pyogenic spondylitis was diagnosed based on magnetic resonance imaging (MRI). Blood culture on day14 identified Corynebacterium striatum as the causative bacteria of blood stream infection (BSI). The pyogenic spondylitis resolved after treatment with daptomycin for 2 months. Patient 2 was a 65-year-old man with relapsed angioimmunoblastic T-cell lymphoma who received bone marrow transplantation from an HLA-DR single-antigen-mismatched unrelated donor. Lower back pain appeared on day30, and L4-L5 pyogenic spondylitis was diagnosed based on MRI. Blood culture was negative. Daptomycin and clindamycin were selected for treatment based on the drug susceptibility of bacteria that had caused pre-engraftment BSI (Escherichia coli on day3 and Corynebacterium striatum on day9), and the pyogenic spondylitis resolved after 6 months of this treatment. Pyogenic spondylitis should be considered in the differential diagnosis of back pain accompanied by BSI before engraftment in allogeneic hematopoietic stem cell transplant recipients.

Application of Piezosurgery in Revision Surgery through Posterior Approach for Infection after Percutaneous Vertebral Augmentation: Technique Note with Case Series.

OBJECTIVES: Pyogenic spondylitis after vertebral augmentation (PSVA) is a severe complication and even threatens the life of patients. How to deal with infectious bone cement is a big problem for surgeons. The application of piezosurgery has advantages in removal the infectious bone cement in limb bone and spinal laminectomy, but it is rarely used in PSVA. So, the present study aimed to introduce the application of piezosurgery in revision surgery for PSVA and report the preliminary radiological and clinical results. METHODS: The data of nine patients with PSVA who had undergone revision surgery were retrospectively reviewed between May 2017 and January 2023 in our hospital. The technique of removal of infectious bone cement and lesion by piezosurgery and the reconstruction of the spinal stability were described, and the operation time and intraoperative blood loss were recorded. Postoperatively, radiographs and computed tomography scans were reviewed to evaluate the condition of bone cement removal, control of infection, and bone fusion. Oswestry disability index (ODI) and visual analog scale (VAS) were assessed pre- and postoperatively, and clinical outcomes were assessed using Odom's criteria. RESULTS: All patients achieved satisfactory tainted bone cement cleaning and restoration of spinal alignment. The surgical time was 258.8 ± 63.2 (160-360) min, and the intraoperative blood loss was 613.3 ± 223.8 (300-900) mL. The VAS score decreased from 7.0 (6-8) points preoperatively to 2.4 (1-4) points postoperatively. The ODI index decreased from 71% (65%-80%) preoperatively to 20% (10%-30%) postoperatively. The patient's VAS and NDI scores after operation were significantly improved compared with those before surgery (p ≤ 0.05). Odom's outcomes were good for all patients in the last follow-up, and all patients reported satisfactory results. CONCLUSIONS: Piezosurgery can effectively remove large blocks of infectious bone cement through a posterior approach while avoiding nerve and spinal cord damage. We cautiously suggest that a one-stage posterior approach using piezosurgery is an alternative option for surgical treatment of PSVA.

Application of Metagenomic Next-Generation Sequencing in Suspected Spinal Infectious Diseases.

OBJECTIVE: This study aimed to explore the clinical efficacy of metagenomic next-generation sequencing (mNGS) in diagnosing and treating suspected spinal infectious diseases. METHODS: Between October 2022 to December 2023, a retrospective analysis was performed on patient records within the Department of Spinal Surgery at Guilin People's Hospital. The analysis included comprehensive data on patients with presumed spinal infectious diseases, incorporating results from mNGS tests conducted externally, conventional pathogen detection results, laboratory examination results, and imaging findings. The study aimed to assess the applicability of mNGS in the context of suspected spinal infectious lesions. RESULTS: Twenty-seven patients were included in the final analysis. Pathogenic microorganisms were identified in 23 cases. The included cases encompassed 1 case of tuberculous spondylitis, 1 case of fungal infection, 3 cases of Brucella spondylitis, 3 cases of viral infection, 9 cases of bacterial infection, and 6 cases of mixed infections. Pathogenic microorganisms remained elusive in 4 cases. The application of the mNGS method demonstrated a significantly elevated positive detection rate compared to conventional methods (85.19% vs. 48.15%, P < 0.05). Moreover, the mNGS method detected a greater variety of pathogen species than traditional methods (Z = 10.69, P < 0.05). Additionally, the mNGS method exhibited a shorter detection time. CONCLUSIONS: mNGS demonstrated significantly higher detection rates for bacterial, fungal, viral, and mixed infections in cases of suspected spinal infectious diseases. The clinical implementation of mNGS could further enhance the efficiency of diagnosing and treating suspected spinal infectious diseases.

Surgical Treatment of Brucellar Cervical Epidural Abscess.

OBJECTIVES: Brucellar cervical epidural abscess (CEA) is a rare condition with potentially permanent neurological damage if left untreated. This study aims to define the clinical presentation of brucellar CEA and evaluate the outcome of surgical treatment, specifically decompression and fusion surgery. The findings will contribute to understanding whether all patients with brucellar CEA could benefit from this surgical intervention. METHODS: A retrospective study on brucellar spondylitis was conducted at the First Hospital of Jilin University from August 2018 to August 2022. During this period, a total of 37 patients were diagnosed with brucellar spondylitis at the hospital. Out of the 37 cases, six patients (16.2%) were confirmed to have CEA through cervical magnetic resonance imaging examination and serology test results.. RESULTS: Six patients were diagnosed with brucellar CEA (16.2%), of whom 5 successfully underwent anterior cervical decompression and fusion surgery. One patient had a large prevertebral abscess that could only be drained. In combination with effective antibiotic therapy, the clinical performance of the 5 patients who underwent surgery improved after the surgery. The remaining one patient required delayed surgery due to instability of the cervical spine. The follow-up period of all the 6 patients was 6 months. CONCLUSIONS: Brucellosis should be considered as a potential cause of CEA, especially in endemic areas. Timely detection and effective management of this condition are crucial in order to minimize the associated morbidity and mortality. For patients with detectable brucellar CEA, we recommend decompression and fusion surgery.

Axial Involvement in Psoriatic Arthritis: A Cross-sectional Clinical and Radiologic Studies.

OBJECTIVE: This study aimed to investigate spinal involvement in psoriatic arthritis (PsA) patients using clinical and radiographic methods. METHODS: A cross-sectional clinical study was conducted on 50 PsA patients diagnosed according to the CASPAR criteria. Clinical examinations and functional assessments were performed. A radiographic assessment of the spine was performed. RESULTS: Out of 50 PsA patients (mean age of 45.50 ± 9.90 years), (males and females constituted 27 (54.0%) and 23 (46.0%) respectively), 76% had radiological axial involvement; (26%) with inflammatory axial pain and (50%) without inflammatory axial pain (subclinical). Three axial radiographic patterns were detected including spondylitis without sacroiliitis (15.78%), spondylitis with sacroiliitis (78.94%), and sacroiliitis without spondylitis (5.26%). In axial PsA patients, males were more affected than females (χ2=11.679, p = 0.003), with older age (H = 15.817, p < 0.001) and higher body mass index (BMI) (F = 5.145, p = 0.010), increased psoriasis duration (H = 9.826, p = 0.007) and severity (Η=25.171, p < 0.001), and more spinal movement limitations than PsA patients without axial involvement (F = 26.568, p < 0.001). Cervical involvement was higher than lumbar involvement. Axial radiographic severity assessed by the PsA Spondylitis Radiology Index was associated with increased disability as assessed by the Health assessment questionnaire (rs = 0.533, p = 0.001) and decreased quality of life assessed by short form-36 score (rs = -0.321, p = 0.050). CONCLUSION: This study shows that a high percentage of PsA patients had axial involvement with a high percentage of them having asymptomatic radiological findings. The cervical spine is more frequently and severely affected than the lumbar spine. Axial PsA occurs in males more than females with characteristic older age and higher BMI, increased psoriasis duration, and more limitation of spinal mobility.

Characteristics of patients with psoriatic arthritis in Korea: focusing on axial involvement.

BACKGROUND/AIMS: We aimed to clarify the clinical characteristics of psoriatic arthritis (PsA) in Korean patients focusing on PsA with axial involvement. METHODS: A retrospective medical chart review was performed to identify PsA patients at a single tertiary center. Cases of AS patients with psoriasis were recruited from a prospective AS registry of the same center. Demographics, laboratory findings, and radiologic characteristics were assessed. RESULTS: A total of 69 PsA patients were identified. In PsA patients, spondylitis (46.4%) was the most common form. Compared to AS patients with psoriasis, PsA patients with radiographic axial involvement were older (50.9 vs. 32.4 years; p < 0.001) and showed greater peripheral disease activity (peripheral arthritis 78.1 vs. 12.5%, p < 0.001; enthesitis 50.0 vs. 6.3%, p = 0.003). AS patients with psoriasis presented a higher rate of HLA-B*27 positivity (81.3 vs. 17.2%; p < 0.001) and a more frequent history of inflammatory back pain (100.0 vs. 75.0%; p = 0.039) than PsA patients with radiographic axial involvement. Significant proportions of PsA patients with radiographic axial involvement had cervical spine involvement (10/18, 55.6%) and spondylitis without sacroiliitis (10/23, 43.5%). CONCLUSION: We demonstrate that axial involvement is common in Korean PsA patients, and its characteristics can be distinct from those of AS.

Comparative Study on the Efficacy of Two Perioperative Chemotherapy Regimens for Lumbar Brucellosis.

Objective: The clinical efficacy of perioperative chemotherapy regimen (rifampicin, doxycycline, levofloxacin, ceftriaxone) was evaluated for lumbar brucellosis spondylitis patients with neurological injury. Methods: In Beijing Ditan Hospital affiliated with Capital Medical University, 32 patients with lumbar brucellosis spondylitis underwent surgery and triple perioperative chemotherapy (rifampicin, doxycycline, levofloxacin) between 2011 and 2021 due to neurological injury, and 34 patients matched up with the triple group underwent rifampicin, doxycycline, levofloxacin, and ceftriaxone. Both groups were compared in terms of changes in inflammation index, low back/leg pain, lumbar function, neurological function, and adverse drug reactions. Results: There was no significant difference in erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), low back pain visual analogue scale (VAS), leg pain VAS, lumbar Oswestry disability index (ODI) and nerve function injury rate between the two groups before chemotherapy (P>0.05). The ESR, CRP at 1 week and 2 weeks after chemotherapy and 1 week, 2 weeks, 1 month postoperatively in the quadruple group were significantly lower than those in the triple group, which is the same to ESR 3 months postoperatively (P<0.05). The low back pain VAS, leg pain VAS and lumbar ODI in the quadruple group were significantly lower than those in the triple group at 1 month and 3 months postoperatively (P<0.05). The recovery rate of neurological function in the quadruple group was significantly higher than that in the triple group at 3 and 6 months postoperatively (P<0.05). Both groups did not experience significantly different perioperative and postoperative adverse reactions (P>0.05). Conclusion: For lumbar brucellosis spondylitis with neurological injury, quadruple perioperative chemotherapy of rifampicin, doxycycline, levofloxacin and ceftriaxone can significantly reduce perioperative inflammation, and improve low back/leg pain, as well as promoting neurological function recovery in the short term.

A rare case of aggressive pyogenic spondylitis with giant abscesses after vertebral augmentation.

Although Streptococcus constellatus (SC), an opportunistic pathogen, can cause abscesses and empyema. The SC infection after vertebral augmentation (VA) can interfere with patients' daily living activities and can be life-threatening in severe cases. A 67-year-old male complained of lumbar pain for two months. The patient underwent percutaneous vertebroplasty of the second and third lumbar vertebrae two months ago. On admission, laboratory and imaging evidence suggested infection of the second and third lumbar vertebrae with bilateral psoas major and left lumbodorsal abscesses. After three weeks of empirical anti-infective therapy, abscess removal and the second and third lumbar vertebrae fusion with iliac bone graft were performed under general anesthesia. Intraoperative pathology and next-generation sequencing (NGS) examination of the pus suggested SC infection, and oral linezolid was given for 12 weeks after surgery. The infection was eventually cured and the patient achieved satisfactory function. In conclusion, pyogenic spondylitis due to SC infection after VA is a life-threatening complication. In addition to infectious disease consultation and routine etiological screening, NGS is important to identify infection with unknown pathogens. Surgery combined with sensitive antibiotics is appropriate for patients with progressive neurological deficits.

Genetic Variations in IL-1ß, TNF-α, and TGF-ß Associated with the Severity of Chronic Cervical Spondylitis in Patients.

Chronic cervical spondylitis (CCS), a degenerative disorder of the spine, is known for causing disability among old and young people. Single-nucleotide polymorphisms (SNPs) in various cytokine genes have demonstrated an impactful association with several inflammatory disorders. In the present study, we have investigated the SNPs and allelic distribution of the three most prevalent cytokines genes, IL-1ß (-511C/T), TNF-α (-308G/A), and TGF-ß (-509C/T), along with serum levels of these cytokines in 252 subjects. SNPs were analyzed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and digested fragments were separated and visualized using agarose gel electrophoresis and Native Polyacrylamide gel electrophoresis (PAGE). The serum cytokine levels were analyzed with a flow cytometer using a customized multiplex bead-based assay. It was observed that these SNPs did not reflect the susceptibility to CCS but were associated with susceptibility to CCS. We found a significant association between the C/C and G/G genotypes and the C and G alleles of IL-1ß and TNF-α, respectively, suggesting a lower risk of CCS. The frequency distribution of risk alleles (-511T) and (-308A) were simultaneously higher in CCS compared to the control, reflecting the susceptibility to CCS. TGF-ß showed a significant association with disease susceptibility, along with a significant correlation between age and the chronicity of CCS. The serum cytokine levels were significantly different in CCS and controls.

Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions.

Spinal tuberculosis, also known as Pott's disease or tuberculous spondylitis, is usually secondary to primary infection in the lungs or other systems, and in most instances, is thought to be transmitted via blood. Typical manifestations of infection include narrowing of the intervertebral disc by erosion and bone destruction of adjacent vertebrae. Atypical spinal tuberculosis is a specific type of spinal tuberculosis. It mainly consists of single vertebral lesions, single posterior structure lesions, multiple vertebral lesions, and intra-spinal lesions. Skipped multifocal spinal tuberculosis is one of these types and is characterized by two or more vertebral lesions without the involvement of the adjoining intervertebral discs, regardless of their location. To date, only a few cases have been reported. Upon clinical admission, it can be treated conservatively or surgically, depending on the patient's symptoms. In addition, gene or biological therapies are being investigated. However, because of the exceptional imaging findings and insidious symptoms, it is often misdiagnosed as a neoplastic lesion, osteoporotic fracture, or other infectious spondylitis, increasing the risk of neurological deficit and kyphotic deformity, and delaying the optimal treatment window. In this study, we review the diagnosis and treatment strategies for skipped multifocal spinal tuberculosis lesions and enumerate the common differential diagnoses, to provide reference and guidance for clinical treatment and diagnosis direction.

Delayed Pyogenic Spondylitis at the Same Level as Rod Fracture After Surgery for Adult Spinal Deformity: A Case Report.

CASE: Rod fracture (RF) occurred at L5-S level in a 79-year-old woman 7 months after spinal corrective surgery for adult spinal deformity (ASD). Four years after the surgery, pyogenic spondylitis occurred at the same level as RF. After the reinforcement of broken rods posteriorly, a transperitoneal approach was used for debridement and bone graft. However, prolonged infection, adhesive ileus, and small bowel perforation led to a total of 3 reoperations, resulting a colostomy. Three years after the reoperation, she was ambulatory with assistance. CONCLUSION: We need to follow-up postoperative ASD patients carefully because a single complication can lead to serious consequences.

Identification of Cutibacterium modestum in Spondylitis by Metagenomics Analysis.

BACKGROUND/AIM: Identifying pathogens with culture-negative pyogenic spondylitis is difficult. Shotgun metagenomic sequencing is an unbiased and culture-free approach in the diagnosis of infectious diseases. There are, however, a variety of contaminating factors that can confound the precision of metagenomic sequencing. CASE REPORT: In a 65-year-old man suffering from culture-negative L3-5 spondylitis, metagenomics was applied to facilitate the diagnosis. The patient underwent percutaneous endoscopic lumbar discectomy. We applied metagenomic sequencing with a robust contamination-free protocol to the bone biopsy. By comparing the abundance for each taxon between the replicates and negative controls, we reliably identified Cutibacterium modestum as having a statistically higher abundance in all replicates. The patient's antibiotic therapy was switched to penicillin and doxycycline based upon the resistome analysis; the patient fully recovered. CONCLUSION: This application of next-generation sequencing provides a new perspective in the clinical approach to spinal osteomyelitis and illustrates the potential of this technique in rapid etiological diagnosis.