Comparative analysis of different treatment strategies for septic spondylitis: a retrospective study of one hundred and twelve patients.

PURPOSE: To compare the clinical efficacy and prognosis differences between conservative treatment and surgical treatment in patients with non-serious neurologically intact pyogenic spondylitis (Nsi-Nsni-PS), and to provide theoretical reference for the clinical treatment of Nsi-Nsni-PS patients. METHODS: A retrospective analysis was conducted on 112 cases of Nsi-Nsni-PS patients treated in our hospital from June 2016 to June 2021. According to different treatment methods, they were divided into conservative treatment group (53 cases) and surgical treatment group (59 cases). The general data, laboratory tests, imaging examinations, length of hospital stay, duration of antibiotic use, VAS for pain before and after treatment, ODI, local kyphotic angle correction of diseased vertebrae, and recurrence rate were collected and analyzed in both groups. SPSS 26.0 statistical software was used for analysis. Measurement data were expressed as mean ± standard deviation, and independent sample t-test or rank sum test was used for comparison between groups, while variance analysis was used for intra-group comparison. Count data were expressed as number (%) and compared between groups using chi-square test or Fisher's exact test. Mann-Whitney U test was used to evaluate the changes in local kyphotic angle between the two groups. A p value < 0.05 was considered statistically significant. RESULTS: There were no significant differences in general data and imaging characteristics between the two groups (P > 0.05); there were no statistically significant differences in the positive culture rate of pathogens, length of hospital stay, duration of antibiotic use, treatment complications, WBC, CRP, ESR levels at admission and discharge, VAS and ODI at admission and last follow-up between the two groups (P > 0.05). The WBC and CRP levels of patients in the conservative group at discharge were lower than those in the surgical group (P < 0.05), and there was no significant difference in the decrease in inflammatory indicators (WBC, CRP, ESR) between the two groups (P > 0.05). By the last follow-up, the neurological function of patients in both groups had significantly improved compared to admission (P < 0.05), with 12 out of 15 ASIA grade D patients in the conservative group recovering to grade E, and 21 out of 25 grade D patients in the surgical group recovering to grade E, with no worsening of neurological function in either group. The differences in VAS and ODI scores at the last follow-up compared to before treatment were statistically significant in both groups (P < 0.05), and all patients regained normal activity. Compared with before treatment, the correction degree of local kyphotic angle in the surgical group at the last follow-up was 0.93 ± 4.94°, slightly higher than that in the conservative group (-0.83 ± 3.37°), and the difference was statistically significant(P < 0.05). CONCLUSIONS: During our follow-up, we found that both conservative and surgical treatments achieved satisfactory clinical outcomes in patients with Nsi-Nsni-PS. Compared to conservative treatment, surgical intervention did not demonstrate significant advantages in reducing hospitalization time and antibiotic usage duration, increasing pathogen culture positivity rate, lowering treatment complications, or controlling recurrence. However, surgical intervention showed superiority in correcting the local kyphotic angle of spinal lesions, albeit with relatively increased surgical trauma, risks, and treatment costs. At the last follow-up, the surgical group did not exhibit better long-term efficacy. Therefore, when formulating clinical treatment strategies for patients with Nsi-Nsni-PS, it may be preferable to prioritize conservative treatment, supplemented by the use of sensitive or empiric antibiotics for infection management, to improve patient prognosis.

[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.

The Association of Spondylitis and Aortic Aneurysm Disease.

OBJECTIVES: The aim of this study is to assess any relation between spondylitis and aortic aneurysmal disease by reviewing the current literature. METHODS: A systematic search was undertaken using MEDLINE, EMBASE and CENTRAL databases till May 2019, for articles reporting on patients suffering from spondylitis and aortic aneurysm. RESULTS: The most involved aortic segment was infrarenal aorta (56.9%). The lumbar vertebrae were more frequently affected (79.7%). Commonest symptoms were back pain (79.1%), fever (33.7%) and lower limb pain (29.1%). 55.8% of cases were diagnosed using computed tomography. The pathology was attributed to infectious causes in 25.1% of cases. 53.4% of patients were treated only for the aneurysm, 27.9% for both pathologies, while two patients solely for the vertebral disease. Endovascular aneurysm repair was chosen in 12.8% of cases. The 30-day mortality was 8.1% (7/86); mostly from vascular complications. CONCLUSIONS: A synchronous spondylitis and aortic aneurysm may share common etiopathology, when an infectious or inflammatory cause is presented. The lumbar vertebrae are more frequently affected. Low quality data do not allow safe conclusion to suggest the best treatment option.

An infected aneurysm of the vertebral artery following cervical pyogenic spondylitis: a case report and literature review.

BACKGROUND: An important complication of pyogenic spondylitis is aneurysms in the adjacent arteries. There are reports of abdominal aortic or iliac aneurysms, but there are few reports describing infected aneurysms of the vertebral artery. Furthermore, there are no reports describing infected aneurysms of the vertebral arteries following cervical pyogenic spondylitis. We report a rare case of an infected aneurysm of the vertebral artery as a complication of cervical pyogenic spondylitis, which was successfully treated by endovascular treatment. CASE PRESENTATION: Cervical magnetic resonance imaging (MRI) of a 59-year-old man who complained of severe neck pain showed pyogenic spondylitis. Although he was treated extensively by antibiotic therapy, his neck pain did not improve. Follow-up MRI showed the presence of a cyst, which was initially considered an abscess, and therefore, treatment initially included guided tapping and suction under ultrasonography. However, under ultrasonographic examination an aneurysm was detected. The contrast-enhanced computed tomography (CT) scan showed an aneurysm of the vertebral artery. Following endovascular treatment (parent artery occlusion: PAO), the patient's neck pain disappeared completely. CONCLUSION: Although there are several reports of infected aneurysms of the vertebral arteries, this is the first report describing an infected aneurysm of the vertebral artery as a result of cervical pyogenic spondylitis. Whenever a paraspinal cyst exist at the site of infection, we recommend that clinicians use not only X-ray, conventional CT, and MRI to examine the cyst, but ultrasonography and contrast-enhanced CT as well because of the possibility of an aneurysms in neighboring blood vessels. It is necessary to evaluate the morphology of the aneurysm to determine the treatment required.

[Effects of serial mud baths on inflammatory rheumatic and degenerative diseases]. / Wirkeffekte serieller Heiltorfbäder bei entzündlich-rheumatischen und degenerativen Erkrankungen.

BACKGROUND: Mud baths have been used for a long time for the treatment of musculoskeletal diseases. In addition to a reduction of pain and improved function, serially applied mud baths lead to a reduction in the inflammatory processes, which often underlie degenerative and inflammatory rheumatic diseases. OBJECTIVE: This study investigated the effects of serial mud baths on parameters of functional health, on pain perception and at the molecular level in patients with inflammatory rheumatic diseases, e.g. rheumatoid arthritis (RA) and ankylosing spondylitis (AS), and degenerative alterations, e.g. gonarthritis and/or coxarthritis. MATERIAL AND METHODS: A total of 41 patients with inflammatory rheumatic (33 RA and 8 AS) and 40 patients with degenerative diseases were subdived into 2 groups by computer-assisted randomization. In each group a subgroup received 9 serial mud baths within 21 days in addition to a multimodal physical rehabilitative complex treatment (intervention groups). In the other subgroups only the physical rehabilitative treatment was carried out and no mud baths were administered (control group). The outcome parameters were assessment of the functional capacity and pain perception (HAQ, FFbH, VAS and WOMAC), diesease activity (DAS28 and BASDAI) as well as laboratory markers of inflammatory activity (CRP, BSG, IL-1 beta and IL-10) and the patient assessment. RESULTS: In the intervention groups after serial mud baths there was a significant improvement in the functional parameters (HAQ and FFbH, both p < 0.01) and a significant reduction in pain strength (VAS, p < 0.01) persisting for 3 months after the end of treatment. A significant reduction in disease activity (RA in DAS28 and AS in BASDAI) could be shown for the intervention groups as well as the control groups, whereby the effect strength was more pronounced in the intervention groups. In patients with gonarthritis and/or coxarthritis a significant improvement in functional limitations (WOMAC, p < 0.01) was only found in the intervention groups. A significant improvement in the proinflammatory cytokine IL-1 beta (p < 0.01) was only found in the intervention groups with a simultaneous increase in the anti-inflammatory cytokine IL-10 (p < 0.01). The CRP and BSG remained within the normal range and showed no significant changes even after serial mud baths. CONCLUSION: Mud baths applied within the framework of a physical rehabilitative complex treatment brought about an improvement of parameters of functional health for both inflammatory rheumatic and degenerative diseases. Effects at the molecular level were induced, which are possibly accompanied by osteoprotective and chondroprotective effects.

Management of destructive Candida albicans spondylodiscitis of the cervical spine: a systematic analysis of literature illustrated by an unusual case.

PURPOSE: Candida induced spondylodiscitis of the cervical spine in immunocompetent patients is an extremely rare infectious complication. Since clinical symptoms might be nonspecific, therapeutic latency can lead to permanent spinal cord damage, sepsis and fatal complications. Surgical debridement is strongly recommended but there is no standard antimycotic regime for postsurgical treatment. This paper summarizes available data and demonstrates another successfully treated case. METHODS: The systematic analysis was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed and Web of Science were scanned to identify English language articles. Additionally, the authors describe the case of a 60-year-old male patient who presented with a Candida albicans induced cervical spondylodiscitis after an edematous pancreatitis and C. albicans sepsis. Anterior cervical corpectomy and fusion of C4-C6, additional anterior plating, as well as posterior stabilization C3-Th1 was followed by a 6-month antimycotic therapy. There was neither funding nor conflict of interests. RESULTS: A systematic literature analysis was conducted and 4599 articles on spondylodiscitis were scanned. Only four cases were found reporting about a C. albicans spondylodiscitis in a non-immunocompromised patient. So far, our patient was followed up for 2 years. Until now, he shows free of symptoms and infection parameters. Standard testing for immunodeficiency showed no positive results. CONCLUSION: Candida albicans spondylodiscitis of the cervical spine presents a potentially life-threatening disease. To our knowledge, this is the fifth case in literature that describes the treatment of C. albicans spondylodiscitis in an immunocompetent patient. Surgical debridement has to be considered, following antimycotic regime recommendations vary in pharmaceutical agents and treatment duration.

[Clinical characteristics and prognosis of cultured negative pyogenic spondylitis].

OBJECTIVE: There are limited data describing the clinical characteristics and prognosis of culture negative pyogenic spondylitis. The aim of this study was to investigate the treatment, prognosis and clinical characteristics of culture negative pyogenic spondylitis. METHODS: A retrospective study reviewed 74 patients who were diagnosed with spondylitis in Peking University First Hospital from January 2010 to December 2015. A total of 27 patients suffered from pyogenic spondylitis. According to the pathogenic culture results, the patients were divided into two groups: culture negative group and culture positive group. The clinical characteristics and treatment outcomes between the two groups were compared. RESULTS: The elder were more vulnerable to pyogenic spondylitis, and of the 27 patients, 12 patients were female and 15 male. All patients had no history of administration of antibiotics prior to obtaining culture samples. A causative germ was identified in 14/27 patients (51.9%) with Staphylococcus aureus being the most common pathogen. There was no significant difference between the two groups in the patient's age, gender, visual analogue score (VAS), predisposing factor, clinical symptom, sign and spinal segment (P>0.05). Erythrocyte sedimentation rate (ESR) (P=0.056) and C-reactive protein (CRP) (P=0.040) of culture negative group were lower in contrast to culture positive group. The incidence of vertebral abscess in culture negative group was higher than in culture positive group (P=0.046). After treatment, ESR dropped almost equally in both groups, and CRP dropped faster in the culture positive group (P=0.192). At last, there was no significant difference between the two groups in hospital stay, pain relief, open debridement operation rate, and recurrence rate of infection. CONCLUSION: ESR and CRP of the culture negative patient were lower than those of the culture positive patient, and the incidence rate of paravertebral abscess was higher than that of the culture positive patient. After administration of antibiotics, there was no significant difference between the two groups in duration of antibiotics, open debridement operation rate and recurrence rate of infection. So, culture negative may not necessarily be a negative prognostic factor for pyogenic spondylitis. However, we should watch out for the drug resistant bacteria or double infection, due to the long term use of wide-spectrum antibiotic in culture negative patients.

Clinical features, outcomes, and survival factor in patients with vertebral osteomyelitis infected by methicillin-resistant staphylococci.

PURPOSE: To elucidate clinico-radiological features, therapeutic outcomes, and survival factors of vertebral osteomyelitis patients infected by methicillin-resistant staphylococci (MRS). METHODS: Vertebral osteomyelitis patients admitted to the orthopaedic department between 2007 and 2011 (n = 248) were selected for this multicenter study. We compared patients' backgrounds, therapeutic course, and in-hospital mortality between MRS and methicillin-susceptible staphylococci (MSS). We also examined survival factors of vertebral osteomyelitis due to MRS. RESULTS: Sixteen patients of MRS vertebral osteomyelitis and 55 patients of MSS were included in this study. In MRS vertebral osteomyelitis, the rates of comorbid diabetes mellitus, involvement of >2 vertebral bodies, in-hospital mortality, and operation of surgical debridement were higher compared to those in MSS vertebral osteomyelitis. Univariate analysis showed that operation of surgical debridement was a factor related to survival in MRS patients. CONCLUSIONS: Higher rate of comorbid diabetes mellitus, involvement of >2 vertebral bodies, in-hospital mortality, and performing surgical debridement are peculiar features of MRS vertebral osteomyelitis compared to MSS vertebral osteomyelitis. If patients with MRS vertebral osteomyelitis respond poorly to antibiotic therapy, it might be better to consider surgical debridement not to lose an opportunity of operation due to exacerbation of systemic conditions.

2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults.

These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical intervention.

Executive Summary: 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults.

These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical intervention.

Outcome-related co-factors in 105 cases of vertebral osteomyelitis in a tertiary care hospital.

PURPOSE: Vertebral osteomyelitis (VO) is an infection of the vertebral body and the adjacent disc space. The aim of our study was to identify outcome-related co-factors of patients with VO treated in the last decade. METHODS AND RESULTS: We retrospectively identified 105 patients with VO (mean age 66.1 years) who had been treated at our institution from 2004 to 2011. The median time of hospitalization at our institution was 31.5 days, and 44 patients required intensive medical care. Back pain and fever were documented in 66.7 and 33.3 % of cases, respectively. The radiologic diagnosis of VO was made in 94.8 % of all obtained magnetic resonance imaging scans and in 66.2 % of all computed tomography (CT) scans. Biopsies were taken in 71 patients, and the causative organisms were identified in 56.2 % of patients, with Staphylococcus aureus being the predominant pathogen. Fifty-six patients underwent surgical treatment. During hospitalization, infectious complications were observed in 63 patients (60.0 %). The most common complications were psoas, paravertebral and epidural abscesses. Patients with S. aureus infections had a significantly higher rate of infectious complications than those without (76.5 vs. 40.3 %, respectively), and were more frequently treated in intensive care units (58.8 vs. 34.7 %, respectively). Overall in-hospital mortality rate was 12.4 %. Elevated C-reactive protein levels at admission, advanced age and a Charlson Comorbidity Index of ≥2 were associated with higher mortality. CONCLUSIONS: Magnetic resonance imaging currently is the imaging procedure of choice for the radiologic diagnosis of VO. Mortality is attributable in part to co-morbidities. However, infections with S. aureus are frequent in this patient population and are associated with a higher rate of complications and a trend towards higher mortality.

Indications and limitations of conservative treatment for pyogenic spondylitis.

STUDY DESIGN: Retrospective comparative study. OBJECTIVE: To elucidate the indications and limitations of conservative treatment for pyogenic spondylitis (PS). SUMMARY OF BACKGROUND DATA: The optimal strategy for treating PS, conservative or surgical, remains controversial. METHODS: Sixty-eight consecutive patients (44 males, 24 females; 62.6±13.8 y) suffering from PS were enrolled. Forty-three were successfully treated with conservative therapy including immobilization and administration of antibiotics [conservative treatment success (CTS) group]. Twenty-five patients underwent surgical intervention because of ineffective conservative treatment [conservative treatment failure (CTF) group]. Clinical parameters such as duration of symptoms, C-reactive protein (CRP) at admission, durations of hospital stay, and Frankel score, and radiologic parameters such as the presence of epidural abscess, were investigated in both groups. RESULTS: The duration of symptoms, CRP at admission, and the duration of hospital stay were 1.72±1.02 months, 5.89±6.29 mg/dL, and 85.7±46.0 days, respectively, in the CTS group compared with 7.92±16.9 months, 2.22±3.08 mg/dL, and 95.0±28.0 days in the CTF group. Differences were significant. At follow-up, 100% of the CTS group and 84% of the CTF group were ambulatory. A total of 86.1% of the CTS group lesions occurred at the lumbosacral region, whereas the majority (52%) of those in the CTF group were in the thoracic region. The incidence of epidural abscess was higher in the CTF group (84.0%) than in the CTS group (30.2%), and their greatest likelihoods were at the cervical/thoracic regions and lumbosacral region, respectively. CONCLUSIONS: The early phase of PS, in which the duration of disease between onset and admission was short and CRP at admission was active, was a good indication for conservative treatment regardless of the sites if there was neither paralysis nor worsening of kyphosis, and can even be an option for cases with mild paralysis due to epidural abscess occurring at the lumbosacral region.

[Septic arthritis and spondylitis].

Septic arthritis and spondylitis in elderly adult are uncommon disease. But symptoms and signs of septic arthritis and spondylitis are an important medical emergency, with high mortality and morbidity. Delayed or inadequate treatment can result in irreversible joint destruction and neurological condition. Early diagnoses as well as prompt and effective treatment are essential for avoiding severe outcomes. In spite of advances in diagnostic imaging techniques, the incidence of septic arthritis and spondylitis appears to have been increased. The aging of the population, the widespread use of immunosuppressant therapies, including systemic corticosteroids, cytokines and anticytokines, and growing resistance to conventional antibiotics seem to be the major cause.

Clinical and radiological outcomes after conservative treatment of TB spondylitis: is the 15 years' follow-up in the MRC study long enough?

INTRODUCTION: Tuberculosis of the spine is a still a common disease entity, not only in developing countries but is also returning in developed countries especially in the immune-compromised patients. Conservative treatment with chemotherapy is still the main stay of treatment. This article focuses on the clinical and radiological outcomes, and problems with conservative treatment. METHOD: The available literature of anti-tuberculosis chemotherapy in managing spinal tuberculosis was reviewed. Data sources included relevant literature of the English language identified through Medline search from 1946 to 2011. Personal experience and unpublished reviews from the authors' institution were also included. RESULTS: Although majority of patients respond well to anti-tuberculosis chemotherapy, about 15 % of them develop paradoxical response. The Medical Research Council (MRC) studies have shown that for patients without significant neurological deficits, operative and conservative treatment could produce the same clinical outcome at 15 years follow-up. Patients treated operatively with debridement and spinal fusion with strut graft had faster bony fusion and less kyphotic deformity. In contrast, those treated with drugs alone or with simple debridement without fusion may result in disease reactivation, severe kyphosis or late instability, which in turn may lead to late-onset Pott's paraplegia, back pain, sagittal imbalance and compromised pulmonary function that are difficult or risky to treat. CONCLUSION: Recognition of the clinical and radiologic features of these late sequels is important for the management. Prevention of deformity in the early disease has been added to the modern standard of treatment of TB spine.

Spinal infection: state of the art and management algorithm.

INTRODUCTION: Spinal infection is a rare pathology although a concerning rising incidence has been observed in recent years. This increase might reflect a progressively more susceptible population but also the availability of increased diagnostic accuracy. Yet, even with improved diagnosis tools and procedures, the delay in diagnosis remains an important issue. This review aims to highlight the importance of a methodological attitude towards accurate and prompt diagnosis using an algorithm to aid on spinal infection management. METHODS: Appropriate literature on spinal infection was selected using databases from the US National Library of Medicine and the National Institutes of Health. RESULTS: Literature reveals that histopathological analysis of infected tissues is a paramount for diagnosis and must be performed routinely. Antibiotic therapy is transversal to both conservative and surgical approaches and must be initiated after etiological diagnosis. Indications for surgical treatment include neurological deficits or sepsis, spine instability and/or deformity, presence of epidural abscess and upon failure of conservative treatment. CONCLUSIONS: A methodological assessment could lead to diagnosis effectiveness of spinal infection. Towards this, we present a management algorithm based on literature findings.

Cervical pyogenic spinal infections: are they more severe diseases than infections in other vertebral locations?

PURPOSE: Cervical spine pyogenic infections are unusual compared to other vertebral segments, but they can be associated to worse clinical outcomes. We compared all patients with cervical spine pyogenic infections to those with thoracolumbar involvement in terms of epidemiology, prognostic factors and clinical outcomes. METHODS: We retrospectively reviewed all patients discharged from our institution with diagnosis of pyogenic spinal infections (PSI) during a 14-year period. Patients' demographics, etiologic agent, co-morbidities, site of infection, white blood cell count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) at time of presentation, neurological impairment and mortality were registered to compare clinical outcomes of patients with PSI affecting the cervical spine and other segments. RESULTS: We studied 102 patients with PSI. Nineteen (18.6 %) had cervical involvement; 73.7 % of them were males, with a mean age of 65.22 years. 89.7 % of them presented spondylodiscitis; 12 patients (63.2 %) exhibited a one segment involvement (C5-C6 being the most common), and 11 patients presented an epidural abscess. Thirteen patients (68.4 %) exhibited neurological deficit. Seventeen patients (89.5 %) presented elevated ESR and CRP, while 12 patients (63.2 %) exhibited leukocytosis. The causative organism was identified in 17 patients (89.5 %). Despite similar baseline characteristics, compared to PSI in other locations, patients with cervical PSI presented significantly more neurological involvement (68.4 vs. 41 %; p = 0.03), they more often required surgical treatment (84.2 vs. 46.3 %; p < 0.01), and they had and increased mortality (21.1 % compared to 3.6 %; p = 0.02). CONCLUSION: An early diagnosis and prompt treatment should be the goal treating cervical PSI, considering the potential devastating complications and increased mortality.

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.

Pyogenic spondylitis.

Pyogenic spondylitis is a neurological and life threatening condition. It encompasses a broad range of clinical entities, including pyogenic spondylodiscitis, septic discitis, vertebral osteomyelitis, and epidural abscess. The incidence though low appears to be on the rise. The diagnosis is based on clinical, radiological, blood and tissue cultures and histopathological findings. Most of the cases can be treated non-operatively. Surgical treatment is required in 10-20% of patients. Anterior decompression, debridement and fusion are generally recommended and instrumentation is acceptable after good surgical debridement with postoperative antibiotic cover.

[Pyogenic spondylodiscitis: therapy algorithm and a new classification for therapeutic decision-making]. / Pyogene Spondylodiszitis : Therapiealgorithmus und neue Klassifikation zur therapeutischen Entscheidungsfindung.

The incidence of pyogenic spondylodiscitis is low but has been steadily increasing in recent years. To date there has been no consensus concerning selection of the appropriate treatment, management and strategies and the recommendations for an operative strategy are still a highly controversial issue. In the literature a few statements have been published concerning therapeutic decision-making in pyogenic spondylodiscitis. The classification given in this article is based on clinical experience and retrospective data analysis considering the degree of segmental bony destruction, grade of kyphosis and instability, epidural involvement of the disease and neurological deficits, which are pivotal for therapeutic decision-making. The therapeutic procedure can be defined based on this classification.

[Challenges and characteristics of spondylodiscitis of the cervical spine]. / Herausforderungen und Besonderheiten der Spondylodiszitiden der Halswirbelsäule.

The human cervical spine is a unique structure that differs dramatically from the thoracic and lumbar spine. The main differences concern the topographic anatomy of the spinal cord, anatomy and physiology of the occipito-atlanto-axial joint complex, the close course of the vertebral artery to the cervical spine and the very close relationship of the esophagus, vessels, peripheral and cranial nerves to the spine. To avoid serious complications during surgical treatment of spondylodiscitis within the cervical spine, these aspects must be kept in mind. They will be explained in detail in this article.