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The cases
Published in Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young, Paediatric Radiology for MRCPCH and FRCR, 2020
Chris Schelvan, Annabel Copeman, Jacky Davis, Annmarie Jeanes, Jane Young
MRI is the modality of choice in the assessment of discitis. It can easily assess early inflammation in the disc and vertebral bodies, whilst identifying complications such as epidural abscesses, which may require urgent drainage.
Community-acquired spinal infections
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Tammy L. Tyree, Luis M. Tumialán
Discitis is an infection of the intervertebral disc space that, in adults, is most often caused by an invasive procedure; spontaneous discitis is uncommon in adults (Honan et al., 1996). Osteomyelitis typically occurs from the progression of discitis to adjacent vertebral endplates; however, the medical literature frequently groups discitis and osteomyelitis as a single entity. Discitis and osteomyelitis can further be delineated into pyogenic (pus-forming) or nonpyogenic types. Nonpyogenic etiologies include—but are not limited to—Mycobacterium, Brucella sp., Candida tropicalis, and fungal organisms such as Aspergillus sp., Blastomyces sp., and Coccidioides sp. (Greenberg, 2010). These nonpyogenic infections can occur spontaneously or postoperatively. An epidural abscess is a collection of purulent material between the dura mater of the spinal cord and the vertebral canal.
The Child With A Limp
Published in Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan, Diagnosing and Treating Common Problems in Paediatrics, 2017
Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan
Although discitis can occur at any age, the incidence is increased in the toddler age group. Discitis is inflammation of the intervertebral disc space or vertebral end plate and occurs most commonly in the lumbar region. It is an uncommon condition with a good prognosis. Presentation is usually non-specific and gradual. Toddlers present with limp or refusal to walk. They are systemically well and may have a low-grade fever. Examination may reveal restricted spinal mobility and loss of lumbar lordosis. There may be tenderness at the site of the lesion. The key is to distinguish discitis from vertebral osteomyelitis. Vertebral osteomyelitis affects older children, who are systemically unwell with high fever and complain of pain in the lumbar, thoracic or cervical spine. The white cell count (WCC) and C-reactive protein (CRP) are usually normal or slightly elevated; the erythrocyte sedimentation rate (ESR) is usually raised and can be used to monitor response to treatment. Blood cultures are usually negative. Spinal X-rays can be normal initially; however, after 2–4 weeks, disc space narrowing and irregular end plates of neighbouring vertebrae can be seen. Magnetic resonance imaging (MRI) of the spine is the investigation of choice to detect early discitis and rule out spinal tumours. The aetiology is unknown. Although an infectious cause has been proposed, organisms are rarely isolated and children recover without antibiotics.
Bi-needle technique versus transforaminal endoscopic spine system technique for percutaneous endoscopic lumbar discectomy in treating intervertebral disc calcification: a propensity score matched cohort analysis
Published in British Journal of Neurosurgery, 2021
Zeng Xu, Jian-Cheng Zheng, Bin Sun, Ke Zhang, Yun-Hao Wang, Chang-Gui Shi, Hui-Qiao Wu, Xiao-Dong Wu, Hua-Jiang Chen, Wen Yuan
Before propensity score matching, in the Bi-needle group 1, patient had recurrence of symptoms during follow up, after drug therapy the symptoms were relieved (Table 3). In the TESSYS group, three patients had recurrence of symptoms during follow-up, one patient relieved after drug therapy (NSAIDs), two patients finally received open surgery. After propensity score matching, there no patient suffered recurrence in the Bi-needle group and two patients suffered recurrence of symptoms in TESSY group, both of which received posterior open reoperation. Bacterial discitis was diagnosed in one patient in the TESSYS group, there were no patients with postoperative discitis in the Bi-needle group. Cerebrospinal fluid leakage was observed in two patients, one in each matched group, which resulted from wide and firm adhesions between the calcification and nervous tissue. However, the symptom were not severe and resolved within one with bed rest in both cases. Two 2 patients had persistent dysesthesia after surgery in the TESSYS group and they resolved at 1 week and 3 weeks post op. Comparing specific complications, there were no statistically difference between two groups. When all complication were taken together the difference was significant (p < 0.05).
Use of lasers in minimally invasive spine surgery
Published in Expert Review of Medical Devices, 2018
Laser-associated complications have produced a small number of complications, regardless of the method of surgical approaches. Potential complications include infections, bleeding, neural damage, worsened pain, failure of technique, recurrence, large vessel injury, and bowel or visceral injury [71–75]. Infectious discitis is one of the most common complications, with an incidence rate of less than 1%. This is especially true when using heat, as it may cause necrosis at the vascular plexus of the endplate and cause potential nutritional discitis [71]. Neural damage or cauda equina syndrome can occur due to poor orientation of the laser tip or excessive application of the laser beam. Sometimes, even when the patient is conscious, inappropriate use of laser and thermal injury to neural tissues may not be detected. If any painless muscle twitching is detected during the procedure, the surgeon must stop the procedure immediately and adjust the orientation of the laser beam. Another important issue is vascular or bowel injury due to working cannula or laser beam. In the case of open CO2 laser discectomy, excessive use of laser may puncture the anterior annulus and injure a major vessel or the bowel [40,74]. This is extremely rare, but it is disastrous. To prevent this complication, the surgical field should be kept moist, as water can immediately absorb laser energy. A properly trained surgeon performing laser spine surgery with live imaging on a conscious patient is the best safeguard against potential complications.
Cervical dural calcification and cervical myelopathy in X-linked hypophosphataemic rickets: a case report and review of the literature
Published in British Journal of Neurosurgery, 2019
Ali A. Najefi, Daniel B. Beder, Shiraz A. Sabah, Kia Rezajooi
A 55-year old, right-hand dominant gentleman presented to our Neurosurgical Spine service with a three-month history of altered sensation in his left hand. He had been under the care of our Spinal Rehabilitation physicians for 3 years following a T4 ASIA A spinal cord injury (SCI), secondary to Staphylococcus aureus discitis and epidural abscess. Previous treatment included single-level posterior decompression, washout and suppressant antibiotics. He had been diagnosed with XLHR as a child.