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Epidural Abscess
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
This patient is suffering from vertebral osteomyelitis. Intravenous drug abuse and diabetes are amongst the most common risk factors for this condition. In cases of native vertebral osteomyelitis, infection tends to occur most commonly at the vertebral endplates via haematogenous seeding. Spread is from the endplate to the disc and then to the opposite end-plate. Direct inoculation is most common in post-operative patients. The most common pathogen is staphylococcus aureus, followed by Staphylococcus epidermidis. In the IVDU patient population, Pseudomonas is also common.
Radionuclide Bone Scintigraphy
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
Kanhaiyalal Agrawal, Gopinath Gnanasegaran
A three-phase bone scan’s typical pattern is increased tracer accumulation at the infection site in all three phases. Although the bone scan is highly sensitive with more than 95 per cent sensitivity, the specificity is low. Other conditionsalso show positive three-phase uptake, for example, malignancy, stress fracture, and osteoid osteoma. However, in non-violated bone with clinical suspicion of osteomyelitis, three phase bone scan detects bone infection with good specificity. False-negative findings may be seen in chronic osteomyelitis and vertebral osteomyelitis. Indium-111 labelled WBC, along with marrow imaging, is the radionuclide imaging of choice in violated bone infection. Septic arthritis, like osteomyelitis, shows increased tracer accumulation in the involved joints in all three phases.
Osteomyelitis
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
In adults, vertebral osteomyelitis occurs following haematogenous spread. One should suspect the diagnosis of vertebral osteomyelitis in patients with new or worsening back or neck pain and fever together with one or more of the following: elevated ESR or CRP, bloodstream infection or infective endocarditis, or new neurologic symptoms.
Chronic Q fever vertebral osteomyelitis, an underrecognized clinical entity
Published in Infectious Diseases, 2021
S. B. Buijs, J. M. Weehuizen, J. J. Oosterheert, S. E. van Roeden
Ghanem-Zoubi et al. [1] describe four patients with chronic Q fever vertebral osteomyelitis – which may be accompanied by discitis – and provide an extensive overview of literature. Chronic Q fever itself is a rare diagnosis, and osteomyelitis or spondylodiscitis is reported in up to 7% of patients with chronic Q fever [2,4]. In all four cases described by Ghanem-Zoubi et al., the abdominal aorta was involved. In three cases, a mycotic aneurysm or activity of the abdominal aorta on PET-CT was present. The other case describes a patient with infected spondylosynthesis material and fluid collections around the abdominal aorta. In two of these cases, another pathogen besides C. burnetii was identified. In the discussion, they provide an overview of 34 cases of vertebral osteomyelitis from literature of whom two-thirds had a confirmed vascular infection as well. Most of these patients had a history of vascular disease, were male and the mean age was 67 years – as is typical for chronic Q fever patients in general. Remarkable is that fever was frequently absent upon presentation, and that inflammatory markers were not always (or only mildly) elevated. Moreover, the course of disease can be indolent with symptoms being present for months or even years before diagnosis [1].
Q fever vertebral osteomyelitis among adults: a case series and literature review
Published in Infectious Diseases, 2021
Nesrin Ghanem-Zoubi, Tony Karram, Olga Kagna, Goni Merhav, Zohar Keidar, Mical Paul
The diagnosis of the causative aetiology of vertebral osteomyelitis is challenging in non-bacteremic patients. In the past, vertebral osteomyelitis was considered a rare manifestation of chronic Q fever. In a cohort of 313 chronic Q fever cases from France diagnosed between 1985 to 1998, seven patients had osteoarticular infection (2.2%) and only one patient had vertebral osteomyelitis [3]. In more recent studies, osteoarticular infections including vertebral osteomyelitis, were reported more frequently. In a large cohort of 439 cases with chronic Q fever from the Netherlands, almost 5% (20 patients) had spondylodiscitis. In the subgroup of proven chronic Q fever in this cohort the rate increased to almost 8% (19/249 patients). Of notice, in 19 out of 20 patients with vertebral osteomyelitis a concomitant vascular or cardiac infection existed [14]. Similarly, a recent large cohort study of patients with Q fever infections from the French national reference centre for rickettsiosis reported that 56 (7.3%) out of 766 cases of persistent focal Q fever infections diagnosed between 1991 to 2016 had osteoarticular infection. Vertebral osteomyelitis was the most common manifestation (observed in 24 cases, 3.1% of all persistent Q fever cases) [15]. The variable incidence reported in different series might be due to different infection characteristics in different locations or a more frequent use of FDG PET/CT in the diagnosis and follow up of chronic Q fever in recent years [15,16].
Targeting feasibility evaluation of magnetic resonance-guided focused ultrasound in the management of osteomyelitis: a virtual treatment planning study in 75 patients
Published in International Journal of Hyperthermia, 2019
Amanda Beserra, Samuel Pichardo, David Kisselgoff, Valentina Peeva, Laura Curiel
Administration of antibiotics (preferably intravenous) remains the first line of treatment for acute osteomyelitis and vertebral osteomyelitis. Bed-side debridement and surgical interventions, combined with antibiotics, are often the preferred treatment approach for chronic osteomyelitis and infections in the foot [21]. The main purpose of debridement and surgery is to eliminate dead bone and repair vascular environment [20,23]. Depending on the extension of the damage, repair surgery may be necessary to compensate for large bone and soft tissue losses. For vertebral infections, surgical intervention is recommended only when there is a need to provide relief from the compression of the spinal cord or create a drainage path for the abscesses [1]. Administration of antibiotics is often performed from 4 to 6 weeks up to 3 months, depending on the prevalence of symptoms. Intravenous administration is performed during the first 4–6 weeks. Nafcillin/Oxacillin and vancomycin are often used, respectively, for methicillin-sensitive S. aureus (MSSA)-related and MRSA-related infections [1,23]. For diverse streptococci, gram-negative bacilli, anaerobes and mixed-type infection, the first line of recommended antibiotic regime is based on, respectively, benzylpenicillin, quinolones, clindamycin and ampicillin [1].