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Revision of failed posterior cervical fusions
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Trevor Mordhorst, Vadim Goz, William Ryan Spiker
Labs are beneficial for determining the presence of infection and evaluating for risk factors of nonunion. Diagnostic workup prior to revision fusion may include complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). ESR and CRP will be elevated in infection, but they may be difficult to interpret in the acute postoperative setting. CRP is the most sensitive marker for acute postoperative infection, while leukocytosis is not always present. Acute spondylodiscitis is characterized by high inflammatory markers; however, inflammatory markers may be normal in chronic infection.
Musculoskeletal
Published in Vincent Helyar, Aidan Shaw, The Final FRCR, 2017
Involvement of two vertebrae and the intervertebral disc (i.e. one spinal segment) is nearly pathognomic of spondylodiscitis. Infection begins by haematogenous seeding or direct spread post-trauma/surgery/adjacent sepsis. A total of 85% of infections are in the lumbar and thoracic regions; up to 90% are due to Staphylococcus aureus. Back pain of gradual onset is the most common presenting feature (Figure 2.7).
Bones and joints
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Brian J Pollard, Gareth Kitchen
Complications include fractures with little or no history of trauma, collapse of vertebral end-plates (spondylodiscitis) and spinal nerve root compression. Cervical fractures (commonly C5-6) may occur with minimal trauma or hyperextension. Clinically significant atlanto-axial subluxation occurs in 21%. About 47% with vertebral compression fractures have a neurological complication ranging from paraesthesia to loss of muscle strength.
Site matters: Image-guided percutaneous sampling of intervertebral disc results in increased positive diagnostic yield in spondylodiscitis
Published in British Journal of Neurosurgery, 2023
Nektarios K. Mazarakis, James Baren, Peter R. Loughenbury, Christos Koutsarnakis, Harun Gupta, Richard W. Fawcett
Spondylodiscitis is an infection of the intervertebral disc with secondary inflammatory and infective change seen within the adjacent vertebral bodies. The infection can also extend into the surrounding soft tissue. The incidence of spondylodiscitis ranges from 2.2 to 9.8 per 100000.1 Clinical presentation can vary significantly and range from displaying no symptoms to acute or progressive symptoms, including back pain and neurological deterioration. In more severe cases impaired neurology can occur due to infection-related biomechanical instability and compromise of the neuronal components or ischaemia of the cord secondary to infection.2 It is, therefore, important that a persistent or worsening complaint of back pain should include the possibility of spondylodiscitis in the differential diagnosis, and that prompt diagnosis is made so that the appropriate antimicrobial treatment is commenced. If infection progresses it can lead to destruction of the disc and surrounding bone, deformity and biomechanical instability.
Novel strategies to diagnose prosthetic or native bone and joint infections
Published in Expert Review of Anti-infective Therapy, 2022
Alex Van Belkum, Marie-Francoise Gros, Tristan Ferry, Sebastien Lustig, Frédéric Laurent, Geraldine Durand, Corinne Jay, Olivier Rochas, Christine C. Ginocchio
Spondylodiscitis results from infection of intervertebral discs. The infection can spread to nearby bone tissue and represents 5% of all osteomyelitis forms [21]. Spondylodiscitis occurs via hematogenous spread or post-surgically. Symptoms include general malaise, weight loss, fever, back pain, spinal cord, or nerve compression. Risk factors include diabetes mellitus, malnutrition, and other disorders inducing a loss of weight, steroid therapy, rheumatic diseases, and spinal surgery. Worldwide, the most frequent microorganism responsible for spondylodiscitis is M. tuberculosis [22]. Half of the non-TB cases are due to S. aureus, with various species of coagulase-negative staphylococci, gram-negative bacteria (less than 30%) and streptococci ranking lower in frequency. Brucella spp. represents the predominant cause of spondylodiscitis in some Mediterranean countries and the Middle East [23]. Treatment consists of wearing corsets and undergoing long courses of antibiotic therapy. Diagnostic specimens included drainage fluids from abscesses, bone tissue, and positive blood culture samples. Different etiological agents require different cultivation strategies with different sensitivities and specificities. Serological testing aiming at the detection of antibodies to the best known pathogens is another distinct though usually less specific and sensitive diagnostic option [24].
Different kinetics of infectious processes in vertebral osteomyelitis of pyogenic or tuberculous origin explain different timing of surgery
Published in Infectious Diseases, 2020
Ségolène Perrineau, Virginie Zarrouk, Mohamed Zoghlami, Wassim Allaham, Véronique Leflon-Guibout, Marc-Antoine Rousseau, Bruno Fantin
Spondylodiscitis and spondylitis were defined with radiological features (with MRI and/or CT scan). Proven HPVO were defined by the isolation of a causative agent in blood cultures; if blood cultures were negative, CT-guided biopsies of the disk and vertebra were performed, and if cultures of biopsies were negative, surgical biopsies were done. TVO was defined by the presence of mycobacteria of the Mycobacterium tuberculosis complex on vertebral or paravertebral abscess biopsy (CT-guided or surgical), or on other clinical samples. Probable TVO was defined as spinal infection without microbial confirmation, but considered as tuberculosis based on epidemiology, suggestive clinical and radiological findings, positive histology (giant cell epithelioid granuloma with caseous necrosis), or other localization of tuberculosis, and successful outcome after empirical treatment against tuberculosis [15]. We excluded post-operative VO, VO of fungal origin, and patients with VO whose only indication for surgery was for diagnostic purposes.