Evaluation of conservative treatment of non specific spondylodiscitis
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The objective of this study was to analyse the presentation, aetiology, conservative management, and outcome of non-tuberculous pyogenic spinal infection in adults. We performed a retrospective review of 56 patients (35 women and 21 men) of pyogenic spinal infection presenting over a 7-year period (1999–2006) to the Department of Spinal Surgery of Hesperia Hospital. The medical records, radiologic imaging, bacteriology results, treatment, and complications of all patients were reviewed. The mean age at presentation was 47.8 years (age range 35–72 years), the mean follow-up duration was 12.5 months. The most common site of infection was lumbar spine (n: 48), followed by the thoracic spine (n: 8). Most patients were symptomatic for between 4 and 10 weeks before presenting to hospital. The frequently isolated pathogen was Staphylococcus aureus in 31 of 56 cases (57.6%). Percutaneous biopsies were diagnostic in 57% of patients; the open biopsy was indicated if closed biopsy failed and when the infection was not accessible by percutaneous technique. The patients were managed by conservative measures alone, including antibiotic therapy and spinal bracing. The mean period of antibiotic therapy was 8.5 weeks (range 6–9 weeks), followed by oral antibiotics for 6 weeks. All patients had a supportive spinal brace for mean 8 weeks (range 6–10 weeks). The duration of the administration of oral antibiotics was dependent on clinical and laboratory evidence (white cell count, erythrocyte sedimentation rate, C-reactive protein) that the infection was resolved. The follow-up MR gadolinium scans were essential to monitor the response to medical treatment. The diagnosis of pyogenic spinal infection should be considered in any patient presenting with severe localised unremitting back and neck pain, especially when accompanied with systemic features, such as fever and weight loss and in the presence of elevated inflammatory markers. The conservative management of infection with antibiotic therapy and spinal bracing was very successful.
KeywordsOpen Biopsy Discitis Anatomic Segment Chronic Kidney Failure Pyogenic Spondylodiscitis
Conflict of interest statement
None of the authors has any potential conflict of interest.
- 3.An HS, Seldomridge JA (2006) Spinal infections: diagnostic tests and imaging studiesGoogle Scholar
- 16.Dagirmanjian A, Schils J, McHenry M, Modic MT (1996) MR imaging of vertebral osteomyelitis revisited. AJR Am J Roentgenol 67:1539–1543Google Scholar
- 21.Grollmus J, Perkins RK, Rusel W (1974) Erythrocyte sedimentation rate as a possible 16. Indicator of early disc space infection. Neurochirurgia (Stuttg) 17:30–35Google Scholar
- 27.Lerner RK, Esterhai JL Jr, Polomono RC, Cheatle MC, Heppenstall RB, Brighton CT (1991) Psychosocial, functional, and quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower extremity amputation. Arch Phys Med Rehabil 72:122–126PubMedGoogle Scholar
- 40.Rothman SL (1996) The diagnosis of infections of the spine by modern imaging techniques. Orthop Clin North Am 27:111–123Google Scholar
- 46.Slucky AV, Eismont FJ (1997) Spinal infections. In: Bridwell KH, De-Wald RL (eds) The textbook of spinal surgery, vol 2. Lippincott-Raven, Philadelphia, pp 2141–2183Google Scholar
- 48.Still JM, Abranson R, Law EJ (1995) Development of an epidural abscess following staphylococcal septicaemia in an acutely burned patient: case report. J Trauma 38:158–159Google Scholar
- 54.Verner EF, Musher DM (1995) Spinal epidural abscess. Med Clin North Am 69:375–384Google Scholar
- 56.Ware JE (1993) SF-36 health survey manual and interpretation guide. Nimrod Press, BostonGoogle Scholar