Skip to main content

Advertisement

SpringerLink
Log in

Spondylodiscitis Associated with Major Abdominal Surgical Intervention: Challenging Diagnostic and Therapeutic Modalities

  • Original Article
  • Published:
Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

Post-operative spondylodiscitis (PS) is a relatively rare infectious disease, with incidence varying from 0.21–3.6% in association with all surgical procedures. The entity appears insidiously, with non-specific symptoms such as neck or back pain, fever, muscle contractures, limited range of spinal motion, sciatica and neurological symptoms. C-reactive protein (CRP) remains the most reliable laboratory finding, while magnetic resonance imaging (MRI) has proven to be the most effective method for demonstrating the site of the infection. Treatment consists of immobilization along with antimicrobial therapy. The aim of this investigation was to analyse two isolated cases of PS presented in our institution. Into this retrospective survey were consecutively enrolled one patient with PS after complete common bile duct (CBD) obstruction and subsequent endoscopic retrograde cholangiopancreatography (ERCP) and Whipple operation along with one case of PS in a patient with vascular graft placement for therapeutic approach of an aortoenteric fistula as a consequence of an abdominal aorta pseudoaneurysm. PS is mainly associated with major surgical procedures and possesses a mortality rate of 11%. The most common etiological factor is Staphylococcus aureus but there is also evidence of gram-positive cocci, gram-negative bacilli, anaerobia bacteria, fungi, parasites and multi resistant microorganisms. Furthermore, there are many risk factors which contribute to this pathological situation such as advanced age, diabetes mellitus, smoking, steroid treatment, obesity, alcohol, malnutrition, concomitant infections, prolonged hospitalization and relevant serious co-morbidities. Also, the diagnosis is based on combination of clinical, haematological, microbiological and histopathologic findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Garcia-Vidal C, Cabellos C, Ayats J, Font F, Ferran E, Fernandez-Viladrich P (2009) Fungal postoperative spondylodiscitis due to Scedosporium prolificans. Spine J 9:e1–e7

    Article  PubMed  Google Scholar 

  2. Jiménez-Mejías ME, de Dios CJ, Sánchez-Lora FJ, Palomino-Nicás J, Reguera JM, García de la Heras J, García-Ordoñez MA, Pachón J (1999) Postoperative spondylodiskitis: etiology, clinical findings, prognosis, and comparison with nonoperative pyogenic spondylodiskitis. Clin Infect Dis 29:339–345

    Article  PubMed  Google Scholar 

  3. D'Agostino C, Scorzolini L, Massetti AP, Carnevalini M, d'Ettorre G, Venditti M, Vullo V, Orsi GB (2010) A seven-year prospective study on spondylodiscitis: epidemiological and microbiological features. Infection 38:102–107

    Article  PubMed  Google Scholar 

  4. Hegde V, Meredith DS, Kepler CK, Huang RC (2012) Management of postoperative spinal infections. World J Orthop 3:182–189

    Article  PubMed  PubMed Central  Google Scholar 

  5. Marques N, Sá R, Coelho F, da Cunha S, Meliço-Silvestre A (2007) Spondylodiscitis associated with recurrent Serratia bacteremia due to a transjugular intrahepatic portosystemic shunt (TIPS): a case report. Braz J Infect Dis 11:525–527

    Article  PubMed  Google Scholar 

  6. d'Ettorre G, Ceccarelli G, Zaffiri L, Falcone M, Mastroianni CM, Venditti M, Vullo V (2009) Infectious aortitis and spondylodiscitis in patients with endovascular stents. Minerva Med 100:167–170

    PubMed  Google Scholar 

  7. Lee BB, Ngan Kee WD, Griffith JF (2002) Vertebral osteomyelitis and psoas abscess occurring after obstetric epidural anesthesia. Reg Anesth Pain Med 27:220–224

    Article  PubMed  Google Scholar 

  8. Curry JM, Cognetti DM, Harrop J, Boon MS, Spiegel JR (2007) Cervical discitis and epidural abscess after tonsillectomy. Laryngoscope 117:2093–2096

    Article  PubMed  Google Scholar 

  9. Bolzoni A, Peretti G, Piazza C, Farina D, Nicolai P (2006) Cervical spondylodiscitis: a rare complication after phonatory prosthesis insertion. Head Neck 28:89–93

    Article  PubMed  Google Scholar 

  10. Zohoun A, Ngoh Akwa E, El Ochi M, Oragwu N, Akhaddar A, Albouzidi A, El Ouennass M (2012) Bacteriological features of infectious spondylodiscitis at Mohammed V Military Teaching Hospital of Rabat. Braz J Microbiol 43:1327–1331

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Stosić-Opinćal T, Perić V, Grujicić D, Gavrilović S, Golubicić I (2004) The role of magnetic resonance imaging in the diagnosis of postoperative spondylodiscitis. Vojnosanit Pregl 61:479–483

    Article  PubMed  Google Scholar 

  12. Acosta FL Jr, Chin CT, Quinones H, Ames CP, Weinstein PR, Chou D (2004) Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine. Neurosurg Focus 17:E2

    Article  PubMed  Google Scholar 

  13. Butler JS, Shelly MJ, Timlin M, Powderly WG, O’Byrne JM (2006) Non-tuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center. Spine 31:2695–2700

    Article  PubMed  Google Scholar 

  14. Cassinelli EH, Eubanks J, Vogt M, Furey C, Yoo J, Bohlman HH (2007) Risk factors for the development of perioperative complications in elderly patients undergoing lumbar decompression and arthrodesis for spinal stenosis: an analysis of 166 patients. Spine 32:230–235

    Article  PubMed  Google Scholar 

  15. Friedman ND, Sexton DJ, Connelly SM, Kaye KS (2007) Risk factors for surgical site infection complicating laminectomy. Infect Control Hosp Epidemiol 28:1060–1065

    Article  PubMed  Google Scholar 

  16. Schuster JM, Rechtine G, Norvell DC, Dettori JR (2010) The influence of perioperative risk factors and therapeutic interventions on infection rates after spine surgery: a systematic review. Spine 35:S125–S137

    Article  PubMed  Google Scholar 

  17. Abdul-Jabbar A, Takemoto S, Weber MH, Hu SS, Mummaneni PV, Deviren V, Ames CP, Chou D, Weinstein PR, Burch S, Berven SH (2012) Surgical site infection in spinal surgery: description of surgical and patient-based risk factors for postoperative infection using administrative claims data. Spine 37:1340–1345

    Article  PubMed  Google Scholar 

  18. Rao SB, Vasquez G, Harrop J, Maltenfort M, Stein N, Kaliyadan G, Klibert F, Epstein R, Sharan A, Vaccaro A, Flomenberg P (2011) Risk factors for surgical site infections following spinal fusion procedures: a case-control study. Clin Infect Dis 53:686–692

    Article  PubMed  Google Scholar 

  19. Stambough JL, Beringer D (1992) Postoperative wound infections complicating adult spine surgery. J Spinal Disord 5:277–285

    Article  CAS  PubMed  Google Scholar 

  20. Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, Fraser VJ (2008) Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am 90:62–69

    Article  PubMed  Google Scholar 

  21. Pull ter Gunne AF, Cohen DB (2009) Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine 34:1422–1428

    Article  PubMed  Google Scholar 

  22. Maragakis LL, Cosgrove SE, Martinez EA, Tucker MG, Cohen DB, Perl TM (2009) Intraoperative fraction of inspired oxygen is a modifiable risk factor for surgical site infection after spinal surgery. Anesthesiology 110:556–562

    Article  PubMed  Google Scholar 

  23. Fang A, Hu SS, Endres N, Bradford DS (2005) Risk factors for infection after spinal surgery. Spine 30:1460–1465

    Article  PubMed  Google Scholar 

  24. O‘Toole JE, Eichholz KM, Fessler RG (2009) Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine 11:471–476

    Article  PubMed  Google Scholar 

  25. Parker SL, Adogwa O, Witham TF, Aaronson OS, Cheng J, McGirt MJ (2011) Post-operative infection after minimally invasive versus open transforaminal lumbar interbody fusion (TLIF): literature review and cost analysis. Minim Invasive Neurosurg 54:33–37

    Article  CAS  PubMed  Google Scholar 

  26. Dietze DD, Fessler RG, Jacon RP (1997) Primary reconstruction for spinal infections. J Neurosurg 86:981–989

    Article  PubMed  Google Scholar 

  27. Bavinzski G, Schoeggl A, Trattnig S, Standhardt H, Dietrich W, Reddy M et al (2003) Microsurgical management of postoperative disc space infection. Neurosurg Rev 26:102–107

    Article  PubMed  Google Scholar 

  28. Piotrowski WP, Krombholz MA, Muhl B (1994) Spondylodiscitis after lumbar disc surgery. Neurosurg Rev 17:189–193

    Article  CAS  PubMed  Google Scholar 

  29. Lee SJ, Choi EJ, Nahm FS (2013) Spondylodiscitis after cervical nucleoplasty without any abnormal laboratory findings. Korean J Pain 26:181–185

    Article  PubMed  PubMed Central  Google Scholar 

  30. Ang BS, Ngan CC (2002) Eikenella corrodens discitis after spinal surgery: case report and literature review. J Inf Secur 45:272–274

    CAS  Google Scholar 

  31. Rätsep T (2012) Postoperative spondylodiscitis caused by Mycobacterium Bovis BCG: a case study. Spine J 12:e1–e5

    Article  PubMed  Google Scholar 

  32. Celik SE (2009) Pott disease mimics postsurgical pyogenic spondylodiscitis. J Neurosurg Sci 53:161–164

    CAS  PubMed  Google Scholar 

  33. Propst K, Tunitsky-Bitton E, Schimpf MO, Ridgeway B (2014) Pyogenic spondylodiscitis associated with sacral colpopexy and rectopexy: report of two cases and evaluation of the literature. Int Urogynecol J 25:21–31

    Article  PubMed  Google Scholar 

  34. Voelker A, Hoeckel M, Heyde CE (2012) Lumbosacral spondylodiscitis after sacral colpopexy of a sigmoid neovagina in a patient with vaginal melanoma. Surg Infect 13:134–135

    Article  Google Scholar 

  35. Tang TJ, Janssen HL, van der Vlies CH, de Man RA, Metselaar HJ, Tilanus HW, de Marie S (2000) Aspergillus osteomyelitis after liver transplantation: conservative or surgical treatment? Eur J Gastroenterol Hepatol 12:123–126

    Article  CAS  PubMed  Google Scholar 

  36. McQueen AS, Eljabu W, Latimer J, Raju PP (2011) Thoracic discitis as a complication of self-expanding metallic stents in esophageal carcinoma. Cardiovasc Intervent Radiol 34:S300–S302

    Article  PubMed  Google Scholar 

  37. Köklü S, Koçak E, Akbal E (2011) Air cholangiography for severe hilar obstruction at ERCP. Gastrointest Endosc 73:1326

    Article  PubMed  Google Scholar 

  38. de Koning HD, van Sterkenburg SM, Pierie ME, Reijnen MM (2008) Endovascular abdominal aortic aneurysm repair complicated by spondylodiscitis and iliaco-enteral fistula. J Vasc Surg 47:1330–1332

    Article  PubMed  Google Scholar 

  39. Yazici N, Yalçin B, Cila A, Alnay A, Büyükpamukçu M (2005) Discitis following lumbar puncture in non-Hodgkin lymphoma. Pediatr Hematol Oncol 22:689–694

    Article  PubMed  Google Scholar 

  40. Feldskou E, Olsen PR (2011) Complications after ultrasound-guided transrectal prostate biopsies. Ugeskr Laeger 173:1784–1785

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini str, 12462, Chaidari, Athens, Greece

    Aikaterini Mastoraki, Ioannis S. Papanikolaou, Maria Tsikala-Vafea, Vasiliki Tsigou & Nikolaos Arkadopoulos

  2. Vascular Unit, 3rd Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini str, 12462, Chaidari, Athens, Greece

    Sotiria Mastoraki & Andreas Lazaris

Authors
  1. Aikaterini Mastoraki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sotiria Mastoraki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ioannis S. Papanikolaou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Tsikala-Vafea
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vasiliki Tsigou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andreas Lazaris
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nikolaos Arkadopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aikaterini Mastoraki.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mastoraki, A., Mastoraki, S., Papanikolaou, I.S. et al. Spondylodiscitis Associated with Major Abdominal Surgical Intervention: Challenging Diagnostic and Therapeutic Modalities. Indian J Surg Oncol 8, 274–278 (2017). https://doi.org/10.1007/s13193-017-0641-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13193-017-0641-6

Keywords

Search

Navigation