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Management of infectious discitis. Outcome in one hundred and eight patients in a University Hospital

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Abstract

Purpose

The optimal management of pyogenic discitis is not agreed on. We conducted a retrospective, cross-sectional, observational study in which all patients with discitis who attended Hospital San Carlos Madrid from January 1999 to January 2009 were included.

Methods

We identified 108 consecutive adult patients with infectious discitis. There were 49 men and 59 women with an average age of 67,5 (+/- 16,89) years in the study group. Mean follow-up interval was 6,06 (12,5-2) years. 78 patients had spontaneous discitis and 30 patients had postoperative discitis. Inclusion criteria for the review were illness compatible with vertebral infection and / or evidence of spinal involvement on magnetic resonance imaging (MRI).

Results

In 56 percutaneous discal biopsy (52% patients) were positive in 28 cases. A single disc was infected in 100 patients. The segments involved were the cervical spine in four, the thoracic spine in 38 and the lumbar spine in 66. One or more comorbid diseases were present in 73 (68%) of 108 patients. Diabetes mellitus was the most common disease. Comorbid disease was rapidly fatal in four patients, ultimately fatal in seven patients, and nonfatal or not present in 97 patients (90 %).

Conclusion

Early diagnosis is a major challenge. Heightened awareness and the prompt use of MRI are necessary to avoid diagnostic delay. Prolonged antimicrobial therapy and the judicious application of timely surgical intervention are essential for an optimal outcome.

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References

  1. McCabe WR, Jackson GG (1962) Gram-negative bacteremia. I. Etiology and ecology. Arch Intern Med 110:847–855

    Article  Google Scholar 

  2. McHenry MC, Easley KA, Locker GA (2002) Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis 34:1342–1350

    Article  PubMed  Google Scholar 

  3. Friedman JA, Maher CO (2002) Spontaneous disc space infections in adults. Surg Neurol 57:81–86

    Article  PubMed  Google Scholar 

  4. Jensen AG, Espersen F, Skinhoj P et al (1997) Increasing frequency of vertebral osteomyelitis following Staphylococcus aureus bacteraemia in Denmark 1980–1990. J Infect 34:113–118

    Article  PubMed  CAS  Google Scholar 

  5. Espersen F, Frimodt-Moller N, Thamdrup Rosdahl V et al (1991) Changing pattern of bone and joint infections due to Staphylococcus aureus: study of cases of bacteremia in Denmark, 1959–1988. Rev Infect Dis 13:347–358

    Article  PubMed  CAS  Google Scholar 

  6. Cottle L, Riordan T (2008) Infectious spondylodiscitis. J Infect 56:401–412

    Google Scholar 

  7. Khan IA, Vaccaro AR, Zlotolow DA (1999) Management of vertebral diskitis and osteomyelitis. Orthopedics 22(8):758–765

    PubMed  CAS  Google Scholar 

  8. Varma R, Lander P, Assaf A (2001) Imaging of pyogenic infectious spondylodiscitis. Radiol Clin North Am 39(2):203–213

    Article  PubMed  CAS  Google Scholar 

  9. Hopkinson N, Stevenson J, Benjamin S (2001) A case ascertainment study of septic discitis: clinical, microbiological and radiological features. Q J Med 94:465–470

    Article  CAS  Google Scholar 

  10. An HS, Seldomridge JA (2006) Spinal infections. Clin Orthop Relat Res 444:27–33

    Article  PubMed  Google Scholar 

  11. Chew FS, Kline MJ (2001) Diagnostic yield of CT-guided percutaneous aspiration procedures in suspected spontaneous infectious diskitis. Radiology 218:211–214

    PubMed  CAS  Google Scholar 

  12. Hadjipavlou AG, Kontakis GM, Gaitanis JN et al (2003) Effectiveness and pitfalls of percutaneous transpedicle biopsy of the spine. Clin Orthop Relat Res 411:54–60

    Article  PubMed  Google Scholar 

  13. Rankine JJ, Barron DA, Robinson P et al (2004) Therapeutic impact of percutaneous spinal biopsy in spinal infection. Postgrad Med J 80:607–609

    Article  PubMed  CAS  Google Scholar 

  14. Enoch DA, Cargill JS, Laing R et al (2008) Value of CT-guided biopsy in the diagnosis of septic discitis. J Clin Pathol 61:750–753

    Article  PubMed  CAS  Google Scholar 

  15. Kornblum MB, Wesolowski DP, Fischgrund JS et al (1998) Computed tomography-guided biopsy of the spine. A review of 103 patients. Spine (Phila Pa 1976) 23:81–85

    Article  CAS  Google Scholar 

  16. Friedman JA, Maher CO, Quast LM et al (2002) Spontaneous disc space infections in adults. Surg Neurol 57:81–86

    Article  PubMed  Google Scholar 

  17. Sapico FL, Montgomerie JZ (1990) Vertebral osteomyelitis. Infect Dis Clin North Am 4:539–550

    PubMed  CAS  Google Scholar 

  18. Eismont FJ, Bohlman HH, Soni PL, Goldberg FM, Freehafer AA (1983) Pyogenic and fungal osteomyelitis with paralysis. J Bone Joint Surg Am 65:19–29

    PubMed  CAS  Google Scholar 

  19. Kulowski J (1936) Pyogenic osteomyelitis of the spine: an analysis and discussion of 102 cases. J Bone Joint Surg 18:343–364

    Google Scholar 

  20. Ross PM, Fleming JL (1976) Vertebral body osteomyelitis: spectrum and natural history: a retrospective study of 37 cases. Clin Orthop 118:190–198

    PubMed  Google Scholar 

  21. Collert S (1977) Osteomyelitis of the spine. Acta Orthop Scand 48:283–290

    Article  PubMed  CAS  Google Scholar 

  22. Patzakis MJ, Rao S, Wilkins J et al (1991) Analysis of 61 cases of vertebral osteomyelitis. Clin Orthop Relat Res 264:178–183

    PubMed  Google Scholar 

  23. Colmenero JD, Jimenez-Mejias ME, Sanchez-Lora FJ et al (1997) Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases. Ann Rheum Dis 56:709–715

    Article  PubMed  CAS  Google Scholar 

  24. Legrand E, Flipo R-M, Guggenbuhl P et al (2001) Management of nontuberculous infectious discitis. Treatments used in 110 patients admitted to 12 teaching hospitals in France. Joint Bone Spine 68:504–509

    Google Scholar 

  25. Cheung WY, Luk KD (2011). Pyogenic spondylitis. Int Orthop. Oct 28 [Epub ahead of print]

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedics & Traumatology, Hospital Clínico San Carlos, C. Prof. Martin Lagos s/n, 28040, Madrid, Spain

    Juan Luis Cebrián Parra, Alvaro Saez-Arenillas Martín, Antonio L. Urda Martínez-Aedo, Isabel Soler Ivañez & Luis Lopez-Duran Stern

  2. Department of Internal Medicine, Hospital Clínico San Carlos, Madrid, Spain

    Emilio Agreda

Authors
  1. Juan Luis Cebrián Parra
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  2. Alvaro Saez-Arenillas Martín
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  3. Antonio L. Urda Martínez-Aedo
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  4. Isabel Soler Ivañez
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  5. Emilio Agreda
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  6. Luis Lopez-Duran Stern
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Correspondence to Juan Luis Cebrián Parra.

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Cebrián Parra, J.L., Saez-Arenillas Martín, A., Urda Martínez-Aedo, A.L. et al. Management of infectious discitis. Outcome in one hundred and eight patients in a University Hospital. International Orthopaedics (SICOT) 36, 239–244 (2012). https://doi.org/10.1007/s00264-011-1445-x

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  • DOI: https://doi.org/10.1007/s00264-011-1445-x

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