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Evaluation of conservative treatment of non specific spondylodiscitis

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Abstract

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.

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References

  1. Acosta FL Jr, Chin CT, Quiñones-Hinojosa A, 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 

  2. Acosta FL, Galvez LF, Ames C (2006) Recent advances: infections of the spine. Curr Infect Dis Rep 8:390–393

    Article  PubMed  Google Scholar 

  3. An HS, Seldomridge JA (2006) Spinal infections: diagnostic tests and imaging studies

  4. Arnold PM, Baek PN, Bernardi RJ, Luck EA, Larson SJ (1997) Surgical management of nontuberculous thoracic and lumbar vertebral osteomyelitis: report of 33 cases. Surg Neurol 47:551–561

    Article  PubMed  CAS  Google Scholar 

  5. Babu NV, Titus VT, Chittaranjan S, Abraham G, Prem H, Korula RJ (1994) Computed tomographically guided biopsy of the spine. Spine 19:2436–2442

    Article  PubMed  CAS  Google Scholar 

  6. Belzunegui J, Del Val N, Intxausti JJ, De Dios JR, Queiro R, González C, Rodríguez-Valverde V, Figueroa M (1999) Vertebral osteomyelitis in northern Spain. Report of 62 cases. Clin Exp Rheumatol 17:447–452

    PubMed  CAS  Google Scholar 

  7. Blake C, Codd MB, O’Meara YM (2000) The Short form 36 (SF-36) health survey: normative data for the Irish population. Ir J Med Sci 169:195–200

    Article  PubMed  CAS  Google Scholar 

  8. Brugieres P, Revel MP, Dumas JL (1991) Ct-guided vertebral biopsy: a report of 89 cases. J Neuroradiol 18:351–359

    PubMed  CAS  Google Scholar 

  9. Buranapanitkit B, Lim A, Geater A (2001) Misdiagnosis in vertebral osteomyelitis: problems and factors. J Med Assoc Thai 84:1743–1750

    PubMed  CAS  Google Scholar 

  10. Buranapanitkit B, Lim A, Kiriratnikom T (2001) Clinical manifestation of tuberculous and pyogenic spine infection. J Med Assoc Thai 84:1522–1526

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  12. Cahill DW, Love LC, Rechtine GR (1991) Pyogenic osteomyelitis of the spine in the elderly. J Neurosurg 74:878–886

    Article  PubMed  CAS  Google Scholar 

  13. Calderone RR, Larsen JM (1996) Overview and classification of spinal infections. Orthop Clin North Am 27:1–8

    PubMed  CAS  Google Scholar 

  14. Carragee EJ (1997) Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am 79:874–880

    Article  PubMed  CAS  Google Scholar 

  15. Chelsom J, Solberg CO (1998) Vertebral osteomyelitis at a Norwegian university hospital 1987–1997: clinical features, laboratory findings and outcome. Scand J Infect Dis 30:147–151

    Article  PubMed  CAS  Google Scholar 

  16. Dagirmanjian A, Schils J, McHenry M, Modic MT (1996) MR imaging of vertebral osteomyelitis revisited. AJR Am J Roentgenol 67:1539–1543

    Google Scholar 

  17. Dagirmanjian A, Schils J, McHenry M (1999) MR imaging of spinal infections. Magn Reson Imaging Clin N Am 7:525–538

    PubMed  CAS  Google Scholar 

  18. Digby JM, Kersley JB (1979) Pyogenic non-tuberculous spinal infection: an analysis of thirty cases. J Bone Joint Surg Br 61(1):47–55

    PubMed  CAS  Google Scholar 

  19. Gasbarrini AL, Bertoldi E, Mazzetti M, Fini L, Terzi S, Gonella F, Mirabile L, Barbanti Bròdano G, Furno A, Gasbarrini A, Boriani S (2005) Clinical features, diagnostic and therapeutic approaches to haematogenous vertebral osteomyelitis. Eur Rev Med Pharmacol Sci 9:53–66

    PubMed  CAS  Google Scholar 

  20. Govender S (2005) Spinal infections. J Bone Joint Surg Br 87:1454–1458

    Article  PubMed  CAS  Google Scholar 

  21. Grollmus J, Perkins RK, Rusel W (1974) Erythrocyte sedimentation rate as a possible 16. Indicator of early disc space infection. Neurochirurgia (Stuttg) 17:30–35

    CAS  Google Scholar 

  22. Kallio MJ, Unkila-Kallio L, Aalto K, Peltola H (1997) Serum C-reactive protein, erythrocyte sedimentation rate and white blood cell count in septic arthritis in children. Pediatr Infect Dis 16:411–413

    Article  CAS  Google Scholar 

  23. Kapeller P, Fazekas F, Krametter D, Koch M, Roob G, Schmidt R, Offenbacher H (1997) Pyogenic infectious spondylitis: clinical, laboratory and MRI features. Eur Neurol 38:94–98

    Article  PubMed  CAS  Google Scholar 

  24. Kornblum MB, Wesolowski DP, Fischgrund JS, Herkowitz HN (1998) Computed tomography-guided biopsy of the spine: a review of 103 patients. Spine 23:81–85

    Article  PubMed  CAS  Google Scholar 

  25. Krogsgaard MR, Wagn P, Bengtsson J (1998) Epidemiology of acute vertebral osteomyelitis in Denmark: 137 cases in Denmark 1978–1982, compared to cases reported to the National Patient Register 1991–1993. Acta Orthop Scand 69:513–517

    PubMed  CAS  Google Scholar 

  26. Ledermann HP, Schweitzer ME, Morrison WB, Carrino JA (2003) MR imaging findings in spinal infections: rules or myths? Radiology 228:506–514

    Article  PubMed  Google 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 72:122–126

    PubMed  CAS  Google Scholar 

  28. Mallya RK, de Beer FC, Berry H (1982) Correlation of clinical parameters of disease activity in rheumatoid arthritis with serum concentration of C-reactive protein and erythrocyte sedimentation rate. J Rheumatol 9:224–228

    PubMed  CAS  Google Scholar 

  29. Mampalam TJ, Rosegay H, Andrews BT (1989) Nonoperative treatment of spinal epidural infections. J Neurosurg 71:208–210

    Article  PubMed  CAS  Google Scholar 

  30. Matsui H, Hirano N, Sakaguchi Y (1998) Vertebral osteomyelitis: an analysis of 38 surgically treated cases. Eur Spine J 7:50–54

    Article  PubMed  CAS  Google Scholar 

  31. Modic MT, Feiglin DH, Piraino DW, Boumphrey F, Weinstein MA, Duchesneau PM, Rehm S (1985) Vertebral osteomyelitis: assessment using MR. Radiology 157:157–166

    PubMed  CAS  Google Scholar 

  32. Nolla JM, Ariza J, Gómez-Vaquero C, Fiter J, Bermejo J, Valverde J, Escofet DR, Gudiol F (2002) Spontaneous pyogenic vertebral osteomyelitis in nondrug users. Semin Arthritis Rheum 31:271–278

    Article  PubMed  Google Scholar 

  33. Nussbaum ES, Rigamonti D, Standiford H (1992) Spinal epidural abscess: a report of 40 cases and review. Surg Neurol 38:225–231

    Article  PubMed  CAS  Google Scholar 

  34. O’Daly BJ, Morris SF, O’Rourke SK (2008) Long-term functional outcome in pyogenic spinal infection. Spine 33:E246–E253

    Article  PubMed  Google Scholar 

  35. Ogden AT, Kaiser MG (2004) Single-stage debridement and instrumentation for pyogenic spinal infections. Neurosurg Focus 17:E5

    Article  PubMed  Google Scholar 

  36. Quinones-Hinojosa A, Jun P, Jacobs R, Rosenberg WS, Weinstein PR (2004) General principles in the medical and surgical management of spinal infections: a multidisciplinary approach. Neurosurg Focus 17:e1

    Article  PubMed  Google Scholar 

  37. Redekop GJ, Del Maestro RF (1992) Diagnosis and management of spinal epidural abscess. Can J Neurol Sci 19:180–187

    PubMed  CAS  Google Scholar 

  38. Rodiek SO (2001) Diagnostic methods in spinal infections. Radiology 41:976–986

    Article  CAS  Google Scholar 

  39. Ross PM, Fleming JL (1976) Vertebral body osteomyelitis: spectrum and natural history. A retrospective analysis of 37 cases. Clin Orthop Relat Res 118:190–198

    PubMed  Google Scholar 

  40. Rothman SL (1996) The diagnosis of infections of the spine by modern imaging techniques. Orthop Clin North Am 27:111–123

    Google Scholar 

  41. Sapico FL, Montgomerie JZ (1979) Pyogenic vertebral osteomyelitis: report of nine cases and review of the literature. Rev Infect Dis 1:754–776

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  43. Sapico FL (1996) Microbiology and antimicrobial therapy of spinal infections. Orthop Clin North Am 27:9–13

    PubMed  CAS  Google Scholar 

  44. Schimmer RC, Jeanneret C, Nunley PD, Jeanneret B (2002) Osteomyelitis of the cervical spine: a potentially dramatic disease. J Spinal Disord Tech 15:110–117

    PubMed  Google Scholar 

  45. Siddiq F, Chowfin A, Tight R, Sahmoun AE, Smego RA Jr (2004) Medical vs surgical management of spinal epidural abscess. Arch Intern Med 164:2409–2412

    Article  PubMed  Google 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 2141–2183

    Google Scholar 

  47. Garcia Solis, del Pozo J, Soto MV, Solera J (2007) Vertebral osteomyelitis: long-term disability and prognostic factors. J Infect 54:129–134

    Article  Google 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 38:158–159

    Google Scholar 

  49. Tali ET (2004) Spinal infections. Eur J Radiol 50:120–133

    Article  PubMed  Google Scholar 

  50. Thelander U, Larsson S (1992) Quantitation of C-reactive protein levels and erythrocyte sedimentation rate after spinal surgery. Spine 17:400–404

    Article  PubMed  CAS  Google Scholar 

  51. Tsiodras S, Falagas ME (2006) Clinical assessment and medical treatment of spine infections. Clin Orthop Relat Res 444:38–50

    Article  PubMed  Google Scholar 

  52. Tyrell PNM, Cassar-Pollucino VN, McCall IW (1999) Spinal infection. Eur Radiol 9:1066–1077

    Article  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  54. Verner EF, Musher DM (1995) Spinal epidural abscess. Med Clin North Am 69:375–384

    Google Scholar 

  55. Vinas FC, King PK, Diaz FG (1999) Spinal aspergillus osteomyelitis. Clin Infect Dis 28:1223–1229

    Article  PubMed  CAS  Google Scholar 

  56. Ware JE (1993) SF-36 health survey manual and interpretation guide. Nimrod Press, Boston

    Google Scholar 

  57. Weinberg J, Silber JS (2004) Infections of the spine: what the orthopaedist needs to know. Am J Orthop 33:13–17

    Article  PubMed  Google Scholar 

  58. Whalen JL, Brown ML, McLeod R, Fitzgerald RH Jr (1991) Limitations of indium leukocyte imaging for the diagnosis of spine infections. Spine 16:193–197

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Scoliosis and Spine Surgery Center, Hesperia Hospital, Modena, Via Arquà 80/A, 41100, Modena, Italy

    N. Bettini, E. Dema & S. Cervellati

  2. Department of Spine Surgery, C.T.O./C.R.F./Maria Adelaide, Via Zuretti 29, 10126, Torino, Italy

    M. Girardo

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  1. N. Bettini
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Correspondence to M. Girardo.

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Bettini, N., Girardo, M., Dema, E. et al. Evaluation of conservative treatment of non specific spondylodiscitis. Eur Spine J 18 (Suppl 1), 143–150 (2009). https://doi.org/10.1007/s00586-009-0979-8

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