Estudiamos retrospectivamente las manifestaciones clínicas, biológicas radiológicas, así como el tratamiento y la evolución de las espondilodiscitis infecciosas. Request PDF | On May 1, , Roberto Oropesa Juanes and others published Espondilodiscitis infecciosa. Request PDF on ResearchGate | Espondilodiscitis infecciosa | Vertebral osteomyelitis is a rare entity. Its diagnosis is often difficult because of nonspecific .
|Published (Last):||24 April 2017|
|PDF File Size:||11.26 Mb|
|ePub File Size:||8.91 Mb|
|Price:||Free* [*Free Regsitration Required]|
To evaluate the clinical and radiological results of treatment of patients with spondylodiscitis. Ezpondilodiscitis exams used in this infexciosa were plain radiographs and magnetic resonance imaging of the spine. Data from 33 patients, 10 Surgical treatment was performed in 22 patients Despite technological advances in complementary exams, early diagnosis of spondylodiscitis remains a challenge.
However, drug treatment associated with surgery shows good results. Spondylodiscitis is the term used to describe an infection that affects the intervertebral disc, inrecciosa body, or posterior arch of the vertebra. It is a disease with insidious onset and slow evolution, and with the presentation of vague symptoms pain and fevermaking early diagnosis difficult.
The annual incidence of espondilodiscitiz varies from 0. The objective of this article is to evaluate the clinical and radiological presentation, pathogens, treatment, and complications associated with pyogenic infections of the spine.
Following approval by the local Research Ethics Committee, the study was conducted by means of a review of the medical histories and imaging exams of the Medical Archives Service SAME of the same hospital.
The patients were included if they had an illness compatible with vertebral infection and evidence of its involvement, in simple radiographs or magnetic resonance. The diagnosis was considered definitive when the organism was isolated from material from the affected vertebra, the intervertebral disc space, or an epidural abscess; infeccioas the blood culture results were positive; or when the image exams presented no doubt after evaluation by an expert radiologist.
Patients who did not meet any of the above criteria, and any patients with infections following spine surgery, were excluded from the study. The clinical evaluation included patient age, sex, signs and symptoms at initial presentation, time elapsed from the initial symptoms to the first consultation in our hospital, the presence ezpondilodiscitis associated comorbidities, laboratory espondilodsicitis before espondilodoscitis after treatment, the type of treatment administered, and complications resulting from the infection and the treatment.
As this is a retrospective study, the follow-up considered in the evaluation of the outcome was the last patient consultation recorded in the medical records in our service. The outcome was classified as follows:. The data were entered into a spreadsheet and the results were presented as percentages. The data from 33 patients, 10 females All cases were diagnosed as spondylodiscitis. The time between the onset espondilodisciitis symptoms and the first visit to our service ranged from 7 days to 24 months, with an average of 4 months and 28 days.
Distribution of time of first visit with percentage espondilofiscitis visits vs. At the time of the first visit, 19 patients The frequency of neurological changes was higher in patients with infection of the thoracic spine with 7 patients Regarding comorbidities, nine patients had diabetes mellitusthe most frequent concomitant disease.
None of the patients in our study acquired the infection in the hospital, i. In 24 of the patients with discitis, the focus of the infection was apparently hematogenic.
The most common sites of entry were the urinary tract The locations of the lesions by segment and level are shown in Figures esponddilodiscitis and 4respectively.
The infection generally involved two or more contiguous vertebral bodies and the intervening intervertebral disc space. The involvement of non-contiguous vertebrae occurred in one case. In 12 cases In six cases Distribution of percentages of cases by region of the spine affected. Distribution of the results of the cultures and bacterial agents isolated in the cases studied.
Cultures of specimens obtained by percutaneous CT or biopsy of the spine, intervertebral disc, or paravertebral abscess were positive, and specimens of bacteria were identified in 24 Figure 5 The most commonly encountered pathogen was Staphylococcus aureus.
Distribution of post-treatment infeccioss of life in the cases studied expressed as espojdilodiscitis. The leukocyte count was determined for all patients, while the erythrocyte sedimentation rate ESR was determined for 31 The C-reactive protein CRP value was determined for 21 patients Definitive drug therapy was used in 25 We define definitive antibiotic therapy as medication administered according to the results of a sensitivity profile of the etiological agent to specific drugs.
Removal of the infected tissue was performed using a combined anterior and posterior approach in 11 patients. In nine patients only the posterolateral approach was used and in two patients, only drainage of the abscess was performed. Surgical complications occurred in only three patients, which were cases of worsening symptoms of an already weakened clinical profile, one of which resulted in death, making a total of 9.
Espondilodiscitis infecciosa | Reumatología Clínica (English Edition)
Although retrospective, our study allowed the evaluation and adequate follow-up of the patients, with the careful description of medical data from the valuable Medical Archives Service SAME database. It therefore enabled significant conclusions to be drawn. In our series, The predominance in males in this case series Despite the significant technological advances in diagnostic tests, the major challenge of pyogenic infection of the spine continues to be early diagnosis.
This was evidenced by the average of 4 months and 28 days elapsed from the onset espondilodiecitis symptoms to a diagnosis and the beginning of treatment. In other studies, the period was 1 month and 24 days. Blood cultures were positive in 24 patients Infeecciosa bloodstream is predominant, enabling infection from distant foci.
Twenty-four of our cases Intravenous drug abuse is also considered to be a predisposing factor, 16 though we found no such case in our study. In this study, laboratory tests such as leukocyte counts espojdilodiscitis apparently not sensitive in the diagnosis of spondylodiscitis, as espondjlodiscitis were high in only nine patients Leukocytes are not typically elevated in spinal infections.
In addition, it enables not only differentiation between pyogenic discitis, neoplasia, and tuberculosis, providing better definition of the paravertebral and epidural spaces, but also assessment of the compression of neural elements. The association between ifnecciosa and the presence of infectious spondylodiscitis is well-documented in the literature.
Diabetes and high blood pressure HBP were the most common comorbidities present among patients with spondylodiscitis in our experience.
There was a problem providing the content you requested
HBP was the most common disease, occurring in 14 patients Other case series have demonstrated the role of diabetes mellitus as a risk factor for developing spine infections. The distribution of neurological deficit by affected segment was seven patients These findings are consistent with previous reports that more cephalic infections present a greater likelihood of paraplegia. The main treatment for spondylodiscitis is the intravenous administration of antibiotics followed by oral antibiotics, together with immobilization of the spine.
There were no reports of recurrence in our study. Our approach was to reserve surgical debridement for patients requiring drainage of the abscess, decompression of the spinal canal, and stabilization of the spine.
The procedure of choice, in agreement with other authors, 1931 is anterior decompression and arthrodesis with an autologous bone graft, followed by posterior fixation. The espodnilodiscitis of reconstruction is to maintain alignment, preventing deformity, to achieve arthrodesis, and to decompress the spinal canal.
One pa tient espondilidiscitis DVT and pneumonia, one patient developed clinical complications and died after 13 days, and the implant in one patient broke after 3 years, making a total of 9. According to the quality of life classification presented earlier, our study had 13 infecciosw rated as excellent According to the results of our espondilodizcitis, early diagnosis of spondylodiscitis continues to be a challenge, despite the imfecciosa advances in complementary tests.
However, even when there is a delay in the definitive diagnosis and isolation of the specific etiological agent, treatment with medication in combination with surgery has good results.
Surgical treatment of spondylodiscitis.
Case records of the Massachusetts General Hospital. Low-back pain and fever in a year-old man. N Engl J Med. Interventional radiology case conference: Percutaneous management of pyogenic spondylodiskitis.
Increasing frequency espondliodiscitis vertebral osteomyelitis following Staphylococcus aureus bacteraemia in Denmark Changing pattern of bone and joint infections due to Staphylococcus aureus: Analysis of 61 cases of vertebral osteomyelitis. Clin Orthop Relat Res. Management of vertebral diskitis and osteomyelitis.
Enfermedades Infecciosas y Microbiología Clínica
Management of nontuberculous infectious discitis. Pyogenic and tuberculous spondylodiskitis vertebral osteomyelitis in 80 adult patients. Etiology, diagnosis, progression and treatment. Are blood cultures performed after disco-vertebral biopsy useful in patients with pyogenic infective spondylitis? Treatment of hematogenous pyogenic vertebral osteomyelitis with anterior debridement and primary bone grafting.
Spine Phila Pa Pyogenic non-tuberculous spinal infection: J Bone Joint Surg Br. Pyogenic infections occurring primarily in intervertebral discs. Neurosurgical management of thoracic and lumbar vertebral osteomyelitis and discitis in adults: Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis. Diagnosis and management of pyogenic vertebral osteomyelitis in adults. Cottle L, Riordan T. Imaging of pyogenic infectious spondylodiskitis.