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T11 / T12 infection with tubercle bacilli-corporectomy of T11 and partial corporectomy of T12, arthrodesis with a titanium cage and an anterolateral plate fi xation (Case No. 15, Tables 2, 3 ). (A) Pre-operative gadolinium-enhanced T 1-weighted MRI scan; X-ray controls at 6-month follow-up: (B) anteriorposterior projection and (C) lateral view.
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The best surgical technique for patients with bacterial spinal infections is still discussed controversially. But recent publications suggest that titanium implants can be used safely in infectious sites in combination with debridement and antibiotic therapy. The purpose of this study is to provide further evidence in support of debridement and ins...
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There are few studies about anatomical reduction of the fractured vertebral body before stabilization for treatment of vertebral compression fracture (VCF). Although restoration on vertebral height has been useful, the reduction of fractured endplates is limited. The vertebra is part of a joint, and vertebral endplates must be treated like other we...
Study Design Retrospective cohort study.
Objective To evaluate whether the proposed one-stage biopsy, culture, debridement, and reconstruction with stabilization strategy is a viable option for pyogenic vertebral osteomyelitis (PVO). PVO is increasing in frequency globally, particularly in immunologically compromised individuals. Typically, biopsy...
Citations
... For a long time, primary infections of the thoracic and lumbar spine have been reported frequently, although uncommonly. However, since primary cervical spine infections are even rarer, few studies have investigated this condition, and the number of cases studied remains small [1,2,[10][11][12][13][14][15][16][17]. For this rare type of cervical spine infection, we attempted to analyze the flow and results of the past 30 years at our institution and compare the results according to the chronological period. ...
Primary cervical spine infections progress quickly and cause neurological impairment at an early stage. Despite their clinical significance, few studies have investigated primary cervical spine infections, owing to the rarity of the condition. This study analyzed the characteristics of 59 patients treated for primary cervical spine infections between 1992 and 2018 at our hospital. Clinical and radiological analyses were conducted. Moreover, a comparative analysis was performed, incorporating each patient’s underlying disease, mortality and complications, and treatment results. Comparison between groups based on the chronological period (1992–2000, 2001–2009, and 2010–2018) revealed that the mean age of onset has increased significantly in recent years. The rate of neurological impairment, duration of antibiotic use, and frequency of underlying disease increased significantly with time. No significant differences among groups were observed in the hematological and microbiological analyses. The incidence rate of epidural abscess and multisegmental infection increased significantly in recent years. There was no statistically significant difference in the complication and mortality rates, according to the time period. We think that prompt diagnosis and appropriate treatment are necessary, considering the current trends in primary cervical spine infection.
... Allerdings sind das erneute Narkose-und Operationsrisiko nicht außer Acht zu lassen und sollten neben dem Allgemeinzustand des Patienten, dem Ausmaß des segmentalen Befalls und dem etwaigen Vorliegen weiterer Infektionsherde die Entscheidung über das Operationsverfahren beeinflussen[57,67,103,156,163,225]. Süss et al. weisen zudem auf die Bedeutung einer postoperativen Frühmobilisierung bei einzeitigen Vorgehen hin, die vor allem bei der zunehmend älteren Bevölkerung und bei Patienten mit hoher Komorbidität vorteilhaft ist[233].Trotz der aktuell positiven Studienlage bezüglich der intraoperativen Verwendung von Implantaten (Schrauben, Stangen und Cages) sind weiterführende Studien erforderlich, um eine klare evidenzbasierte Grundlage für die operative Therapie der Spondylodiszitis schaffen zu können[254]. ...
Die Spondylodiszitis ist definiert als infektiöse Entzündung bakterieller oder nicht-bakterieller Genese, die die Wirbelkörper, Bandscheiben sowie die benachbarten Strukturen betrifft [25,93,150,163,246]. Infektionen der Wirbelsäule sind selten, jedoch stellen sie ein schwerwiegendes Krankheitsbild dar, verbunden mit hoher Morbidität und Mortalität [225, 253]. Aufgrund des breiten Erregerspektrums und einer Zunahme multiresistenter Keime stellt die Spondylodiszitis noch heute eine Herausforderung für Diagnostik und Therapie dar [65]. Neben der Beseitigung des ursächlichen Infektionsherdes, ist die Wiederherstellung der Wirbelsäulenfunktionalität sowie die suffiziente Schmerzlinderung Ziel der Therapie [92]. Anerkannte Behandlungsmöglichkeiten der Spondylodiszitis sind, neben der konservativen Therapie, auch operative Verfahren, u. a. die interne Stabilisierung der betroffenen Wirbelkörperabschnitte in Kombination mit einer systemischen Antibiose. Bei insuffizienter Behandlung wird in der Literatur eine Gesamtmortalität von bis zu 20 % angegeben [224,110]. Die aktuelle Datenlage für die spezifische Behandlungsempfehlung sowie für die Behandlungsdauer ist sehr heterogen [100,190]. Aufgrund der unterschiedlichen Studienaussagen (Level I-IV) sowie Expertenmeinungen (Level V) ist es bislang nicht gelungen, ein einheitliches Therapiekonzept zu formulieren [92]. Sowohl in der operativen als auch konservativen Therapie reichen nur wenige der vorliegenden Studien über den Evidenzgrad 3 hinaus, sodass hier weiterer Untersuchungsbedarf besteht [57,81]. Das primäre Ziel dieser vorliegenden Arbeit ist es daher, auf Grundlage einer systematischen Literaturrecherche eine evidenzbasierte Therapiegrundlage für die Behandlung der Spondylodiszitis zu erfassen. Eine sich anschließende Metaanalyse soll die Ergebnisse der einzelnen Studien – in Abhängigkeit von der Behandlungsmethode und auf Grundlage der aktuell bestmöglichen Evidenz – vergleichen und in einer entsprechenden Behandlungsempfehlung zusammenfassen. Mithilfe einer systematischeLiteraturrecherche über die Online-Suchplattform OVID SP konnten für den Zeitraum 01/2006-01/2019 2.948 Publikationen entsprechend identifiziert werden. Im Anschluss wurden diese Paper nach den vorab definierten Ein-bzw. Ausschlusskriterien überprüft. Anhand dieser Kriterien wurden insgesamt 2.720 Studien primär nach Sichtung des Abstracts, sowie 228 Studien sekundär nach Prüfung der Originalarbeiten ausgeschlossen. Abschließend verblieben 68 Studien, die entsprechend den Einschlusskriterien in die Auswertung der vorliegenden Arbeit eingegangen sind. Insgesamt konnte für 3.285 Patienten das klinische Outcome, abhängig vom jeweiligen Therapiekonzept nach operativ und konservativ, beschrieben werden.
... After radical debridement and irrigation, our patient proceeded with spinal fixation in the same setting. Study shows that debridement and spine instrumentation can be performed in a single-stage surgery for spine infection [6]. The advantages are early post-operative rehabilitation, reduced risk of multiple surgeries, and shorter hospital stay [6]. ...
... Study shows that debridement and spine instrumentation can be performed in a single-stage surgery for spine infection [6]. The advantages are early post-operative rehabilitation, reduced risk of multiple surgeries, and shorter hospital stay [6]. We decided to proceed with spine instrumentation in the same setting because healthy boundaries were achieved during the radical debridement. ...
For patients with pyogenic spondylodiscitis, medical therapy with antibiotics is the first line of treatment. Response to antibiotics can be assessed by improvement of symptoms, reduction in inflammatory markers, and radiological evidence of infection resolution with magnetic resonance imaging (MRI). We report a case of a 60-year-old man who presented with intermittent fever and persistent back pain. He was initially treated with an intravenous antibiotic for sepsis secondary to Salmonella enteritidis bacteremia. His spine MRI showed compression of the T10 vertebra with vertebral abnormality suggestive of metastases. He showed no clinical improvement after a course of intravenous antibiotics. Following that, debridement and spinal instrumentation of the thoracic vertebra were done in single-stage surgery.
... Other authors reported that surgical instrumentation can be covered with bacterial biofilm, so postoperative antibiotics don't work on the infective lesion effectively [10,11]. Other authors have reported that surgical instrumentation improved postoperative instability and did not increase the recurrence rate of spinal infections [12][13][14][15][16]. Actually, study of elderly patients is rarely done and there is no definitive clinical consensus on the use of instrumentation for spinal infections. ...
... However, most of the studies were done regardless of age. Our results for the elderly patients are also consistent with those studies [12][13][14][15][16][20][21][22]. The tendency toward efficacy and safety of instrumentation seen in the elderly patients in this study will be more supported and augmented by emerging techniques, such as antibiotics-coating and drug-delivery system [23,24]. ...
... Before the 2000s, several reports suggested the combination of autologous bone graft, debridement, and massive irrigation without instrumentation as the optimal surgical therapy for pyogenic spinal infection [28][29][30][31]. However, recently, surgical treatment with instrumentation for pyogenic spinal infection has been widely attempted and many authors have reported its acceptance as a therapeutic alternative [12][13][14][15][16][20][21][22][32][33][34]. When treating spinal infection with surgery, the author used instrumentation to reduce, not only motion tenderness from instability but also the risk of deformity progression. ...
... A total of 239 patients from 24 articles were included in the present study. The countries of origin were the United States, 6,12,13,15,18,19,24,27,30,31 Germany, 11,17,21,23,32 China, 10,28 Korea, 20 Taiwan, 22 Japan, 26 Greece, 14 the United Kingdom, 16 the Czech Republic, 29 The mean age across the included studies ranged from 49 to 84 years, and the mean age of the individual patients was 56.7 years (18 of 24 studies). Comorbidity data were only available for 14 of the 24 studies. ...
... Only 8 of 24 articles had reported definitively on which patients had undergone corpectomies. 11,15,17,18,21,22,24,26 Of these studies, the rate of receiving any corpectomy (single vs. multilevel, not always specified) ranged from 13% to 100%, with several smaller series reporting that 100% of their patients had undergone corpectomies. 15,17,18,24,26 However, most of these studies had not quantified the degree of bony debridement. ...
... 11,15,17,18,21,22,24,26 Of these studies, the rate of receiving any corpectomy (single vs. multilevel, not always specified) ranged from 13% to 100%, with several smaller series reporting that 100% of their patients had undergone corpectomies. 15,17,18,24,26 However, most of these studies had not quantified the degree of bony debridement. ...
Objective:
For cases of cervical osteomyelitis that require surgery, concern has continued regarding instrumentation owing to the potential for bacterial seeding of the hardware. We performed a systematic review of the current data.
Methods:
A search was performed using Medline, Embase, and Ovid for articles using the keywords "cervical osteomyelitis/spondylodiscitis" and "fusion" or "instrumentation" reported from 1980 to 2017. Prospective or retrospective studies describing ≥2 patients with cervical osteomyelitis were included in the analysis; non-English reports were excluded. Individual patients were excluded from the final analysis if they had previously undergone spinal instrumentation.
Results:
A total of 239 patients from 24 studies met our criteria. Surgical approaches were classified as anterior-only, combined anteroposterior, and posterior-only for 64.8%, 31.9%, and 3.3% of the patients respectively. Of the patients treated using an anterior-only approach, 76.5% had received anterior plating and 85.3%, a cage or spacer implants. Of the patients who had undergone combined approaches, 85.1% underwent circumferential fixation and 14.9%, anterior debridement with posterior instrumentation. The follow-up period ranged from 6 weeks to 11 years (mean, 31.0 months). All the studies reporting the fusion rates, except for 1, reported a 100% fusion rate. The reported rates of pain improvement and neurologic recovery were favorable. The incidence of hardware failure and wound complications was 4.6% and 4.0%, respectively.
Conclusions:
Despite placing instrumentation during active infection, the rates of hardware failure and wound complications were comparable to those of elective cervical spine procedures. These results suggest that surgical intervention with instrumentation is a safe treatment option for patients with cervical spine osteomyelitis.
... This is done to obtain a better stabilization after the vertebral corpectomy, without significant complications (infections and migration of implanted materials). 10 Our patients reported a PICC-related sepsis approximately 4 months after PICC insertion. The insertion was conducted under strict antiseptic technique, and it seems unlikely as an infection occurrence at the time of implantation. ...
... In our case, surgical intervention for evacuation of pus via anterior approach and corpectomy of the C4 and C5, iliac crest graft with plate and screws fixation was done [11][12][13][14]. Many are believed nowadays that the cervical epidural abscesses are best managed with bony decompression followed by internal stabilization in purulent osteomyelitis and usually by anterior fusion [5,12,15]. ...
Extensive Cervical Epidural Abscess: Case Report
Mohamed E Elsebaey* and Mohamed Elgohary
Department of Neurosurgery, Damanhour Medical National Institute, Egypt
Received: October 01, 2017 | Published: November 07, 2017
*Corresponding author: Mohamed E Elsebaey, Department of Neurosurgery, Damanhour Medical National Institute, Damanhour, Egypt, Email:
Citation: Elsebaey ME, Elgohary M (2017) Extensive Cervical Epidural Abscess: Case Report. J Neurol Stroke 7(6): 00260. DOI: 10.15406/jnsk.2017.07.00260
Abstract
Background: Spinal epidural abscess is very irritating annoying problems that get the emergent proper decision is a must. Its presence within the cervical spine is life threating issue because of the vital functions that can be compromised as a result from just the compression effect. So the concept of the bony decompression is essential in such cases.
Study design: To describe a rare presentation of spinal epidural abscess
Patients and Methods: A case report of an extensive epidural abscess within the cervical spinal region.
Results: Case report of cervical epidural abscess in 56 year old male from Rosetta complained of acute onset of neck pain for about 2 months with progressive course of upper and lower limbs weakness with no sphincter affection. No previous neck and back surgery. History of renal impairment and on medical treatment for about 4 years. Magnetic Resonance imaging of the cervical spine showing ventral cervical spinal cord compression by an epidural abscess extending from the apex of dens to the level of C5. Surgical intervention via anterior approach and corpectomy of the C4 and C5, iliac crest graft with plate and screws fixation was done. About 3 months after surgery, the patient markedly improved and was able to perform the usual lifestyle activities.
Conclusion: Diagnosing patient with epidural abscess within the cervical spine is somewhat is a difficult suspecting issue in patient with no history of chronic illness nor previous spine surgery. Evacuation of the abscess and corpectomy of the friable pathological levels, fusion with iliac crest graft and fixation with plate and screws was a suitable option in management of this case.
Keywords: Cervical; Epidural abscess; Corpectomy
... In the application of metal implants in the presence of infection no implant complications have been reported by some authors (5). On the contrary other authors recommended long-term oral antibiotic regimes, eventual removal of these implants and microbiological resampling (6). ...
In this case report, we demonstrate that the use of a winged expandable cage was able to obtain good clinical and radiological results in a case of cervical tuberculosis with severe kyphosis. However, case series will be necessary to affirm its validity as a stand-alone device for similar cases with high risk of instability.
... However, if the patient also has a neurological deficit, the determination of operation time is still controversial. [4,5] 2. Clinical data and methods ...
It was a retrospective analysis.
The aim of the study was to explore the safety and reliability of emergency 1-stage radical debridement and reconstruction using titanium mesh filled with autologous bone for patients with cervical spine infection complicated by epidural abscess.
At present, cervical spine infection complicated by epidural abscess is known as a severe spine disease. Recently, case report of this disease is showing quite an increasing tendency, particularly in economically undeveloped areas and countries. Regarding the treatment of this disease, 1-stage radical debridement and reconstruction has been widely adopted; however, emergency 1-stage anterior approach surgery without medication is considered as a relatively taboo, since it is generally acknowledged that such operation would possibly cause unexpected infection. Nevertheless, regular elective surgery may require longer time for preparation. In addition, long hour compression and stimulation of the abscess may leave the patients with irreversible spinal neural impairment. However, our department has finished 14 cases of cervical spine infection complicated with epidural abscess without 1 single case of postoperative infection.
A retrospective study was conducted on 14 patients (9 males and 5 females; average age 57.4 years) who were diagnosed with cervical spine infection complicated by epidural abscess from January 2005 to December 2014. All the patients were admitted to hospital with varying degrees of neurological function losses, and then underwent 1-stage anterior focal debridement and reconstruction using titanium mesh within 24 hours after admission. They received postoperative standard antibiotic chemotherapy for 10 to 12 weeks. They were followed up for 18 to 36 months, an average of 27.4 months. X-ray, computed tomography (CT), and MRI (magnetic resonance imaging (MRI) were used to determine the fusion state and vertebral stability. American Spinal Injury Association (ASIA) international standards for neurological classification were adopted, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were evaluated to infection activity, and Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) criteria were used to judge clinical efficacy.
All the 14 patients had no postoperative spread of infection. No recurrence of infection was found during the last follow-up. ASIA grade, VAS score, and JOA score were significantly improved (P < .05) after the operation. WBC, ESR, and CRP became normal after the operation (P < .05). Postoperative follow-up imaging results showed no significant loss of cervical curvature, collapse of the grafted bone or implant displacement but good spinal canal volume.
Emergency 1-stage radical debridement and reconstruction using titanium mesh filled with autologous bone, combined with antibiotic chemotherapy, is a safe and effective surgical therapy for cervical infection complicated by epidural abscess.
... Several authors have reported no complications related to the use of these implants. 10 Our patient was treated according to this protocol and recovered satisfactorily. ...
Spondylodiscitis affecting the cervical spine is the most unusual type. Disease progression can be dramatic, even causing quadriplegia and death. We present an unusual case that progressed with osteolytic lesions between C2 and C3, causing cord compression and epidural abscess. The patient was treated surgically by a double approach and improved without neurological deficits and with better inflammatory markers. We reviewed the current literature on the subject.
