But because of the potentially irreversible neurologic consequences and the great expense and time required to adequately treat this rare infection, establishing a diagnosis is paramount. This material can then be examined at the cellular level under a microscope. It is important to identify and treat spondylodiscitis as early as possible. The term spondylodiscitis refers to the primary infection of the intervertebral disc by a pathogen and secondary osteomyelitis of the adjacent endplates, usually occurring in conjunction with one another. The medical literature was searched using pubmed, employing the key words discitis, disc space infection, infectious spondylodiscitis, pyogenic discitis, septic discitis and postoperative discitis. Learning objectives learning the main imaging findings of spondylodiscitis, its most frequent complications. The aim of this study was to propose a clinicalradiological classification of pyogenic spondylodiscitis to define a standard treatment algorithm. Spondylodiscitis may occur after lumbar operations on intervertebral discs. Current diagnosis and treatment of spondylodiscitis 07. Spondylodiscitis and hiv diagnosis and treatment strategies, hiv infection in the era of highly active antiretroviral treatment and some of its associated complications, elaheh aghdassi, intechopen, doi. Neurological point of view bacterial spondylodiscitis. Cases occurring in neonates or younger infants are usually the most severe and are frequently associated with sepsis and multiple infectious foci.
Jun 28, 2016 spondylodiskitis spondylodiscitis, infectious spondylitis is an infection that involves 1 or more of the extradural components of the spine. The diagnosis and management of these two entities are similar in most patients. Spondylodiscitis represents an inflammatory process, localized in the vertebrae body and in the intervertebral discs. Pdf merge combine pdf files free tool to merge pdf online. Osteomyelitis, discitis, epidural abscess and meningitis all represent infections of the spine. In this article, we will discuss the diagnosis, treatment and outcome of spontaneous as well as postoperative bacterial pyogenic spondylodiscitis. It is approximately two times more common in men than in women.
Infectious spondylodiscitis presents a diagnostic conundrum, and establishing the diagnosis often. Although it affects a small proportion 27% of all patients with osteomyelitis, it is important because of its potential morbidity and mortality. Comparison of gramnegative and grampositive hematogenous. It is associated with multimorbidity and shows a high mortality rate and a high neurological affection rate. Infectious discitis and spondylodiscitis in children.
Hematogenous penetration of infection to intervertebral disc from other sources of infection urogenital system, respiratory system development of spondylodiscitis as complications after injuries and surgeries on the spine. Vertebral osteomyelitis and discitis may occur together or independently. It is a disease with insidious onset and slow evolution, and with the presentation of vague symptoms pain and fever, making early diagnosis difficult. Spondylodiscitis is basically of two types which are endogenous and exogenous. Each refers to an infection of a different portion of the spine. Pdf spontaneous spondylodiscitis is a rare but serious infectious disease which is a combination of an inflammatory process, involving one. Spondylodiscitis an infection of both the intervertebral disc and the adjacent vertebrae. Learning radiology discitis, osteomyelitis, spine, disc. The surgical approach to spontaneous infectious spondylodiscitis is in most cases an anterior debridement and fusion, often in staged surgeries. Conclusions adjacent segment infection after surgical treatment of spondylodiscitis is a rare complication 1. Unusual case of spondylodiscitis due to listeria monocytogenes. Spondylodiscitis is an infection of a disc and the two adjacent vertebrae. Background nontraumatic back pain is a common complaint usually related to biomechanical. The term pyogenic spondylitis refers to either vertebral osteomyelitis or discitis.
Once files have been uploaded to our system, change the order of your pdf documents. The clinical presentation of spondylodiscitis are manifold. Anatomy pyogenic spondylodiscitis mahidol university. This can occur as a rare complication following surgery to the intervertebral disc, or as a bacterial infection caused by germs hematoma carried through the bloodstream in elderly patients or those with a generally weak immune system. Native vertebral osteomyelitis nvo in adults is often the result of hematogenous seeding of the adjacent disc space from a distant focus, as the disc is avascular 1, 2. Spondylodiscitis can characterize in its early stages by rather. This study evaluates the safety and effectiveness of computed tomography ct assisted endoscopic surgery in the treatment of infectious spondylodiscitis of the thoracic and upper lumbar spine in immunocompromised patients. Management of adult spontaneous spondylodiscitis and its rising incidence a sur, k tsang, m brown, n tzerakis university hospitals of north midlands nhs trust, uk abstract introduction spondylodiscitis refers to the infection of the intervertebral disc and osteomyelitis of the adjacent endplates, and it is uncommon in the developed world. In approximately onethird of patients with pyogenic spondylodiscitis, the infectious agent is never identified.
From october 2006 to march 2014, a total of 41 patients with infectious spondylodiscitis underwent percutaneous endoscopic surgery under. From october 2006 to march 2014, a total of 41 patients with infectious spondylodiscitis underwent percutaneous endoscopic surgery under local anesthesia, and lesions. When this diagnosis is put forward and suggested on radiography, though more easily visualised on mri, blood cultures must be carried out and if these are negative, a discovertebral aspiration and biopsy or fineneedle aspiration of the disc must be carried out. Croitoru2 1carol davila university of medicine and pharmacy bucharest, romania 2department of neurosurgery, st. Spondylodiscitis is the most common complication of sepsis or local infection, usually in the form of an abscess. Spondylodiscitis after facet joint steroid injection. Spondylodiscitis is an often very painful inflammation of the intervertebral disc and the adjacent vertebra.
Moreover, when the infection spreads into the spinal channel, d and sd can cause devastating neurologic complications. From 1011998 until 12312004, 37 cases of spondylodiscitis were examined regarding medical history, gender status, location and extent of spondylodiscitis, type and number of operations. Original rticle original o infectious spondylodiscitis. Spondylodiscitis is an important differential diagnosis of lower back, flank, groin, and buttock pain. Escherichia coli is the most common gramnegative organism causing spondylodiscitis. Once you merge pdfs, you can send them directly to your email or download the file to our computer and view. The diagnosis of nvo can often be delayed several months and may initially be misdiagnosed and mismanaged as a degenerative process 3, 4. This reflects expanding elderly and immunocompromised populations, the increasing use of invasive spinal procedures and enhanced ascertainment due to the greater availability of mri, the most sensitive method for radiological diagnosis. Jun 27, 2019 spondylodiscitis when confirmed requires conservative treatment to get rid of the problem. Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Pantelimon emergency hospital bucharest, romania chirurgia 2014 109. The present study was developed with clementino fraga filho university hospital patients with histopathologically and microbiologically confirmed diagnosis of spondylodiscitis, submitted to magnetic resonance imaging of the affected regions.
Spondylodiscitis and hiv diagnosis and treatment strategies. After examining files a total of 49 patients met the inclusion criteria. Most frequently, staphylococcus aureus is the etiological agent implied in the infection, responsible for 55%90% of the cases 18. Mean age of the study population was 69 years, ranging from 40 to 89 years. Spondylodiscitis, a term encompassing vertebral osteomyelitis, spondylitis and discitis, is the main manifestation of haematogenous osteomyelitis in patients aged over 50 years. The vertebrae can be severely damaged and sometimes entirely destroyed, leading to kyphosis. A comparison of the diagnostic value of mri and 18ffdgpetct.
Diagnostics of spondylodiscitis and its most frequent complications poster no c1536. In all of them, the clinical, biological and laboratory criteria crp and esr, also ruled out an infectious origin. Discitis after lumbar epidural corticosteroid injection. Spondylodiscitis due to brucella, mycobacterial pathogens and fungi will not be covered. Prevalence and risk factors of infectious spondylodiscitis. Fluorine18 fluorodeoxyglucose positron emission tomographyct 18ffdg petct is a procedure well known in oncology and infectious.
Note indistinctness of affected end plates and altered signal of bone marrow which represents either marrow edema or infarction. Infectious spondylodiscitis is rising in incidence and diagnosis has been facilitated by the availability of sensitive imaging techniques such as mri. Diagnostics of spondylodiscitis and its most frequent. Nov 01, 2010 spondylodiscitis, a term encompassing vertebral osteomyelitis, spondylitis and discitis, is the main manifestation of haematogenous osteomyelitis in patients aged over 50 years. The incidence of infectious spondylodiscitis has been growing, which could be a. Spondylodiscitis occurs secondary to a variety of causes, most notably bloodstream infections e. Despite the rising incidence, the choice of a proper orthopedic treatment is often delayed by the lack of clinical data. Spondylodiscitis caused by fusobacterium species is rare. The most common site of spondylodiscitis is the lumbar spine 60%, followed by the breast 30% and the cervical spine 10% 3,5,7. The aim of this study was to propose a clinicalradiological classification of pyogenic spondylodiscitis to define a standard treatment. An external file that holds a picture, illustration, etc. In order to treat spondylodiscitis, the mode of treatment is an extensive course of antibiotics to get rid of the infection causing the disease and then a course of the immobilization of the vertebral bodies to allow them to get back to their normal shape. Infectious spondylodiscitis a case series analysis.
The incidence of spondylodiscitis is currently 4241 million, making up to 35 % of total osteomyelitis cases. Robert dunn professor, md the full version of this video can be bough. Infectious spondylodiscitis has been diagnosed with increasing frequency. The main causative organisms are staphylococci and mycobacterium tuberculosis, but potential organisms include a large number of bacteria, fungi, zoonoses.
Spondylodiscitis when confirmed requires conservative treatment to get rid of the problem. Infectious spondylodiscitis presents a diagnostic conundrum, and establishing the diagnosis often requires expensive testing and workup. If spondylodiscitis is suspected, tissue material from the suspected vertebral segment can be obtained by fine needle aspiration or punch biopsies. It usually starts at the interface of the disc and the vertebra. Infections of the spine such as meningitis and discitis. Petct represents a good alternative particularly in the case of contraindications to contrastenhanced mrict e. Spondylodiskitis spondylodiscitis, infectious spondylitis is an infection that involves 1 or more of the extradural components of the spine.
Diagnosis is difficult and often delayed or missed due to the rarity of the disease and the high frequency of low back pain in the general population. Infectious spondylodiscitis, epidural phlegmon, and psoas. Ebscohost serves thousands of libraries with premium essays, articles and other content including infectious spondylodiscitis. L45 inflammatory process involving the vertebral end plates with associated destruction of the veps, marginal osteophytes with enhancement in post contrast images and extension of the enhancement to the paraspinal region. We describe the radiological semiology in detail, emphasizing the imaging findings and clinical data that. Dec 06, 2011 the term spondylodiscitis refers to the primary infection of the intervertebral disc by a pathogen and secondary osteomyelitis of the adjacent endplates, usually occurring in conjunction with one another.
This case illustrates an unusual spondylodiscitis caused by l. Pdf spontaneous spondylodiscitis epidemiology, clinical. Clinical manifestations of infectious spondylodiscitis can significantly vary 2 17 18. From january 2003 to january 20, 54 patients who underwent combined antibiotic and surgical therapy in the treatment of hematogenous. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Pyogenic spondylodiscitis ps is still burdened by a high rate of orthopedic and neurological complications. From january 2003 to january 20, 54 patients who underwent combined antibiotic and surgical. Pathogen identification in suspected cases of pyogenic. This is defined as infection accompanied by destruction of the vertebral bodies, starting at the endplates.
Anaerobic spondylodiscitis due to fusobacterium species. Staphylococcus aureus is the predominant pathogen, accounting for about half of nontuberculous cases. Bacterial spondylodiscitis verterbral osteomyelitis is an infection of the intervertebral disc and the adjacent vertebral bodies. Any information contained in this pdf file is automatically generated from digital. In children, infectious discitis d and infectious spondylodiscitis sd are rare diseases that can cause significant clinical problems, including spinal deformities and segmental instabilities. Spondylodiscitis is a medical condition in which there is infection of the intervertebral disc along with infection of the vertebrae. A minimally invasive endoscopic surgery for infectious. Adjacent segment infection after surgical treatment of. Pdf spondylodiscitis, a term encompassing vertebral osteomyelitis, spondylitis and discitis. We describe the radiological semiology in detail, emphasizing the imaging findings and clinical data that were helpful in making an accurate diagnosis.
The goals of this research were to identify subjective complaints, clinical findings, and laboratory characteristics in patients with spondylodiscitis, as well as to establish. Frontal and lateral radiographs of the thoracic spine demonstrate destruction of the endplates of two contiguous vertebral bodies with considerable endplate sclerosis, findings characteristic of discitis. Most cases of spontaneous spondylodiscitis are caused by staphylococcus aureus and most postoperative cases are caused by staphylococcus aureus or coagulasenegative staphylococci. Management of adult spontaneous spondylodiscitis and its. In most cases, pyogenic spondylodiscitis affects the lumbar spine. Falagas me, bliziotis ia, mavrogenis af, papagelopoulos pj. Osteomyelitis refers to an infection of the vertebral body itself. To the best of our knowledge, no study has compared gramnegative bacillary hematogenous pyogenic spondylodiscitis gnbhps with grampositive coccal hematogenous pyogenic spondylodiscitis gpchps regarding their clinical characteristics and outcomes. Spondylodiscitis, also known as vertebral osteomyelitis. Pyogenic spondylodiscitis affects most frequently the lumbar spine, involving only one vertebral segment one intervertebral disk and adjacent vertebral bodies.
This commonly leads to a several months from initial symptoms to final diagnosis. Fluorine18 fluorodeoxyglucose positron emission tomographyct 18 ffdgpetct is a procedure well known in oncology and infectious diseases and appears to be playing an increasingly important role in the diagnosis of spondylodiscitis 18, 19, 34. Spondylodiscitis can be confirmed either by the histological cellular or microbiological detection of the pathogen. Spontaneous infectious spondylodiscitis is a rare, but serious disease with the risk of progressive neurological impairment. No randomized controlled studies of antimicrobial therapy were identified in this literature search and there appear to be no uk consensus guidelines on investigation and management. Vertebral osteomyelitis, or infectious spondylodiscitis, may present from via hematogenous spread from a distant source, contiguous from an adjacent source, or direct inoculation during surgical spinal procedures. Mar 21, 2017 pyogenic spondylodiscitis ps is still burdened by a high rate of orthopedic and neurological complications. Jan siewe, kourosh zarghooni and rolf sobottke november 14th 2011. Conflicting reports exist regarding the surgical indications, timing, approach, staged or not operation, and spinal instrumentation for patients with spondylodiscitis.
Spondylodiskitis, also referred to as diskitisosteomyelitis, is characterized by infection involving the intervertebral disc and adjacent vertebrae. The annual incidence of cases of spondylodiscitis in france, estimated based on data from the french hospital discharge database pmsi, is in the order of 2. Therefore, we performed this study to evaluate the outcome of a series of patients with spondylodiscitis aiming to answer when and how to operate on these patients. The incidence of spondylodiscitis varies in developed countries between 1. Brown clinical microbiology and public health laboratory, addenbrookes hospital, cambridge cb2 0qw, uk. Spondylodiscitis is the term used to describe an infection that affects the intervertebral disc, vertebral body, or posterior arch of the vertebra.
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