Clinical analysis of intervertebral space infections

Intervertebral space infections are a serious group of diseases caused by various microorganisms. These infections present various pathological processes with neurological deficit due to pain, deformity, instability and spinal cord compression, and lead to high morbidity and mortality. For this reason, our aim in this study was to contribute to the discussions in the literature by comparing etiologically different disc infections, by revealing different aspects of them, and by assessing them in terms of timing of surgical treatment retrospectively in the light of the literature. In this study, 59 patients with spinal infection were retrospectively evaluated between 2010 and 2015 at Inonu University Department of Neurosurgery. The patients were divided into groups based on age, gender, complaints, duration of complaints, preoperative and postoperative findings, and microorganism sites and compared in terms of sites, malformation, instability, and surgical procedures. Tissue samples taken from the histopathological and bacteriological (culture and cultural sensitivity) patients were examined. Lastly, the effects of each parameter on morbidity and mortality were investigated. It was concluded that early diagnosis and treatment decreases morbidity.

PDF

___

1. Benli IT, Kiş M, Akalin S, et al. The results of anterior radical debridement and anterior instrumentation in Pott’s disease and comparison with other surgical techniques. Kobe J Med Sci. 2000;46:39- 68.

2. Khanna RK, Malik GM, Rock JP, Rosenblum ML. Spinal epidural abscess: Evaluation of factors influencing outcome. Neurosurgery. 1996;39:958-64.

3. Korkusuz F, Islam C, Korkusuz Z. Prevention of postoperative late kyphosis in Pott’s disease by anterior decompression and intervertebral grafting. World J Surg. 1997;21:524-8.

4. Singh DK, Singh N, Das PK, et al. Management of postoperative discitis: A review of 31 patients. Asian J Neurosurg. 2018;13:703-6

5. Jain M, Sahu RN, Gantaguru A, et al.Postoperative lumbar pyogenic spondylodiscitis: An institutional review. J Neurosci Rural Pract. 2019;10:511-8.

6. Zileli M. Spinal tüberkülozda klinik yaklaşım ve hasta yönetimi. In: Palaoğlu S, editor. Spinal Enfeksiyonlar. İzmir: TND Spinal Cerrahi Grubu Yayınları; 2000. p. 81-8.

7. Colling DH. The pathology of articular and spinal diseases. London: Edward Arnold & Co.; 1949.

8. Vigorita VJ. Orthopaedic pathology. Philadelphia: Lippincott Williams & Wilkins; 1999.

9. Young EJ. Brucella species. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and Practice of Infectious Diseases. 4th ed. New York: Churchill Livingstone; 1995. p. 2053-60.

10. Iplikçioğlu C, Kökes F, Bayar A,et al. Spinal invasion of pulmonary hydatidosis: Computed tomographic demonstration. Neurosurgery. 1991;29:467-8.

11. Shetty AP, Viswanathan VK, Kanna RM, Shanmuganathan R. Tubercular spondylodiscitis in elderly is a more severe disease: A report of 66 consecutive patients. Eur Spine J. 2017;26:3178-86.

12. Sans N, Faruch M, Lapègue F,et al. Infections of the spinal column– spondylodiscitis. Diagn Interv Imaging. 2012;93:520-9.

13. Berbari EF, Kanj SS, Kowalski TJ, et al. 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis. 2015;61:e26-e46..

14. Aagaard T, Roed C, Dahl B, Obel N. Long-term prognosis and causes of death after spondylodiscitis: A Danish nationwide cohort study. Infect Dis. 2016;48:201-8.

15. Rutges J, Kempen DH, Van Dijk M, et al. Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: A systematic literature review. Eur Spine J. 2016;25:983-99.

16. Sezak N, Tosun S, Eriş N, Ayer A. Ruh sağlığı hastanesinde yatarak tedavi gören hastalarda Hepatit B ve Hepatit C infeksiyonlarının sıklığı ve buna etkili faktörlerin değerlendirilmesi (Prevalence of Hepatitis B and Hepatitis C infections and evaluation of related factors in patients in a mental health hospital). Klimik Dergisi. 2011;24:154-7.

17. Hadjipavlou AG, Mader JT, Necessary JT, Muffoletto AJ. Hematogenous pyogenic spinal infections and their surgical management. Spine (Phila Pa 1976). 2000;25:1668-79.

18. Hashemi SH, Keramat F, Ranjbar M, et al. Osteoarticular complications of brucellosis in Hamedan, an endemic area in the west of Iran. Int J Infect Dis. 2007;11:496-500.

19. Sato K, Yamada K, Yokosuka K, et al. Pyogenic spondylitis: Clinical features, diagnosis and treatment. Kurume Med J. 2018;65:83-9.

20. Currier BL, Kim CW, Eismont FJ. Infections of the spine. In: Herkowitz HN, Garfin SR, Eismont FJ, Bell GR, Balderstan RA, editors. Rothman-Simeone The Spine. 5th ed. Philadelphia: Saunders-Elsevier; 2006. p. 1265-309.

21. Turunc T, Demiroglu YZ, Uncu H,et al. A comparative analysis of tuberculous, brucellar and pyogenic spontaneous spondylodiscitis patients. J Infect. 2007;55:158-63.

22. Luzzati R, Giacomazzi D, Danzi MC, et al.Diagnosis, management and outcome of clinically-suspected spinal infection. J Infect. 2009;58:259-65.

23. Rezai AR, Woo HH, Errico TJ, Cooper PR. Contemporary management of spinal osteomyelitis. Neurosurgery. 1999;44:1018-25.

24. Cottle L, Riordan T. Infectious spondylodiscitis. J Infect. 2008;56:401-12.

25. Govender S. Spinal infections. J Bone Joint Surg Br. 2005;87:1454-8.

26. Waheed G, Soliman MAR, Ali AM, Aly MH. Spontaneous spondylodiscitis: Review, incidence, management, and clinical outcome in 44 patients. Neurosurg Focus. 2019;46:E10.

27. Colmenero JD, Reguera J, Martos F, et al. Complications associated with Brucella melitensis infection: A study of 530 cases. Medicine. 1996;75:195- 211.

28. Jiménez-Mejías ME, de Dios Colmenero J, Sánchez-Lora FJ, et al. Postoperative spondylodiskitis: etiology, clinical findings, prognosis, and comparison with nonoperative pyogenic spondylodiskitis. Clin Infect Dis. 1999;29:339-45.

29. Kandemir Ö, Milcan A, Uğuz M. Spinal infeksiyonlu olguların etyolojik, klinik ve laboratuvar olarak karşılaştırılması: Ön çalışma. J Turk Spinal Surg. 2008;19:427-34.

30. Carragee EJ, Kim D, van der Vlugt T, Vittum D. The clinical use of erythrocyte sedimentation rate in pyogenic vertebral osteomyelitis. Spine (Phila Pa 1976). 1997;22(18):2089-93.

31. D’agostino C, Scorzolini L, Massetti AP, et al. A seven-year prospective study on spondylodiscitis: Epidemiological and microbiological features. Infection. 2010;38:102-7.

32. Colmenero JD, Jimenez-Mejias ME, Sanchez-Lora FJ, et al. Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: A descriptive and comparative study of 219 cases. Ann Rheum Dis. 1997;56:709-15

33. Doğan H. Vertebranın granulomatoz infeksiyonları. J Turk Spinal Surg. 2006;17:33-51.

34. Boody BS, Tarazona DA, Vaccaro AR. Evaluation and management of pyogenic and tubercular spine infections. Curr Rev Musculoskelet Med. 2018;11:643-52.

35. Turgut M, Turgut AT, Koşar U. Spinal brucellosis: Turkish experience based on 452 cases published during the last century. Acta Neurochir (Wien). 2006;148:1033-44.

36. Lucio E, Adesokan A, Hadjipavlou AG,et al. Pyogenic spondylodiskitis: A radiologic/pathologic and culture correlation study. Arch Pathol Lab Med. 2000;124:712-6.

37. Fitzgerald DW, Sterling TR, Haas DW. Mycobacterium tuberculosis. In: Mandell GL, Bennet JE, Dolin R, editors. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier-Churchill Livingstone; 2010. p. 3129-63.

38. Sharif HS, Aideyan OA, Clark DC, et al. Brucellar and tuberculous spondylitis: Comparative imaging features. Radiology. 1989;171:419-25.

39. Irmak H, Buzğan T, Sakarya N, et al. Spinal brusellozda manyetik rezonans görüntüleme bulguları. Tıp Araşt Derg. 2004;2:43-6.

40. Liu X, Li H, Jin C, et al. Differentiation between brucellar and tuberculous spondylodiscitis in the acute and subacute stages by MRI: A retrospective observational study. Acad Radiol. 2018;25:1183-9.

41. Tansel Ö, Yavuz M, Kuloğlu F ve ark. Trakya Üniversitesi Hastanesi’ne başvuran 40 bruselloz olgusunun değerlendirilmesi. İnfeksiyon Derg. 2003;17:1-4.

42. Lee MC, Wang MY, Fessler RG, et al. Instrumentation in patients with spinal infection. Neurosurg Focus. 2004;17:E7.

43. Ang BSP, Ngan CCL. Eikenella corrodens discitis after spinal surgery: Case report and literature review. J Infect. 2002;45:272-4.

44. Franco MP, Mulder M, Gilman RH, et al. Human brucellosis. Lancet Infect Dis. 2007;7:775-86.