BMP use in the surgical treatment of pyogenic spondylodiscitis: Is it safe?

2022 ◽  
Vol 95 ◽  
pp. 94-98
Author(s):  
Lawrence Yoon Yaw Tee ◽  
Sarah Hunter ◽  
Joseph F. Baker
Keyword(s):  
Surgical Treatment ◽  
Pyogenic Spondylodiscitis

scholarly journals Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients

2004 ◽  
Vol 17 (6) ◽  
pp. 1-7 ◽  
Author(s):  
Sascha Mann ◽  
Michael Schütze ◽  
Steffen Sola ◽  
Jürgen Piek
Keyword(s):  
Surgical Treatment ◽  
Spinal Deformity ◽  
Multiorgan Failure ◽  
Vertebral Osteomyelitis ◽  
Clinical Manifestations ◽  
Neurological Deficits ◽  
Causative Organism ◽  
Delay In Diagnosis ◽  
Pyogenic Spondylodiscitis ◽  
Antibiotic Drugs

Object Pyogenic vertebral osteomyelitis is of special interest to neurosurgeons because it often results in acute neurological deterioration and requires a combination of adequate surgical and conservative treatment. The aim of the current study was to evaluate the strategy of a primary surgical approach to this disease. Methods A group of 24 patients with the clinical and radiological signs of acute pyogenic spondylodiscitis was prospectively followed from 1998 to 2004. Of these, 20 had underlying diseases such as diabetes mellitus, chronic alcoholism, and liver cirrhosis. The main causative organism was Staphylococcus aureus. Most infections were localized in the thoracic or lumbar spine (10 cases each); 15 infections were associated with epidural abscesses. Because of a delay in diagnosis, 13 patients presented with neurological deficits on admission. Patients with a complete or rapidly progressing neurological deficit underwent immediate surgery. In patients with minor or no deficits or in a stable neurological condition, surgery was delayed for 3 to 5 days. This group was treated with immobilization and intravenous antibiotic drugs before surgery. Surgical procedures included ventral, dorsal, and combined approaches in one- or two-stage operations. Antibiotic treatment included the use of broad-spectrum antibiotic drugs delivered intravenously for at least 10 days, followed by orally administered antibiotics for 3 months. Twenty patients were independent on follow-up review, 15 with no or minor handicaps. Severe septicemia and multiorgan failure developed in two patients, and these two died of their disease. Major complications were mainly due to long-term antibiotic therapy. Conclusions Surgical treatment is the modality of choice in patients with acute spinal osteomyelitis. It is especially indicated in patients with progressive or severe neurological deficits and spinal deformity. In experienced hands, surgery is safe and offers the advantages of spinal cord decompression, immediate mobilization, and correction of spinal deformity. The decision whether an anterior or posterior approach should be used must be made on an individual basis.

The outcome following spinal instrumentation in haemodialyzed patients with pyogenic spondylodiscitis

2019 ◽  
Vol 101-B (1) ◽  
pp. 75-82 ◽  
Author(s):  
J. Kim ◽  
S. Y. Lee ◽  
J. H. Jung ◽  
S. W. Kim ◽  
J-K. Oh ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Biofilm Formation ◽  
Spinal Instrumentation ◽  
Matched Cohort ◽  
Recurrent Infections ◽  
Kyphotic Angle ◽  
Pyogenic Spondylodiscitis ◽  
First Recurrence ◽  
One Year ◽  
Complications And Mortality

Aims The aim of this study was to evaluate the outcome of spinal instrumentation in haemodialyzed patients with native pyogenic spondylodiscitis. Spinal instrumentation in these patients can be dangerous due to rates of complications and mortality, and biofilm formation on the instrumentation. Patients and Methods A total of 134 haemodialyzed patients aged more than 50 years who underwent surgical treatment for pyogenic spondylodiscitis were included in the study. Their mean age was 66.4 years (50 to 83); 66 were male (49.3%) and 68 were female (50.7%). They were divided into two groups according to whether spinal instrumentation was used or not. Propensity score matching was used to attenuate the potential selection bias. The outcome of treatment was compared between these two groups. Results A total of 89 patients (66.4%) underwent non-instrumented surgery and 45 (33.5%) underwent instrumented surgery. There were no significant differences in the rates of postoperative complications, except for an increased rate of wound problems in the instrumented group, which was found in the unmatched cohorts (p = 0.034). There were no significant differences in the rate of recurrent infections (p = 0.328 for the unmatched cohort; p = 0.269 for the matched cohort) and mortality rate, including in-hospital (p = 0.713 for the unmatched cohort; p = 0.738 for the matched cohort) and one-year rates (p = 0.363 for the unmatched cohort; p = 0.787 for the matched cohort), between the groups. However, the interval between the initial diagnosis and the first recurrence was significantly longer in the instrumented group (p = 0.008 for the unmatched cohort; p = 0.032 for the matched cohort). Conclusion Instrumented surgery for haemodialyzed patients with pyogenic spondylodiscitis showed similar outcomes, including recurrence and mortality, to non-instrumented surgery, despite the instrumented group having more severe neurological deficit, a larger number of involved levels, and increased kyphotic angle.

Surgical Treatment Strategies for Pyogenic Spondylodiscitis of the Thoracolumbar Spine

2021 ◽  
Author(s):  
Max J. Scheyerer ◽  
Christian Herren ◽  
Christian Kühne ◽  
Jörg Neufang ◽  
Philipp Pieroh ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Conservative Therapy ◽  
Surgical Intervention ◽  
Standard Procedure ◽  
Thoracolumbar Spine ◽  
Trauma Surgery ◽  
Treatment Strategies ◽  
German Society ◽  
Surgical Indications ◽  
Pyogenic Spondylodiscitis

Abstract Background Despite advances, the morbidity and mortality rates of patients with spondylodiscitis remains high, with an increasing incidence worldwide. Although conservative therapy has progressed, several cases require surgical intervention. However, the indication and opportunities for surgical treatment are still disputable. Methods In a joint consensus, the members of the ‘Spondylodiscitis’ working group of the Spine Section of the German Society for Orthopaedics and Trauma Surgery considered current literature, particularly the newly published S2k guideline of the AWMF, and examined the surgical indications and treatment strategies for thoracolumbar spondylodiscitis. Results Surgical intervention for spondylodiscitis is only required in a small percentage of patients. In studies comparing conservative and surgical therapies, most patients benefitted from surgery, regardless of the surgical technique selected. Presently, the standard procedure is a combined dorsoventral approach, in which a monolateral attempt should always be made. The choice of material (PEEK, titanium) for ventral support does not influence the clinical result.

scholarly journals Presentation and Outcomes After Medical and Surgical Treatment Versus Medical Treatment Alone of Spontaneous Infectious Spondylodiscitis: A Systematic Literature Review and Meta-Analysis

2018 ◽  
Vol 8 (4_suppl) ◽  
pp. 49S-58S ◽  
Author(s):  
Davis G. Taylor ◽  
Avery L. Buchholz ◽  
Durga R. Sure ◽  
Thomas J. Buell ◽  
James H. Nguyen ◽  
...  
Keyword(s):  
Back Pain ◽  
Surgical Treatment ◽  
Literature Review ◽  
Medical Treatment ◽  
Systematic Literature Review ◽  
Meta Analysis ◽  
Work Status ◽  
Pyogenic Spondylodiscitis ◽  
Neurologic Deficits ◽  
Number Of Patients

Study Design: Systematic literature review. Objectives: The aims of this study were to (1) describe the clinical features, disabilities, and incidence of neurologic deficits of pyogenic spondylodiscitis prior to treatment and (2) compare the functional outcomes between patients who underwent medical treatment alone or in combination with surgery for pyogenic spondylodiscitis. Methods: A systematic literature review was performed using PubMed according to PRISMA guidelines. No year restriction was put in place. Statistical analysis of pooled data, when documented in the original report (ie, number of patients with desired variable and number of patients evaluated), was conducted to determine the most common presenting symptoms, incidence of pre- and postoperative neurologic deficits, associated comorbidities, infectious pathogens, approach for surgery when performed, and duration of hospitalization. Outcomes data, including return to work status, resolution of back pain, and functional recovery were also pooled among all studies and surgery-specific studies alone. Meta-analysis of studies with subgroup analysis of pain-free outcome in surgical and medical patients was performed. Results: Fifty of 1286 studies were included, comprising 4173 patients undergoing either medical treatment alone or in combination with surgery. Back pain was the most common presenting symptom, reported in 91% of patients. Neurologic deficit was noted in 31% of patients. Staphylococcus aureus was the most commonly reported pathogen, seen in 35% of reported cases. Decompression and fusion was the most commonly reported surgical procedure, performed in 80% of the surgically treated patients. Combined anterior-posterior procedures and staged surgeries were performed in 33% and 26% of surgeries, respectively. The meta-analysis comparing visual analog scale score at follow-up was superior among patients receiving surgery over medical treatment alone (mean difference −0.61, CI −0.90 to −0.25), while meta-analysis comparing freedom from pain in patients receiving medical treatment alone versus combined medical and surgical treatment demonstrated superior pain-free outcomes among surgical series (odds ratio 5.35, CI 2.27-12.60, P < .001), but was subject to heterogeneity among studies ( I2 = 56%, P = .13). Among all patients, freedom from pain was achieved in 79% of patients, and an excellent outcome was achieved in 73% of patients. Conclusion: Medical management remains first-line treatment of infectious pyogenic spondylodiscitis. Surgery may be indicated for progressive pain, persistent infection on imaging, deformity or neurologic deficits. If surgery is required, reported literature shows potential for significant pain reduction, improved neurologic function and a high number of patients returning to a normal functional/work status.

Human Stapes Crura: Normal Ultrastructure. Scanning Electron Microscopic Findings

1975 ◽  
Vol 33 ◽  
pp. 528-529
Author(s):  
M.D. Graham
Keyword(s):  
Electron Microscope ◽  
Surgical Treatment ◽  
Scanning Electron Microscope ◽  
Osmic Acid ◽  
Human Cadaver ◽  
Electron Microscopic ◽  
Scanning Electron Microscopic ◽  
Normal Human ◽  
Microscopic Findings ◽  
Scanning Electron

The recent development of the scanning electron microscope has added great impetus to the study of ultrastructural details of normal human ossicles. A thorough description of the ultrastructure of the human ossicles is required in order to determine changes associated with disease processes following medical or surgical treatment.Human stapes crura were obtained at the time of surgery for clinical otosclerosis and from human cadaver material. The specimens to be examined by the scanning electron microscope were fixed immediately in the operating room in a cold phosphate buffered 2% gluteraldehyde solution, washed with Ringers, post fixed in cold 1% osmic acid and dehydrated in graded alcohol. Specimens were transferred from alcohol to a series of increasing concentrations of ethyl alcohol and amyl acetate. The tissue was then critical point dried, secured to aluminum stubs and coated with gold, approximately 150A thick on a rotating stage in a vacuum evaporator. The specimens were then studied with the Kent-Cambridge S4-10 Scanning Electron Microscope at an accelerating voltage of 20KV.

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