Characteristics of and risk factors for severe neurological deficit in patients with pyogenic vertebral osteomyelitis

Older patients with pyogenic vertebral osteomyelitis (PVO) usually have more medical comorbidities compared with younger patients, and present with advanced infections from different causative organisms. To aid surgical decision-making, we compared surgical outcomes of older patients with PVO to those who underwent nonoperative treatment. We identified the risk factors for adverse post-operative outcomes, and analyzed the clinical risks from further spinal instrumentation. This retrospective comparative study included 439 patients aged ≥75 years with PVO. Multivariable analysis was performed to compare treatment outcomes among three groups: 194, 130, and 115 patients in the non-operative, non-instrumented, and instrumented groups, respectively. The risk factors for adverse outcomes after surgical treatment were evaluated using a logistic regression model, and the estimates of the multivariable models were internally validated using bootstrap samples. Recurrence and mortality of these patients were closely associated with neurologic deficits, and increased surgical invasiveness, resulting from additional spinal instrumentation, did not increase the risk of recurrence or mortality. We propose that surgical treatment for these patients should focus on improving neurologic deficits through immediate and sufficient removal of abscesses. Spinal instrumentation can be performed if indicated, within reasonable clinical risk.

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Neurological Deficit after Carotid Infusion of Cisplatin and 1,3-Bis(2-chloroethyl)-1-nitrosourea (BCNU) for Malignant Glioma: An Analysis of Risk Factors

Neurosurgery ◽

10.1227/00006123-198611000-00010 ◽

1986 ◽

Vol 19 (5) ◽

pp. 779-783 ◽

Cited By ~ 16

Author(s):

P. Kapp John ◽

A. Sanford Robert

Keyword(s):

Risk Factors ◽

Neurological Deficit ◽

Infusion Pump ◽

Malignant Gliomas ◽

Internal Capsule ◽

Neurological Deficits ◽

Infusion Therapy ◽

Infusion Line ◽

Permanent Neurological Deficit ◽

Infusion Technique

Abstract The records of 24 patients with malignant gliomas treated with carotid infusion of cisplatin and 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) are reviewed for risk factors that might suggest the development of a permanent neurological deficit after infusion. Permanent neurological deficits were seen with doses of cisplatin as low as 69 mg/m2, although doses as high as 100 mg/m2 were tolerated by other patients. All 3 patients who developed permanent neurological deficits received fixed doses of cisplatin of 150 mg and supplied only 2 major intracranial branches from the infused carotid artery. In none of these patients was a filter used in the infusion line. Other risk factors identified in 2 of the 3 patients were diffuse neoplasm involving the region of the internal capsule and the use of an infusion pump rather than a pulsatile bolus infusion technique. The development of a permanent neurological deficit appeared unrelated to the dose of BCNU within the range utilized, and preinfusion administration of corticosteroids did not prevent neurological deficit. These possible risk factors should be considered in the future development of protocols for arterial infusion therapy of malignant gliomas.

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Incidence and Risk Factors for Neurological Deterioration in Posterior Corrective Surgeries for Severe Angular Kyphotic Deformities: A 10-Year Institutional Retrospective Study

Global Spine Journal ◽

10.1177/2192568220979122 ◽

2020 ◽

pp. 219256822097912

Author(s):

Kalyan Kumar Varma Kalidindi ◽

Sulaiman Sath ◽

Jeevan Kumar Sharma ◽

Gayatri Vishwakarma ◽

Harvinder Singh Chhabra

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Neurological Deficit ◽

Operative Time ◽

Deformity Correction ◽

Neurological Deterioration ◽

Kyphotic Deformity ◽

Neurological Deficits ◽

Retrospective Case ◽

Significant Difference

Study Design: Retrospective case-control study. Objective: Neurological deficit is one of the dreaded complications of kyphotic deformity correction procedures. There is inconsistency in the reports of neurological outcomes following such procedures and only a few studies have analyzed the risk factors for neurological deficits. We aimed to analyze the factors associated with neurological deterioration in severe kyphotic deformity correction surgeries. Methods: We performed a retrospective study of 121 consecutive surgically treated severe kyphotic deformity cases (49 males, 56 females) at a single institute (May 1st 2008 to May 31st 2018) and analyzed the risk factors for neurological deterioration. The demographic, surgical and clinical details of the patients were obtained by reviewing the medical records. Results: 105 included patients were divided into 2 groups: Group A (without neurological deficit) with 92 patients (42 males, 50 females) and Group B (with neurological deficit) with 13 patients (7 males, 6 females) (12.4%). Statistically significant difference between the 2 groups was observed in the preoperative sagittal Cobbs angle (p < 0.0001), operative time (p = 0.003) and the presence of myelopathic signs on neurological examination (p = 0.048) and location of the apex of deformity (p = 0.010) but not in other factors. Conclusions: Preoperative Sagittal Cobbs angle, presence of signs of myelopathy, operative time and location of apex in the distal thoracic region were significantly higher in patients with neurological deterioration as compared to those without neurological deterioration during kyphotic deformity correction surgery. Distal thoracic curve was found to have 4 times more risk of neurological deterioration compared to others.

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P108. Anterior Allograft Bone Dowel Treatment of Pyogenic Vertebral Osteomyelitis

The Spine Journal ◽

10.1016/j.spinee.2006.06.317 ◽

2006 ◽

Vol 6 (5) ◽

pp. 135S-136S

Author(s):

Michael Dabbah ◽

Justin Tortolani ◽

Ira L. Fedder ◽

Farhan Siddiqi ◽

Victor Hayes ◽

...

Keyword(s):

Vertebral Osteomyelitis ◽

Allograft Bone ◽

Pyogenic Vertebral Osteomyelitis

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Percutaneous Drainage Followed by Antibiotic-Impregnated Cement Vertebroplasty for Pyogenic Vertebral Osteomyelitis: A Case Report

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e318160f72b ◽

2008 ◽

Vol 64 (1) ◽

pp. E8-E11 ◽

Cited By ~ 5

Author(s):

Lih-Huei Chen ◽

Shih-Chjeh Yang ◽

Chi-Chien Niu ◽

Po-Liang Lai ◽

Wen-Jer Chen

Keyword(s):

Case Report ◽

Percutaneous Drainage ◽

Vertebral Osteomyelitis ◽

Pyogenic Vertebral Osteomyelitis

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A surgical case of bilateral acute empyema due to pyogenic vertebral osteomyelitis

The Journal of the Japanese Association for Chest Surgery ◽

10.2995/jacsurg.34.364 ◽

2020 ◽

Vol 34 (5) ◽

pp. 364-369

Author(s):

Akihiro Yonei ◽

Hirokazu Moriyama

Keyword(s):

Vertebral Osteomyelitis ◽

Surgical Case ◽

Acute Empyema ◽

Pyogenic Vertebral Osteomyelitis

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Hospital mortality in hematogenous vertebral osteomyelitis

Hirurgiâ pozvonočnika ◽

10.14531/ss2021.3.86-93 ◽

2021 ◽

Vol 18 (3) ◽

pp. 86-93

Author(s):

A. Yu. Bazarov ◽

K. S. Sergeyev ◽

A. O. Faryon ◽

R. V. Paskov ◽

I. A. Lebedev

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Hospital Mortality ◽

Medical Records ◽

Vertebral Osteomyelitis ◽

Hospital Death ◽

Factors Affecting ◽

Comorbidity Index ◽

Probability Of Death ◽

Type C

Objective. To analyze lethal outcomes in patients with hematogenous vertebral osteomyelitis.Material and Methods. Study design: retrospective analysis of medical records. A total of 209 medical records of inpatients who underwent treatment for hematogenous vertebral osteomyelitis in 2006–2017 were analyzed. Out of them 68 patients (32.5 %) were treated conservatively, and 141 (67.5 %) – surgically. The risk factors for lethal outcomes were studied for various methods of treatment, and a statistical analysis was performed.Results. Hospital mortality (n = 9) was 4.3 %. In patients who died in hospital, average time for diagnosis making was 4 times less (p = 0.092). The main factors affecting mortality were diabetes mellitus (p = 0.033), type C lesion according to the Pola classification (p = 0.014) and age over 70 years (p = 0.006). To assess the relationship between hospital mortality and the revealed differences between the groups, a regression analysis was performed, which showed that factors associated with mortality were Pola type C.4 lesions (OR 9.73; 95 % CI 1.75–54.20), diabetes mellitus (OR 5.86; 95 % CI 1.14–30.15) and age over 70 years (OR 12.58; 95 % CI 2.50–63.34). The combination of these factors increased the likelihood of hospital mortality (p = 0.001). Sensitivity (77.8 %) and specificity (84.2 %) were calculated using the ROC curve. In the group with mortality, the comorbidity index (CCI) was significantly higher (≥4) than in the group without mortality (p = 0.002). With a CCI of 4 or more, the probability of hospital death increases significantly (OR 10.23; 95 % CI 2.06–50.82), p = 0.005. Long-term mortality was 4.3 % (n = 9), in 77.8 % of cases the cause was acute cardiovascular pathology, and no recurrence of vertebral osteomyelitis was detected.Conclusion. Hospital mortality was 4.3 %, and there was no mortality among patients treated conservatively. The main risk factors were diabetes mellitus, type C lesion according to Pola and age over 70 years. There was a significant mutual burdening of these factors (p = 0.001). With CCI ≥4, the probability of death is higher (p = 0.005).

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