scholarly journals Who Needs Surgical Stabilization for Pyogenic Spondylodiscitis? Retrospective Analysis of Non-Surgically Treated Patients

2021 ◽  
pp. 219256822110394
Author(s):  
Ronen Blecher ◽  
Sven Frieler ◽  
Bilal Qutteineh ◽  
Clifford A. Pierre ◽  
Emre Yilmaz ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
De Novo ◽  
Vertebral Osteomyelitis ◽  
Case Series ◽  
Spinal Instability ◽  
Radiographic Outcome ◽  
Retrospective Case ◽  
Posterior Element ◽  
Non Surgical Treatment

Study Design: Retrospective case series analysis. Objective: To identify relevant clinical and radiographic markers for patients presenting with infectious spondylo-discitis associated with spinal instability directly related to the infectious process. Methods: We evaluated patients presenting with de-novo intervertebral discitis or vertebral osteomyelitis /discitis (VOD) who initiated non-surgical treatment. Patients who failed conservative treatment and required stabilization surgery within 90 days were defined as “ failed treatment group” (FTG). Patients who experienced an uneventful course served as controls and were labeled as “ nonsurgical group” (NSG). A wide array of baseline clinical and radiographic parameters was retrieved and compared between 2 groups. Results: Overall 35 patients had initiated non-surgical treatment for VOD. 25 patients had an uneventful course (NSG), while 10 patients failed conservative treatment (“FTG”) within 90 days. Factors found to be associated with poorer outcome were intra-venous drug abuse (IVDA) as well as the presence of fever upon initial presentation. Radiographically, involvement of the same-level facets and the extent of caudal and rostral VB involvement in both MRI and CT were found to be significantly associated with poorer clinical and radiographic outcome. Conclusions: We show that clinical factors such as IVDA status and fever as well as the extent of osseous and posterior element involvement may prove to be helpful in favoring surgical treatment early on in the management of spinal infections.

scholarly journals Transforaminal interbody debridement and fusion with antibiotics impregnated bone graft to treat pyogenic discitis and vertebral osteomyelitis: A technique note with preliminary result.

2020 ◽  
Author(s):  
Hsiao-Kang Chang ◽  
Meng-Ling Lu ◽  
Adam M. Wegner ◽  
Re-Wen Wu ◽  
Sung-Hsiung Chen ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Infection Control ◽  
Bone Graft ◽  
Vertebral Osteomyelitis ◽  
Case Series ◽  
Spinal Instability ◽  
Intractable Pain ◽  
Angle Correction ◽  
Antibiotic Duration

Abstract Background Surgical treatment of pyogenic discitis and vertebral osteomyelitis (PDVO) is indicated for neurologic deficit, spinal instability, unknown pathogen, poorly controlled infection, or intractable pain. Although the posterior-only approach has been proved a safe, effective procedure that minimizes the risks and complications of anterior or staged surgery, parenteral antibiotic treatment for 4–6 weeks postoperatively is still necessary. We hypothesized that antibiotic-impregnated bone graft used in an all posterior approach could result in infection control and shorten the postoperative course of pyogenic discitis and vertebral osteomyelitis. Methods 21 consecutive patients with pyogenic discitis and vertebral osteomyelitis of the lumbar or thoracic spine were treated with transforaminal interbody debridement and fusion (TIDF) with antibiotic-impregnated bone graft (AIBG) between March 2014 and January 2017. Minimum follow up was 2 years. Outcomes included visual analog scale (VAS) back pain, ASIA scale for neurological status, kyphotic angle correction, fusion status, and functional outcome using Kirkaldy-Willis criteria, and c-reactive protein (CRP) levels. CRP levels from pre-op, immediately post-op, and 1, 2, 4 & 6 wks post operatively and the duration of treatment with postoperative IV antibiotics in our patients was compared to our previous case series in which TIDF was performed without AIBG. Results Surgical treatment for PDVO resulted in clinical improvement and adequate infection control. There was no difference in pre-op CRP levels between the two groups. Despite shorter post-op IV antibiotic duration (Mean 21.0 d vs 39.8 d), the AIBG group had a stable decline in CRP levels and continued to decrease at 1, 2, 4 & 6 weeks, with significantly lower CRP levels at 6 weeks compared to bone graft without antibiotics. VAS scores improved from a mean of 7.2 to 2.3 one month postoperatively. Patients who had increased kyphotic angles had an average angle correction of 7.9° at last follow-up. Conclusion The technique of TIDF combined with AIBG can achieve local infection control with faster reduction in CRP, leading to shorter antibiotic duration for pyogenic discitis and vertebral osteomyelitis

scholarly journals Non-surgical treatment for patients with spondylolisthesis: a retrospective case series

2015 ◽  
Vol 4 (1) ◽  
pp. 86 ◽  
Author(s):  
Kiok Kim ◽  
Yongjae Jeong ◽  
Yousuk Youn ◽  
Jeongcheol Choi ◽  
Jaehong Kim ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Non Surgical Treatment

scholarly journals Antibiotic-impregnated bone graft decreases time to CRP normalization in pyogenic discitis with vertebral osteomyelitis

2020 ◽  
Author(s):  
Hsiao-Kang Chang ◽  
Meng-Ling Lu ◽  
Adam Wegner ◽  
Re-Wen Wu ◽  
Sung-Hsiung Chen ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Infection Control ◽  
Bone Graft ◽  
Vertebral Osteomyelitis ◽  
Case Series ◽  
Spinal Instability ◽  
Intractable Pain ◽  
Angle Correction ◽  
Antibiotic Duration

Abstract Introduction Surgical treatment of pyogenic discitis with vertebral osteomyelitis (PDVO) is indicated for neurologic deficit, spinal instability, unknown pathogen, poorly controlled infection, or intractable pain. Although the posterior-only approach has been proved a safe, effective procedure that minimizes the risks and complications of anterior or staged surgery, parenteral antibiotic treatment for 4-6 weeks postoperatively is still necessary. We hypothesized that antibiotic-impregnated bone graft used in an all posterior approach could result in infection control and shorten the postoperative course of pyogenic discitis and vertebral osteomyelitis. Patients and Methods 21 consecutive patients with pyogenic discitis and vertebral osteomyelitis of the lumbar or thoracic spine were treated with transforaminal interbody debridement and fusion (TIDF) with antibiotic-impregnated bone graft (AIBG) between March 2014 and January 2017. Minimum follow up was 2 years. Outcomes included visual analog scale (VAS) back pain, ASIA scale for neurological status, kyphotic angle correction, fusion status, and functional outcome using Kirkaldy-Willis criteria, and c-reactive protein (CRP) levels. CRP levels from pre-op, immediately post-op, and 1, 2, 4 & 6 wks post operatively and the duration of treatment with postoperative IV antibiotics in our patients was compared to our previous case series in which TIDF was performed without AIBG. Results Surgical treatment for PDVO resulted in clinical improvement and adequate infection control. There was no difference in pre-op CRP levels between the two groups. Despite shorter post-op IV antibiotic duration (Mean 21.0 d vs 39.8 d), the AIBG group had a stable decline in CRP levels and continued to decrease at 1, 2, 4 & 6 wks, with significantly lower CRP levels at 6 weeks compared to bone graft without antibiotics. VAS scores improved from a mean of 7.2 to 2.3 one month postoperatively. Patients who had increased kyphotic angles had an average angle correction of 7.9° at last follow-up. Eighty-one percent of patients (17/21) had good to excellent functional outcomes. Conclusion TIDF combined with AIBG can achieve local infection control with faster reduction in CRP, leading to shorter antibiotic duration for pyogenic discitis and vertebral osteomyelitis

Clinical Outcomes of Percutaneous Plantar Fasciotomy Using Microdebrider Coblation Wand

2019 ◽  
Vol 41 (2) ◽  
pp. 187-192
Author(s):  
Ricardo E. Colberg ◽  
Monte Ketchum ◽  
Avani Javer ◽  
Monika Drogosz ◽  
Melissa Gomez ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Plantar Fasciitis ◽  
Case Series ◽  
Successful Outcome ◽  
Oral Steroid ◽  
Tarsal Tunnel ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Plantar Fasciotomy

Background: Plantar fasciitis is the most common cause of heel pain in adults. Multiple conservative treatment plans exist; however, some cases do not obtain significant clinical improvement with conservative treatment and require further intervention. This retrospective case study evaluated the success rate of percutaneous plantar fasciotomy and confounding comorbidities that negatively affect outcomes. Methods: A series of 41 patients treated with percutaneous plantar fasciotomy using the Topaz EZ microdebrider coblation wand were invited to participate in this retrospective follow-up study, and 88% ( N = 36) participated. A limited chart review was completed and the patients answered a survey with the visual analog scale (VAS) for pain and the Foot and Ankle Ability Measure (FAAM) questionnaire. Average outcomes were calculated and 45 variables were analyzed to determine if they were statistically significant confounders. Patients had symptoms for an average of 3 years before the procedure and were contacted for follow-up at an average of 14 months after the procedure. Results: The average VAS for pain score was 1.3 ± 1.8 and the average FAAM score was 92 ± 15. Eighty-nine percent of patients had a successful outcome, defined as FAAM greater than 75. In addition, patients at 18 months postprocedure reported complete or near-complete resolution of symptoms with an FAAM score greater than 97. Concurrent foot pathologies (eg, tarsal tunnel syndrome), oral steroid treatment prior to the procedure, and immobilization with a boot prior to the procedure were statistically significant negative confounders ( P < .05). Being an athlete was a positive confounder ( P = .02). Conclusion: Percutaneous plantar fasciotomy using a microdebrider coblation was an effective treatment for plantar fasciitis, particularly without concurrent foot pathology, with a low risk of complications. Level of Evidence: Level IV, retrospective case series.

scholarly journals End-growth final results of an effective conservative treatment: a retrospective case series

Scoliosis ◽  
2007 ◽  
Vol 2 (S1) ◽  
Author(s):  
Stefano Negrini ◽  
Michele Romano ◽  
Alessandra Negrini ◽  
Silvana Parzini
Keyword(s):  
Conservative Treatment ◽  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series

Current Minimally Invasive Surgical Concepts for Sacral Insufficiency Fractures

2021 ◽  
Author(s):  
Ulrich Josef Albert Spiegl ◽  
Klaus J. Schnake ◽  
Bernhard Ullrich ◽  
Max J. Scheyerer ◽  
Georg Osterhoff ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Screw Fixation ◽  
Case Series ◽  
Fracture Morphology ◽  
Iliosacral Screw ◽  
Insufficiency Fractures ◽  
Minimally Invasive Surgical ◽  
Sacral Insufficiency Fractures ◽  
Non Surgical Treatment

AbstractAn increasing incidence of sacral insufficiency fractures in geriatric patients has been documented, representing a major challenge to our healthcare system. Determining the accurate diagnosis requires the use of sectional imaging, including computed tomography and magnetic resonance imaging. Initially, non-surgical treatment is indicated for the majority of patients. If non-surgical treatment fails, several minimally invasive therapeutic strategies can be used, which have shown promising results in small case series. These approaches are sacroplasty, percutaneous iliosacral screw fixation (S1 with or without S2), trans-sacral screw fixation or implantation of a trans-sacral bar, transiliac internal fixator stabilisation, and spinopelvic stabilisation. These surgical strategies and their indications are reported in detail. Generally, treatment-related decision making depends on the clinical presentation, fracture morphology, and attending surgeonʼs experience.

scholarly journals Usefulness of surgical treatment for asymptomatic patients with extra-peritoneal desmoid-type fibromatosis: a systematic review and meta-analysis

2020 ◽  
Vol 50 (5) ◽  
pp. 574-580
Author(s):  
Munehisa Kito ◽  
Akira Ogose ◽  
Masahiro Yoshida ◽  
Yoshihiro Nishida
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Progressive Disease ◽  
Meta Analysis ◽  
Case Series ◽  
Case Control ◽  
Case Control Studies ◽  
Exacerbation Rate ◽  
Asymptomatic Patients ◽  
Non Surgical Treatment

Abstract Objective The purpose of this systematic review is to assess and compare the efficacy of surgical treatment for patients with asymptomatic extra-peritoneal desmoid-type fibromatosis to the wait-and-see policy by evaluating (1) the exacerbation rate (exacerbation; recurrence after surgery or progressive disease following non-surgical treatment) and (2) treatment-associated complications in extra-peritoneal desmoid-type fibromatosis. Methods We evaluated documents published between 1 January 1990 and 31 August 2017. The risk of bias in the selected literature was analyzed using the Cochrane Collaboration Risk of Bias Tool. Quality of evidence was evaluated using Grading of Recommendation, Assessment, Development and Evaluation approach. Results One prospective cohort study, four case–control studies and five case series studies were identified. Meta-analysis was performed to evaluate the exacerbation rate after treatment on one prospective cohort study and four case–control studies. In comparing surgical and non-surgical treatments, the exacerbation rate was significantly higher in the surgical treatment group (odds ratio: 1.32, 95% confidence interval 1.01–1.73, P = 0.05). However, in the case series study, the recurrence rate was 23.4% for the surgical treatment group, while the progressive disease rate was 28.1% for the non-surgical treatment group. The postoperative complication rates associated with surgical treatment in the two studies were 20.8 and 17.2%, respectively. Conclusions When considering the exacerbation rate, non-surgical treatment might be appropriate for asymptomatic patients with extra-peritoneal desmoid-type fibromatosis. However, if patients with tumor-related symptoms opt for surgery, including those who face difficulties due to the presence of tumors, it is important to fully explain to them the possibility that the recurrence rate and treatment-associated functional failures may increase depending on the site of occurrence.

scholarly journals Microbiology of Vertebral Osteomyelitis and Implications on Empiric Therapy

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S6-S6
Author(s):  
Abbye Clark ◽  
Neha Sharma ◽  
Sharon Weissman ◽  
Majdi N Al-Hasan ◽  
Caroline Derrick ◽  
...  
Keyword(s):  
South Carolina ◽  
Antimicrobial Therapy ◽  
Vertebral Osteomyelitis ◽  
Case Series ◽  
Empiric Therapy ◽  
Empiric Antibiotic Therapy ◽  
Retrospective Case ◽  
Gram Negative ◽  
Male Predominance ◽  
Case Series Study

Abstract Background The management of vertebral osteomyelitis (VO) includes empiric antibiotic therapy while clinical cultures are being processed. Optimal antimicrobial therapy for VO, particularly when Gram-negative (GN) organisms are involved, is an area of ongoing debate. Narrow spectrum and oral antimicrobial therapy are preferred. The objective of this study was to identify characteristics of local pathogens and to formulate an institution-specific antibiotic protocol for empiric treatment of VO. Methods We conducted a retrospective case series study of adults diagnosed with VO from August 1, 2010 to August 31, 2015 at Palmetto Health Hospitals in Columbia, South Carolina. Cases identified by ICD-9 codes were included in the analysis if they met clinical, imaging and microbiology, criteria. Results Analysis is based on 150 cases of VO with a mean age of 61 years, a male predominance (91; 61%), and an average body mass index of 29kg/m2. Comorbidities included diabetes mellitus (69; 46%), tobacco use (33; 22%), and hemodialysis (20; 13%). Thirty-seven (25%) cases had recent related injury or vertebral surgery, and 14 (9%) had prior hardware. Bone, disc, or adjacent tissue cultures were obtained in 129 (86%) of cases; 60 (40%) of these had &gt;1 sample taken. The remaining 14% had blood cultures alone. Thirty-six cases (24%) had culture negative VO. In the remaining 114 cases, 132 organisms were isolated. A total of 111 (84%) organisms were Gram-positive cocci (GPC). Of those, the majority was Staphylococcus aureus. (66; 59%) (26/66 were methicillin-resistant), coagulase-negative staphylococci (20; 18%) and Streptococcus spp. (17; 15%). Enterobacteriaceae accounted for 13/17 Gram-negative bacilli (GNB), with only one isolate of Pseudomonas aeruginosa. Of the GNB, 11/17 were susceptible to either ceftriaxone or ciprofloxacin. Conclusion There was a predominance of VO due to GPC suggesting that intravenous vancomycin monotherapy may be reasonable for empiric therapy in noncritically ill patients while awaiting Gram stain and clinical culture results. Addition of either ceftriaxone or ciprofloxacin to vancomycin would increase cumulative antimicrobial coverage from 84 to 92%. Disclosures All authors: No reported disclosures.

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