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

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 Disseminated Coccidioidomycosis to the Spine—Case Series and Review of Literature

2019 ◽  
Vol 9 (7) ◽  
pp. 160 ◽  
Author(s):  
Dinesh Ramanathan ◽  
Nikhil Sahasrabudhe ◽  
Esther Kim
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
Poor Response ◽  
Community Acquired Pneumonia ◽  
Antifungal Drugs ◽  
Neurological Deficits ◽  
Spinal Instability ◽  
Intractable Pain ◽  
Systemic Dissemination ◽  
Paraspinal Abscess

Coccidioidomycosis is a fungal infectious disease caused by the Coccidioides species endemic to Southwestern United States. Symptomatic patients typically present as community-acquired pneumonia. Uncommonly, in about 1% of infections, hematogenous extra pulmonary systemic dissemination involving skin, musculoskeletal system, and meninges occur. Disseminated spinal infection is treated with antifungal drugs and/or surgical treatment. A retrospective review of medical records at our institution was done between January 2009 to December 2018 and we present three cases of spinal coccidioidomycosis and review the current literature. Disseminated coccidioidomycosis can lead to spondylitis that can present as discitis or a localized spinal or paraspinal abscess. Spinal coccidioidomycosis is typically managed with antifungal treatments but can include surgical treatment in the setting poor response to medical therapy, intractable pain, presence of neurological deficits due to compression, or structural spinal instability.

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.

Midcarpal instability

2015 ◽  
Vol 41 (1) ◽  
pp. 86-93 ◽  
Author(s):  
D. G. Hargreaves
Keyword(s):  
Surgical Treatment ◽  
Treatment Options ◽  
Case Series ◽  
Definite Diagnosis ◽  
Stress Tests ◽  
Functional Instability ◽  
Painful Wrist ◽  
Relative Rarity ◽  
Passive Stress

Midcarpal instability is a collective term for a number of conditions where the instability of the wrist is predominantly between the proximal and distal carpal rows. It has been regarded as relatively rare and infrequently requires surgical treatment. Palmar midcarpal instability is the most commonly found type of midcarpal instability and can be responsible for causing a clunking and painful wrist. The diagnosis is made on clinical grounds using the midcarpal instability provocative tests. Standard imaging and arthroscopic inspection do not usually confirm a definite diagnosis, but are important in excluding other pathologies. The classification and staging has been described using the extent of palmar translocation of the distal carpal row, which is elicited on passive stress tests. As this is a functional instability, it may be that a functional staging description might be better, and a proposed scheme is described. Treatment options including partial wrist fusions, tenodesis stabilizations and arthroscopic capsular shrinkage have been described in small case series with limited follow-up. There are no comparative series or randomized studies because of the relative rarity of this condition.

scholarly journals Surgical Correction of Penoscrotal Web: A Case Series With Literature Review

2020 ◽  
Author(s):  
Volkan Sarper Erikçi
Keyword(s):  
Surgical Treatment ◽  
Clinical Characteristics ◽  
Surgical Techniques ◽  
Case Series ◽  
Scrotal Skin ◽  
Penile Skin ◽  
Surgical Experience ◽  
Postoperative Results ◽  
Pediatric Urologist

INTRODUCTION: Penoscrotal webbing (PSW) is an anomaly of penis and it includes penile and scrotal skin aberration. There are various surgical techniques for repairing PSW with different terminologies. Herein we present our surgical experience of Z-plasty procedure in these cases. METHODS: In this retrospective study, 5 patients with an average age of 46 months who were diagnosed and under follow-up for PSW, between June 2017 and May 2019 were included. Along with demographic and clinical characteristics, treatment and follow-up records were collected. RESULTS: Isolated PSW was observed in 4 patients and one patient had an associated megameatus intact prepuce (MMIP) of a hypospadias variant in addition to PSW. Circumcision and ventral prepuce reconstruction of the penis with the aid of "Z-plasty" solved problem and acceptable postoperative results were obtained. DISCUSSION AND CONCLUSION: PSW is a condition that warrants surgical treatment. During the management of these children, in the case of suspicion of penile skin abnormality at the time of circumcision, it should be deferred and should be consulted to a pediatric surgeon or a pediatric urologist. Gentle surgical treatment is recommended for a favourable surgical and psychological result

Evaluation of Metatarsal Head Resurfacing Hemiarthroplasty in the Surgical Treatment of Hallux Rigidus: A Retrospective Study and Mid- to Long-Term Follow-up

2017 ◽  
Vol 11 (1) ◽  
pp. 22-31 ◽  
Author(s):  
Musa Uğur Mermerkaya ◽  
Erkan Alkan ◽  
Mehmet Ayvaz
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Treatment Method ◽  
Hallux Rigidus ◽  
Retrospective Case ◽  
First Metatarsophalangeal Joint

Background. The aim of this study was to evaluate the mid- to long-term outcomes of metatarsal head resurfacing hemiarthroplasty in the surgical treatment of advanced-stage hallux rigidus. Methods. We performed a retrospective review of 57 consecutive patients (25 [43.9%] males, 32 [56.1%] females; mean age, 61.0 ± 6.4 years) who underwent first metatarsal head resurfacing hemiarthroplasty (HemiCAP) for hallux rigidus between August 2007 and September 2010. Sixty-five implantations were performed in 57 patients; 8 patients underwent bilateral procedures. All patients were clinically rated prior to surgery and at the final follow-up visit using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale and first metatarsophalangeal joint range of motion (MTPJ ROM). Results. The median follow-up duration was 81 (range = 8-98) months. The median preoperative AOFAS score was 34 (range = 22-59) points, which had increased to 83 (range = 26-97) points at the final follow-up visit (P < .001). The median preoperative first MTPJ ROM was 25° (range = 15° to 40°), which had increased to 75° (range = 30° to 85°) at the final follow-up visit (P < .001). Conclusions. First MTPJ hemiarthroplasty is an effective treatment method that recovers toe function and first MTPJ ROM, and provides good mid- to long-term functional outcomes. Levels of Evidence: Level IV: Retrospective case series

Novel Surgical Treatment Strategies for Unstable Lumbar Osteodiscitis: A 3-Patient Case Series

2017 ◽  
Vol 14 (6) ◽  
pp. 639-646 ◽  
Author(s):  
Michael A Bohl ◽  
Randall J Hlubek ◽  
Jay D Turner ◽  
Edward M Reece ◽  
U Kumar Kakarla ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Iliac Crest ◽  
Surgical Techniques ◽  
Case Series ◽  
Recurrent Infection ◽  
Surgical Approaches ◽  
Spinal Instability ◽  
Iliac Crest Graft ◽  
Imaging Results ◽  
Novel Methods

Abstract BACKGROUND Lumbar osteomyelitis frequently affects patients with medical comorbidities and poor preoperative health. Surgery is indicated when medical management fails or patients present with spinal instability or neural compromise. Successful arthrodesis can be difficult and sometimes requires alternative surgical techniques. OBJECTIVE To report 3 novel methods, each illustrated by a case, for achieving arthrodesis for lumbar osteomyelitis. METHODS A retrospective review was performed of 3 cases of surgical treatment of lumbar osteomyelitis. Novel aspects of the surgical techniques are reported, as are perioperative clinical details and imaging results. RESULTS In the first patient, a vascularized iliac crest graft on a quadratus lumborum pedicle was rotated into the posterolateral fusion bed of the affected level. In the second, an anterior approach with debridement of affected lumbar levels was followed by rotation of a vascularized iliac crest graft on an iliacus muscle pedicle into the anterior lumbar defect. In the third, a structural, nonvascularized iliac crest graft was harvested via a lateral approach to provide better surgical access, and an autologous tricortical bone graft was obtained for placement in the debridement defect. Follow-up imaging suggested successful early incorporation of all the grafts in the fusion beds. CONCLUSION Patients with multiple risk factors for pseudarthrosis and recurrent infection often require alternative surgical strategies to augment fusion. These 3 novel methods for lumbar debridement, fixation, and fusion using vascularized or nonvascularized autograft accommodate posterior, anterior, and lateral surgical approaches. Further experience with these techniques is required to compare outcomes with those of traditional techniques.

scholarly journals LUMBAR SPINAL STENOSIS: EVALUATION OF PAIN AND LIFE QUALITY AFTER SURGICAL TREATMENT

2019 ◽  
Vol 18 (1) ◽  
pp. 37-42
Author(s):  
Gustavo Alvarenga ◽  
João Otávio Araújo Rotini ◽  
Leonardo Yukio Jorge Asano ◽  
Vinícius Alves de Andrade ◽  
André Evaristo Marcondes Cesar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Life Quality ◽  
Case Series ◽  
Level Of Evidence ◽  
The Mean ◽  
One Year ◽  
Lumbar Spinal

ABSTRACT Objective: The objective of this study was to present an analysis of progression of the quality of life and pain in patients undergoing surgical treatment of LSS and the potential correlations between individual factors and the clinical outcome observed. Methods: We studied 111 patients undergoing surgical treatment of LSS from January 2009 to December 2011 using the functional capacity (ODI) and pain (VAS) questionnaires. The preoperative data were compared statistically with the results obtained during the postoperative follow-up at one month, six months, one year, and two years. Results: The population consisted of 60 men and 51 women. The mean age was 61.16 years at the time of surgery, 33.33% were 60 years or older. When the questionnaires were applied, we found improvement in the progressive disability assessment with a mean drop of 23.65 ODI points after 6 months of the surgical treatment and 27.47 at the end of one year of surgery compared to preoperative for this scale. There was a decline of 3.84 points (mean) in the VAS at first postoperative month. Conclusion: Surgical treatment of LSS presented favorable postoperative evolution in a 2-year follow-up regarding pain and quality of life through VAS and ODI. Level of Evidence IV; Case series.

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