scholarly journals Single-stage debridement and instrumentation for pyogenic spinal infections

2004 ◽  
Vol 17 (6) ◽  
pp. 1-5 ◽  
Author(s):  
Alfred T. Ogden ◽  
Michael G. Kaiser
Keyword(s):  
Epidural Abscess ◽  
Surgical Intervention ◽  
Recurrent Infection ◽  
Single Stage ◽  
Intractable Pain ◽  
Review Of The Literature ◽  
Mechanical Instability ◽  
Hardware Failure ◽  
Spinal Infections

Surgical intervention is indicated for pyogenic vertebral discitis and osteomyelitis in patients in whom medical therapy has failed, and in those with neurological compromise, mechanical instability, epidural abscess, or intractable pain. Surgical management has evolved to include single-stage operations for debridement and stabilization as well as more aggressive reconstruction strategies with respect to instrumentation. A review of the literature demonstrates excellent outcomes with single-stage operations and placement of hardware wherever it is required. Using this method, the authors have treated 16 patients without a single incidence of recurrent infection or hardware failure after almost 2 years of follow up.

Single-stage treatment of chronically infected total hip arthroplasty with cementless reconstruction

2019 ◽  
Vol 101-B (4) ◽  
pp. 396-402 ◽  
Author(s):  
B. Ji ◽  
T. Wahafu ◽  
G. Li ◽  
X. Zhang ◽  
Y. Wang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Recurrent Infection ◽  
Multidrug Resistant ◽  
Single Stage ◽  
Inclusion Criteria ◽  
Total Hip ◽  
Multidrug Resistant Organisms ◽  
Culture Negative

Aims Single-stage revision is not widely pursued due to restrictive inclusion criteria. In this study, we evaluated the results of single-stage revision of chronically infected total hip arthroplasty (THA) using broad inclusion criteria and cementless implants. Patients and Methods Between 2010 and 2016, 126 patients underwent routine single-stage revision with cementless reconstruction with powdered vancomycin or imipenem poured into the medullary cavity and re-implantation of cementless components. For patients with a culture-negative hip, fungal infections, and multidrug-resistant organisms, a direct intra-articular infusion of pathogen-sensitive antibiotics was performed postoperatively. Recurrence of infection and clinical outcomes were evaluated. Three patients died and 12 patients (none with known recurrent infection) were lost to follow-up. There were 111 remaining patients (60 male, 51 female) with a mean age of 58.7 (sd 12.7; 20 to 79). Results Of these 111 patients, 99 (89.2%) were free of infection at a mean follow-up time of 58 months (24 to 107). A recurrent infection was observed in four of the 23 patients (17.4%) with culture-negative infected hip. The success rate in patients with multidrug-resistant organisms was 84.2% (16/19). The mean postoperative Harris hip score was 79.6 points (63 to 92) at the most recent assessment. Conclusion Routine single-stage revision with cementless reconstruction can be a viable option for the treatment of chronically infected THA. The results of this study will add to the growing body of evidence supporting routine use of single-stage revision for the treatment of chronically infected THA. Cite this article: Bone Joint J 2019;101-B:396–402.

Use of structural allografts in spinal osteomyelitis: a review of 47 cases

2000 ◽  
Vol 93 (1) ◽  
pp. 8-14 ◽  
Author(s):  
James M. Schuster ◽  
Anthony M. Avellino ◽  
Frederick A. Mann ◽  
Allain A. Girouard ◽  
M. Sean Grady ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Persistent Infection ◽  
Perceived Risk ◽  
Recurrent Infection ◽  
Content Type ◽  
Hardware Failure ◽  
Spinal Osteomyelitis ◽  
Structural Allografts ◽  
Fine Print

Object. The use of structural allografts in spinal osteomyelitis remains controversial because of the perceived risk of persistent infection related to a devitalized graft and spinal hardware. The authors have identified 47 patients over the last 3.5 years who underwent a surgical decompression and stabilization procedure in which fresh-frozen allografts were used after aggressive removal of infected and devitalized tissue. The patients subsequently underwent 6 weeks of postoperative antibiotic therapy (12 months for those with tuberculosis [TB]). Methods. Follow-up data included results of serial clinical examinations, radiography, laboratory analysis (erythrocyte sedimentation rate and white blood cell count), and clinical outcome questionnaires. Of the original 47 patients (14 women and 33 men, aged 14–83 years), 39 were available for follow up. The average follow-up period at the time this article was submitted was 17 ± 9 months (median 14 months, range 6–45 months). In the majority of cases (57%), a Staphylococcus species was the infectious organism. Predisposing risk factors included intravenous drug abuse (IVDA), previous surgery, diabetes, TB, and concurrent infections. During the follow-up period only two patients suffered recurrent infection at a contiguous level; both had a history of IVDA and one also had a chronic excoriating skin condition. No other recurrent infections have been identified, and no patient has required reoperation for persistent infection or allograft/hardware failure. Conclusions. It is the authors' opinion that the use of structural allografts in combination with aggressive tissue debridement and adjuvant antibiotic therapy provide a safe and effective therapy in cases of spinal osteomyelitis requiring surgery.

Syrinx reduction due to spontaneous spinal cord tear: demonstration on 3 T MRI and review of the literature

2021 ◽  
Vol 14 (12) ◽  
pp. e246235
Author(s):  
Serena Staglianó ◽  
Elena Prodi ◽  
Barbara Goeggel Simonetti ◽  
Alessandro Cianfoni
Keyword(s):  
Spinal Cord ◽  
Surgical Intervention ◽  
Adult Population ◽  
Paediatric Population ◽  
Review Of The Literature ◽  
Thoracic Level ◽  
High Resolution Mri ◽  
Upper Thoracic ◽  
Serial Mri

A holocord syringomyelia due to Chiari 1.5 malformation (CM) in a 12-year-old girl was serially imaged with 3 T MRI over 4 years. The serial MRI showed reduction in size of the syrinx, without any surgical intervention or CM improvement, but rather due to spontaneous spinal cord tear. The tear was clearly demonstrated by evidence of flow signal across the tear between syrinx and subarachnoid space at the upper thoracic level. The tear showed spontaneous closure at follow-up. A medullary tear has been described in the adult population as one of the putative causes of spontaneous syringomyelia reduction, but its clear demonstration with modern high-resolution MRI has not been reported in the paediatric population. Moreover, this is the first reported case of syrinx reduction due to spontaneous fissuration in a paediatric patient.

Single-Stage Reconstruction of Achilles Tendon and Overlying Tissue With the Extended Temporoparietal Fasciagaleal Flap—23-Year Follow-Up and the Review of the Literature

2016 ◽  
Vol 76 ◽  
pp. S165-S170 ◽  
Author(s):  
Marek Dobke ◽  
Ahmed Suliman ◽  
Gina A. Mackert ◽  
Fernando A. Herrera ◽  
Robert Singer ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Single Stage ◽  
Review Of The Literature

Concomitant intramedullary nailing and plate augmentation as a single-stage procedure in treating complicated nonunited femoral shaft fractures

Trauma ◽  
2021 ◽  
pp. 146040862110070
Author(s):  
Ahmed A Khalifa ◽  
Amr A Fadle ◽  
Mohamed E Elsherif ◽  
Hatem G Said ◽  
Essam Elsherif ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Femoral Shaft ◽  
Single Stage ◽  
Leg Length ◽  
Mechanical Instability ◽  
Infected Nonunion ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Biological Environment

Background and Purpose: Complicated femur fracture represents a major challenge for the orthopedic surgeon, with failed internal fixation, nonunion with broken intramedullary nail (IMN), and infected nonunion among the complications. Mechanical instability, as well as the poor biological environment, is considered as a concern when treating these cases. The purpose of this study was to evaluate concomitant IMN and plate augmentation as a single-stage procedure for the management of multiply operated nonunited femoral shaft fractures. Materials and Methods: Between January 2015 and May 2018, nine patients (eight men) with an average age of 40.8 years (range 25–70) diagnosed as nonunion femoral fractures after an average of four previous surgeries (range 2–6). All patients were available for follow-up with an average of 22 months (range 12–36). Results: The average time for fracture union was 6.7 months (range 3–12); five patients needed bone grafting to compensate for the bone defect encountered during the initial procedure, and two patients required secondary bone grafting after 6 months follow-up. Two patients presented with surgical site infection which was treated by antibiotics and daily dressing. The average leg length discrepancy at last follow-up was 1 cm (range 0.5–1.5). No patient had a metalwork failure or needed removal of the implants. Conclusion: In treating complicated multiply operated nonunited femoral shaft fractures, we believe that this technique can provide a robust mechanical foundation as well as an improved biological environment for such nonunited fractures to heal.

scholarly journals Prognosis of spinal infections managed by minimal debridement: A case series in two tertiary centers

2021 ◽  
Vol 12 ◽  
pp. 83
Author(s):  
Ahmed Ali Mohamed ◽  
Hussein Mohammed Soffar ◽  
Hazem Hassan El Zayat ◽  
Hashem Mohamed Aboul-Ela
Keyword(s):  
Epidural Abscess ◽  
Vertebral Osteomyelitis ◽  
Case Series ◽  
Clinical Findings ◽  
Low Back ◽  
Thoracic Region ◽  
Limb Pain ◽  
Lower Limb Pain ◽  
Spinal Infections

Background: Spinal infections can be challenging in their management and include spondylitis, epidural abscess, and spondylodiscitis. Usual treatment is conservative through antimicrobials or surgery to decompress neural tissue, debride all infected tissues, and fix if needed. We propose the concept of surgery without formal debridement aiming at neural protection. Methods: The study was performed at two tertiary centers on 25 patients with clinical findings. One patient was treated conservatively and the rest surgically by laminectomy and fixation if needed. Evacuation of fluid pus was performed. In the cervical and the thoracic region, if the granulation tissue was anterior to the cord, only decompression by laminectomy was done. Results: Low back pain was present in 22 cases (88%), 16 cases (64%) had lower limb pain, and 12 cases (48%) had weakness. The level of spinal infection was lumbar in 15 cases (60%), thoracic in 9 cases (36%) cases, and cervical in 1 case (4%). The type of infection was epidural abscess in 20 cases (80%), discitis in 16 cases (64%), and vertebral osteomyelitis in 12 cases (48%). Laminectomy was performed in 20 cases (80%) and fixation in 17 cases (68%). The symptoms improved in all cases. On follow-up, the lesion was reduced in 14 patients (56%) and disappeared in 11 cases (44%). One case required ventriculoperitoneal shunt placement due to postinfectious hydrocephalus. Conclusion: Dealing with spinal infections surgically through decompression or fixation with minimal debridement of infected tissue appears to be a safe and effective method of management.

scholarly journals The Management of Ureteropelvic Junction Obstruction Presenting with Prenatal Hydronephrosis

2009 ◽  
Vol 9 ◽  
pp. 400-403 ◽  
Author(s):  
C.D. Anthony Herndon ◽  
David M. Kitchens
Keyword(s):  
Systematic Approach ◽  
Ureteropelvic Junction Obstruction ◽  
Surgical Intervention ◽  
Ureteropelvic Junction ◽  
Review Of The Literature ◽  
Mild Disease ◽  
Number Of Patients ◽  
Prenatal Hydronephrosis

The treatment of the newborn diagnosed with a ureteropelvic obstruction prenatally should follow a systematic approach. Although a majority of patients can be followed without surgical intervention, controversy exists concerning appropriate follow-up. Furthermore, a significant number of patients will manifest mild disease and thus deserve abbreviated follow-up. Herein, an appropriate algorithm and a review of the literature are discussed.

Single-Stage Reconstruction of Perforated Choledochal Cyst: Case Report and Review of the Literature

2005 ◽  
Vol 71 (5) ◽  
pp. 398-401 ◽  
Author(s):  
Dion L. Franga ◽  
Charles G. Howell ◽  
John D. Mellinger ◽  
Robyn M. Hatley
Keyword(s):  
Choledochal Cyst ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Rare Event ◽  
Single Stage ◽  
Western World ◽  
Recent Experience ◽  
Type I ◽  
Endoscopic Retrograde

Choledochal cysts represent a rare disease in the Western world. We reviewed our recent experience with a case of perforated choledochal cyst, define the currently accepted treatment options, and review the literature of this unusual disease. An 11-month-old girl presented with abdominal pain and distention as well as non-bilious vomiting. Subsequent workup included endoscopic retrograde cholangiopancreatography revealing a perforated type I choledochal cyst. She underwent single-stage excision and reconstruction with a Roux- en-Y hepaticojejunostomy. Perforated choledochal cyst is a rare event, and prompt surgical intervention is warranted. Single-stage cystectomy and Roux- en-Y reconstruction is possible in select patients. A thorough understanding of the pathophysiology, management, and follow-up is required.

Pneumomediastinum: A Rare Presentation of Inflicted Injuries in Infants

2020 ◽  
Author(s):  
Adam Lee ◽  
Adam Bajinting ◽  
Abby Lunneen ◽  
Colleen M. Fitzpatrick ◽  
Gustavo A. Villalona
Keyword(s):  
Literature Review ◽  
Retrospective Review ◽  
Review Of The Literature ◽  
Rare Presentation ◽  
Spontaneous Pneumomediastinum ◽  
Nonaccidental Trauma ◽  
Comprehensive Literature Review ◽  
Healthy Infants ◽  
History Of

AbstractReports of incidental pneumomediastinum in infants secondary to inflicted trauma are limited. A retrospective review of infants with pneumomediastinum and history of inflicted trauma was performed. A comprehensive literature review was performed. Three infants presented with pneumomediastinum associated with inflicted trauma. Mean age was 4.6 weeks. All patients underwent diagnostic studies, as well as a standardized evaluation for nonaccidental trauma. All patients with pneumomediastinum were resolved at follow-up. Review of the literature identified other cases with similar presentations with related oropharyngeal injuries. Spontaneous pneumomediastinum in previously healthy infants may be associated with inflicted injuries. Clinicians should be aware of the possibility of an oropharyngeal perforation related to this presentation.

Sign in / Sign up

Export Citation Format

Share Document