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

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.

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

10.21203/rs.3.rs-41300/v1 ◽

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

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

10.21203/rs.3.rs-19061/v1 ◽

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

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

Operative Neurosurgery ◽

10.1093/ons/opx162 ◽

2017 ◽

Vol 14 (6) ◽

pp. 639-646 ◽

Cited By ~ 2

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.

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

Global Spine Journal ◽

10.1177/21925682211039498 ◽

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.

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Posterior epidural migration of herniated lumbar disc fragment

Journal of Neurosurgery Spine ◽

10.3171/2010.11.spine10142 ◽

2011 ◽

Vol 14 (3) ◽

pp. 313-317 ◽

Cited By ~ 28

Author(s):

Ahmet Sengoz ◽

Kadir Kotil ◽

Erol Tasdemiroglu

Keyword(s):

Surgical Treatment ◽

Cauda Equina Syndrome ◽

Lumbar Disc ◽

Cauda Equina ◽

Case Series ◽

Rare Condition ◽

Neurological Deficits ◽

Lumbar Region ◽

Duration Of Symptoms ◽

First Choice

Object Posterior epidural migration of a free disc fragment in the lumbar region is a very rare condition that has only been reported in isolated cases to date. Patients with this condition present with radiculopathy or major neurological deficits. Difficulties in diagnosis and the choice and timing of surgical treatment are important in these cases. In this clinical case series, features of cases with posterior epidural migration of free lumbar disc fragments accompanied by cauda equina syndrome are discussed. Methods Eight cases (0.27%) of posterior epidural migration of disc fragments were detected among 2880 patients surgically treated for lumbar disc herniation between 1995 and 2008. Seven of these patients had cauda equina syndrome. The mean duration of symptoms in the 8 cases was 4.2 days (range 1–10 days). The group included 6 men and 2 women, with a mean age of 48 years (range 34–72 years). The sequestered disc fragments were at the L3–4 level in 6 patients (75%) and the L4–5 level in 2 (25%). Magnetic resonance imaging showed tumor-like ring contrast enhancement around sequestered fragments in 5 patients. The patients' motor, sensory, sexual, and urological functions were evaluated postoperatively, and modified Odom criteria and a visual analog scale were used in the assessment of postoperative outcomes. Results A microsurgical approach was used in all cases. Sequestrectomy with minimal hemilaminotomy and removal of the free segments were performed. The patients were followed up for a mean period of 28.5 months. Three patients (37.5%) had excellent results, 3 (37.5%) had good results, 1 patient (12.5%) had fair results, and only 1 patient had poor results according to the Odom criteria. The main factors affecting the long-term outcomes were the presence of cauda equina syndrome and the time period between onset of symptoms and surgery. Conclusions Patients with posterior migration of a disc fragment present with severe neurological deficits such as cauda equina syndrome. Because the radiological images of disc fragments may mimic those of other more common posterior epidural space–occupying lesions, definite diagnosis of posteriorly located disc fragments is difficult. All of these lesions can be completely removed with hemilaminotomy and sequestrectomy, and early surgical treatment is important as a first choice to prevent severe neurological deficits.

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Short-term Complications Associated With Surgery for High-Grade Spondylolisthesis in Adults and Pediatric Patients

Neurosurgery ◽

10.1227/neu.0b013e3182535881 ◽

2012 ◽

Vol 71 (1) ◽

pp. 109-116 ◽

Cited By ~ 32

Author(s):

Manish K. Kasliwal ◽

Justin S. Smith ◽

Christopher I. Shaffrey ◽

Dwight Saulle ◽

Lawrence G. Lenke ◽

...

Keyword(s):

Surgical Treatment ◽

Pediatric Patients ◽

Case Reports ◽

Case Series ◽

Adult Patients ◽

Neurological Deficits ◽

Low Grade ◽

Complication Rates ◽

High Grade ◽

Short Term

Abstract BACKGROUND: Although it is generally agreed upon that surgery for high-grade spondylolisthesis (HGS) is associated with more complications than low-grade spondylolisthesis, its description is primarily based on case reports and relatively small case series. OBJECTIVE: To assess short-term complication rates associated with the surgical treatment of HGS in pediatric and adult patients and to identify factors associated with increased complication rates. METHODS: All cases of HGS from the Scoliosis Research Society Morbidity and Mortality database for the year 2007 were reviewed. Patients were classified as pediatric (⩽18 years) or adult (>18 years). Complications were tabulated, and the rates were compared between the patient groups and based on clinical and surgical factors. RESULTS: 165 cases of HGS were reported (88 pediatric, 77 adult). There were 49 complications (29.7%) in 41 patients (24.8%), with no difference in the proportions of pediatric vs adult patients with a complication (P = .86). Occurrence of new neurological deficit after surgery was the most common complication, seen in 19 (11.5%) patients. Performance of an osteotomy was associated with a higher incidence of new neurological deficits in both adult and pediatric groups (P = .02 and P = .012, respectively). Although most of the new neurological deficits improved over follow-up, 10% had no improvement. CONCLUSION: This study provides short-term complication rates associated with surgical treatment for HGS in adult and pediatric patients and may prove valuable for patient counseling, surgical planning, and in efforts to improve the safety of patient care.

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Palliative treatment for multiple spinal metastasis in patient with ovarian cancer

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v2i1.138 ◽

2019 ◽

Vol 2 (1) ◽

pp. 1

Author(s):

Rully Hanafi Dahlan ◽

Sevline Estethia Ompusunggu ◽

Muhammad Kusdiansah ◽

Ismail Baselim

Keyword(s):

Ovarian Cancer ◽

Surgical Treatment ◽

Palliative Treatment ◽

Spinal Metastasis ◽

Common Type ◽

Spinal Instability ◽

Intractable Pain ◽

Cancer Death ◽

Clinically Significant ◽

Common Malignancy

Ovarian cancer is the fourth most common type of female cancer and the fifth leading cause of cancer death in women. It is the fourth most common malignancy in women. Management varies depending on the patient condition, so one patient can undergo aggressive decompression and stabilization followed by adjuvant therapy, while others may respond to medication and supportive care. The decision to pursue radical surgical treatment is complex, but the indications are becoming clearer. These include radioresistant tumors, obvious spinal instability, clinically significant neural compression secondary to retropulsed bone or from spinal deformity, intractable pain unresponsive to nonoperative measures, and radiation failure.

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Surgical Treatment Outcomes in Metastatic Tumours Located at the Craniocervical Junction

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0011.5836 ◽

2018 ◽

Vol 20 (1) ◽

pp. 5-13

Author(s):

Piotr Biega ◽

Grzegorz Guzik ◽

Tomasz Pitera

Keyword(s):

Cervical Spine ◽

Surgical Treatment ◽

Primary Tumour ◽

Mechanical Damage ◽

Cardiovascular Complications ◽

Craniocervical Junction ◽

Neurological Deficits ◽

Spinal Instability ◽

Upper Cervical Spine ◽

The Mean

Background. Cancer metastases to the upper section of the cervical spine are found in a low percentage of patients. Their conservative treatment consists in radio- and chemotherapy as well as immobilisation in an orthopaedic collar. Surgery is the treatment of choice in patients with lesions causing spinal instability or compressing neural structures. The aim of this study was to assess the outcomes of surgical treatment conducted in patients with metastases located in the upper section of the cervical spine. Material and methods. The study analysed the medical records of 20 patients who underwent surgical treatment at the Department of Oncological Orthopaedics in Brzozów in 2015-2016. The majority of the patients were female (75%). The mean age of the male patients was 58 years and that of the female patients was 68 years. The most common complaints were pain (90%) and neurological deficits (50%; mainly Frankel Grade C). The most common primary tumour was breast cancer (35%). 58% of the patients had slow-growing tumours according to the Tomita system. Surgical procedures lasted a mean of 117 minutes and involved fixation of a mean of 7.5 levels. The treatment reduced the patients’ VAS score for pain by 3.89 points, improved function (Karnofsky scale) by 18 points and produced neurological improvement in 66% of the patients. The overall 2.5-year survival rate was 35%. The mean hospital stay lasted 14.5 days. One patient died on the 8th post-operative day due to cardiovascular complications. There was one case of delayed wound healing due to a haematoma. No mechanical damage to the implants, infections, or cerebrospinal fluid leaks were found. Conclusions. 1. Metastases located in the upper cervical spine are rare and cause significant technical difficulties. 2. Fixation with lateral mass screws and plates fixed with screws to the occipital bone is a safe and effective method. 3. Surgical treatment allows for restoring spinal stability, reducing pain, and improving the patients’ quality of life.

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Lipomas as an Extremely Rare Cause for Brachial Plexus Compression: A Case Series and Systematic Review

Journal of Brachial Plexus and Peripheral Nerve Injury ◽

10.1055/s-0041-1726087 ◽

2021 ◽

Vol 16 (01) ◽

pp. e10-e16

Author(s):

Oliver Gembruch ◽

Yahya Ahmadipour ◽

Mehdi Chihi ◽

Thiemo F. Dinger ◽

Laurèl Rauschenbach ◽

...

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Brachial Plexus ◽

Neurological Outcome ◽

Case Series ◽

Neurological Deficits ◽

Benign Tumors ◽

Nerve Lesion ◽

Neurosurgical Department

Abstract Introduction Brachial plexus lipomas are extremely rare benign tumors that may cause slow progression of neurological deficits leading to thoracic outlet syndrome. Up to now, surgery remains challenging. The aim of this study is to present our surgical treatment regime and long-term neurological outcome in three cases of giant brachial plexus lipomas and to show results of systematic review. Patients and Methods Retrospective analysis of our database “peripheral nerve lesion” to identify patients suffering from brachial plexus lipomas between January 1, 2012, and December 31, 2019. Systematic review was performed for literature published until March 31, 2020, analyzing PubMed, Google Scholar, Scopus, and the Cochrane Collaboration Library independently by two authors. Results Over the past years, three patients suffering from giant brachial plexus lipomas attended to our neurosurgical department. All patients underwent preoperative magnetic resonance imaging (MRI), ultrasound examinations, and electrophysiological testing. Tumors were removed microsurgically via anterior/posterior, supraclavicular/infraclavicular, and combined approaches. The patients were accessed postoperatively by MRI and clinical follow-up. Systematic review of the literature revealed 22 cases, which were analyzed in regard to demographics, surgical treatment, and neurological outcome. Conclusion Brachial plexus lipomas are an extremely rare cause for brachial plexus compression. Total microsurgical removal with intraoperative electrophysiological monitoring is the treatment of choice with excellent long-term MRI and clinical outcome.

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Criteria positive and criteria negative anaphylaxis, with a focus on undifferentiated somatoform idiopathic anaphylaxis: A review and case series

Allergy and Asthma Proceedings ◽

10.2500/aap.2020.41.200076 ◽

2020 ◽

Vol 41 (6) ◽

pp. 436-441 ◽

Cited By ~ 1

Author(s):

Daniel A. Rosloff ◽

Kunal Patel ◽

Paul J. Feustel ◽

Jocelyn Celestin

Keyword(s):

Diagnostic Criteria ◽

Statistical Significance ◽

Case Series ◽

Poor Response ◽

Response To Treatment ◽

Fisher Exact Test ◽

Subjective Symptoms ◽

Significant Difference ◽

Physical Findings ◽

Idiopathic Anaphylaxis

Background: Undifferentiated somatoform (US) idiopathic anaphylaxis (IA) is considered a psychogenic disorder characterized by a lack of observable physical findings and poor response to treatment. Although failure to diagnose true anaphylaxis can have disastrous consequences, identification of US-IA is crucial to limit unnecessary expenses and use of health care resources. Objective: To better define the presentation and understand the potential relationship between US-IA and underlying psychiatric comorbidities. Methods: We retrospectively reviewed 110 visits by 107 patients to our institution for evaluation and management of anaphylaxis over a 1-year period. The patients were classified as having either criteria positive (CP) or criteria negative (CN) anaphylaxis based on whether they met Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium criteria for the clinical diagnosis of anaphylaxis. Patient characteristics, including objective and subjective signs and symptoms, and the presence of psychiatric diagnoses were collected and analyzed. Statistical significance was assessed by using the Fisher exact test. A literature review of US-IA and other psychogenic forms of anaphylaxis was performed. Results: Patients with CP anaphylaxis were more likely to present with hypotension, wheezing, urticaria, and vomiting than were patients with CN anaphylaxis. The patients with CN anaphylaxis were more likely to present with subjective symptoms of sensory throat tightness or swelling compared with patients with CP anaphylaxis. No significant difference was detected in the prevalence of psychiatric conditions between the two groups. Conclusion: Patients who met previously established diagnostic criteria for anaphylaxis were more likely to present with objective physical findings than those who did not meet criteria for true anaphylaxis. CN patients who presented for treatment of anaphylaxis were more likely to present with subjective symptoms. Formal diagnostic criteria should be used by clinicians when evaluating patients with suspected anaphylaxis.

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