Preoperative, intraoperative, and postoperative measures to further reduce spinal infections

Background Deep spinal infection is a devastating complication after epidural injection. This study aimed to investigate the incidence of deep spinal infection primarily after outpatient single-shot epidural injection for pain. Secondarily, this study assessed the national trends of the procedure and risk factors for said infection. Methods Using South Korea’s National Health Insurance Service sample cohort database, the 10-yr national trend of single-shot epidural injections for pain and the incidence rate of deep spinal infection after the procedure with its risk factors were determined. New-onset deep spinal infections were defined as those occurring within 90 days of the most recent outpatient single-shot epidural injection for pain, needing hospitalization for at least 1 night, and receiving at least a 4-week course of antibiotics. Results The number of outpatient single-shot epidural injections per 1,000 persons in pain practice doubled from 40.8 in 2006 to 84.4 in 2015 in South Korea. Among the 501,509 injections performed between 2007 and 2015, 52 cases of deep spinal infections were detected within 90 days postprocedurally (0.01% per injection). In multivariable analysis, age of 65 yr or more (odds ratio, 2.91; 95% CI, 1.62 to 5.5; P = 0.001), living in a rural area (odds ratio, 2.85; 95% CI, 1.57 to 5.0; P < 0.001), complicated diabetes (odds ratio, 3.18; 95% CI, 1.30 to 6.7; P = 0.005), multiple epidural injections (three times or more) within the previous 90 days (odds ratio, 2.34; 95% CI, 1.22 to 4.2; P = 0.007), and recent use of immunosuppressants (odds ratio, 2.90; 95% CI, 1.00 to 6.7; P = 0.025) were significant risk factors of the infection postprocedurally. Conclusions The incidence of deep spinal infection after outpatient single-shot epidural injections for pain is very rare within 90 days of the procedure (0.01%). The data identify high-risk patients and procedure characteristics that may inform healthcare provider decision-making. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Fusion Techniques for Spinal Infections

Spinal Fusion ◽

10.1007/978-1-4612-3272-8_8 ◽

1990 ◽

pp. 127-138

Author(s):

Taylor K. Smith

Keyword(s):

Spinal Infections

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Adjusted T SPOT.TB Criteria Can Increase the Specificity of Diagnosis When Differentiating Spinal Tuberculosis From Other Spinal Infections

10.21203/rs.3.rs-142854/v1 ◽

2021 ◽

Author(s):

Zhongjing Jiang ◽

Qile Gao ◽

Mingxing Tang ◽

Hongqi Zhang ◽

Yanbing Li ◽

...

Keyword(s):

Diagnostic Criteria ◽

Sensitivity And Specificity ◽

Mononuclear Cells ◽

Characteristic Curve ◽

Spinal Tuberculosis ◽

Youden Index ◽

Mycobacterium Tuberculosis Infection ◽

Peripheral Blood Mononuclear ◽

Relative Operating Characteristic ◽

Spinal Infections

Abstract Background: The ability of T-SPOT.TB to differentiate Mycobacterium tuberculosis infection of the spine from other infections is little known. This study quantified the efficiency, sensitivity, and specificity of the T-SPOT.TB assay to distinguish between spinal tuberculosis (STB) caused by M. tuberculosis and other infections of the spine and evaluated whether diagnostic performance was improved by adjusting the T-SPOT.TB assay criteria. Methods: From January 2010 to May 2020, 147 patients with spinal infections were recruited. Peripheral blood mononuclear cells were collected, and the number of spot-forming cells was observed. Patients’ white blood cell (WBC) counts, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), and TB antibodies were recorded. Specimen/tissue bacteriological culture was the reference standard for sensitivity and specificity. Results: There were 77 (52.4%) participants with confirmed TB and 70 (47.6%) with other infections. The groups were comparable in T-SPOT.TB assay results, age, sex, lesions in the segments, WBC count, CRP, procalcitonin, ESR, and TB antibodies. The sensitivity and specificity of the T-SPOT.TB assay for identifying STB was 88.3% and 40.0%, respectively. On the basis of Relative operating characteristic curve (ROC) analysis and the Youden index, when we adjusted the T-SPOT.TB assay’s diagnostic criteria, ESAT-6>12 or CFP-10>19,the sensitivity and specificity of the T-SPOT.TB assay for identifying STB was 83.1% and 64.3%, respectively. Conclusion: The T-SPOT.TB assay has great sensitivity to distinguish STB from other spinal infections; however, the specificity is extremely low. Specificity can be significantly improved while sensitivity is guaranteed by adjusting the diagnostic criteria.

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