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At least 163 records · Page 9Linked to original sources
PubMed1996

Neurosurgical management of thoracic and lumbar vertebral osteomyelitis and discitis in adults: a review of 43 consecutive surgically treated patients.

We report 43 consecutive surgically treated patients with pyogenic (37 patients) and tuberculous (6 patients) osteomyelitis of the thoracic and lumbar spine encountered within an 8-year period, including 1 with late recurrence after 15 months. There were 24 men and 18 women, ranging in age from 21 to 83 years. Twenty-six patients were in poor general condition because of associated illnesses, especially diabetes mellitus. Disease occurred at the thoracic level in 19 patients and on the lumbar spine in 24. After diagnosis, five patients were merely treated by posterior decompression; three of them, however, required further surgery for recurrent infection, spinal instability, and secondary neurological impairment. They are included in the 40 patients who underwent combined posterior débridement and internal fixation with transpedicular screw-rod systems. Autologous interbody bone grafting was performed simultaneously in 18 patients and in a second stage operation in 21 patients. One of them (tuberculous) experienced early recurrence and required anterior fusion. In two patients, methylmethacrylate packing was used for spine reconstruction; one of them had a late recurrence. Of the 26 patients with preoperative marked or severe neurological deficit (Frankel Grades A, 2 patients; B, 1 patient; C, 17 patients; and D, 6 patients), 23 (88%) had significant improvement of one grade (15 patients) or more (8 patients). There were no permanent complications. However, intensive care treatment was necessary in 20 of the 26 patients in reduced general condition (mean age, 72 yr). Two patients required further surgery because of postoperative epidural hematoma and pedicle screw malpositioning. In conclusion, most patients with thoracic and lumbar osteomyelitis can be successfully treated by combined débridement and internal fixation using only a posterior approach. Autogenous interbody bone grafting can be simultaneously performed and allows early mobilization of the patient.

Adult↗
PubMed1999

Anterior disc protrusion as a cause for abdominal symptoms in childhood discitis. A case report.

STUDY DESIGN: A case report on infectious spondylitis in a child who reported abdominal pain and whose magnetic resonance image revealed anterior herniation of disc space contents. OBJECTIVES: To correlate the direction of disc protrusion in infectious spondylitis with clinical manifestations. SUMMARY OF BACKGROUND DATA: Previous studies have correlated posterior protrusion of disc space contents in infectious spondylitis with a clinical presentation of back pain, paravertebral muscle spasm, hamstrings tightness, and radiculopathy. None has connected anterior herniation of disc phlegmon with abdominal pain. METHODS: In addition to plain radiography and bone scintigraphy, magnetic resonance imaging was used to confirm the diagnosis of infectious spondylitis in a 6-year-old child with abdominal pain. Regular review for 1 year included repeat magnetic resonance imaging at 3 months. RESULTS: Initial magnetic resonance imaging revealed characteristic changes associated with infectious spondylitis throughout the L5-S1 vertebra-disc-vertebra unit and anterior protrusion of the disc material and phlegmon. Magnetic resonance imaging at follow-up examination 3 months later demonstrated complete resolution of the disc herniation. CONCLUSION: Future magnetic resonance imaging studies should correlate direction of disc herniation with age and symptomatology to validate or improve classifications of infectious spondylitis, which presently include only the last two parameters.

Abdominal Pain↗
PubMed2005

Gowers' sign in children with discitis of the lumbar spine.

Gowers' sign is pathognomonic in patients with Duchenne muscular dystrophy. These patients, when rising, 'climb up' their thighs using their hands in order to overcome the weakness of the pelvic girdle and paravertebral muscles. We report on four children in the age range of 3.3-8 years with disc space infection in the lumbar region, who demonstrated the sign in the early stages of the disease. Following treatment, Gowers' sign disappeared in all of these patients. We therefore conclude that the presence of Gowers' sign in small children must alert the examiner to the possibility of infection in the lumbar spine. These children use this maneuver in order to avoid painful motion of the lumbar spine.

Anti-Bacterial Agents↗
PubMed2006

Lumbar discitis.

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Discitis↗
PubMed1992

Infectious discitis caused by Enterobacter cloacae.

The case is reported of a patient who developed a vertebral osteomyelitis caused by Enterobacter cloacae. The organism was isolated in cultures of blood and vertebral puncture biopsy samples. The patient was satisfactorily treated with trimethroprim and sulphamethoxazole. Enterobacter cloacae, a Gram negative organism, has been confirmed as the cause of bacteremia in patients with burns, urinary infections, in adults with pneumonia, and in children with joint infections. Spondylodiscitis caused by Enterobacter cloacae has not previously been described.

Aged↗