1/33. psoas abscess secondary to discitis: a case report of conservative management.We report a case of secondary psoas abscess in a 37-year-old man with a 3-week history of severe low backache managed conservatively without surgical drainage. Apart from bilaterally restricted straight leg raising (<70 degrees), his neurologic examination was within normal limits. magnetic resonance imaging showed discitis of the L3-L4 space and a left-sided secondary psoas abscess. Aspiration biopsy of the abscess material under radiologic control isolated staphylococcus aureus, which responded to appropriate antibiotic therapy with complete resolution. A high index of suspicion is necessary for diagnosis of psoas abscess, which should be considered in patients with pyrexia and backache with a neurologic examination that is otherwise normal. We discuss the recommendations for surgical and nonsurgical approaches.- - - - - - - - - - ranking = 1keywords = discitis (Clic here for more details about this article) |
2/33. Spondylodiscitis associated with bacteraemia due to coagulase-negative staphylococci.Three cases are reported of spondylodiscitis caused by coagulase-negative staphylococci in patients without osteosynthetic material. All three patients had bacteraemia associated with an infected intravascular device left in place. On the basis of this observation, it is concluded that such devices should be removed promptly in cases of prolonged or relapsing bacteraemia. Furthermore, spondylodiscitis should be suspected in patients with back pain after bacteraemia caused by coagulase-negative staphylococci.- - - - - - - - - - ranking = 1.7851130011201keywords = spondylodiscitis, discitis (Clic here for more details about this article) |
3/33. Septic arthritis of a lumbar facet joint caused by staphylococcus aureus.STUDY DESIGN: Case report of a 35-year-old woman with septic arthritis of a lumbar facet joint. OBJECTIVES: To report a rare case of severe low back pain and the specific differential diagnostic problems. SUMMARY OF BACKGROUND DATA: Differential diagnosis between spondylodiscitis and facet joint septic arthritis on a clinical basis is very difficult. The lesions of the joint appear on a plain film only approximately 1.5 months after onset of the symptoms. Although the radionuclide bone scan is sensitive and shows a more laterally and vertically localized uptake than in spondylodiscitis, this technique is not very specific. Computed tomography scan and magnetic resonance imaging are the most reliable investigations even at the very early stages of the disease. Confirmation of the diagnosis has to be obtained by blood cultures or, in exceptional cases, by direct puncture of the joint. Appropriate antibiotic treatment is in most cases sufficient to heal this lesion. methods: The etiology, clinical presentation, technical examinations, and treatment are reviewed. RESULTS: Computed tomography scan and magnetic resonance imaging complemented by positive blood cultures led to the very early diagnosis of septic arthritis of the lumbar facet joint in this relatively young patient. CONCLUSIONS: With our case report we confirm the very small number of data reported in the literature, indicating that infections of the facet joint can be detected at a very early stage using magnetic resonance imaging and computed tomography scan.- - - - - - - - - - ranking = 0.9851130011201keywords = spondylodiscitis, discitis (Clic here for more details about this article) |
4/33. Septic arthritis of the spine facet joint: early positive diagnosis on magnetic resonance imaging. review of two cases.We report two cases of septic arthritis of the spine facet joint in two patients with no previous medical history. Clinical symptoms were consistent with a spondylodiscitis. blood cultures were positive for staphylococcus aureus. The infection was initially shown and precisely localised with magnetic resonance imaging, despite an initially negative or aspecific bone scintigraphy. magnetic resonance imaging of the spine demonstrated infection involving the epidural space and paraspinal musculature and enhancement of the infected thoracic and lumbar facet joint after gadolinium injection.- - - - - - - - - - ranking = 0.49255650056005keywords = spondylodiscitis, discitis (Clic here for more details about this article) |
5/33. Infective discitis as an uncommon but important cause of back pain in older people.case reports: two elderly patients (aged 70 and 80 years) presented with severe back pain and restriction of spinal movements. Inflammatory markers were raised and in each case computed tomography findings confirmed infective discitis. One patient improved with antibiotics but the second developed paraplegia, a recognized complication of discitis. CONCLUSION: the association of back pain, restricted spinal movements and raised inflammatory markers should act as 'red flags', alerting the clinician to the presence of serious, but potentially treatable pathology.- - - - - - - - - - ranking = 1.2keywords = discitis (Clic here for more details about this article) |
6/33. Pyogenic spondylitis in an S1-S2 immobile segment.STUDY DESIGN: A case of pyogenic spondylitis in S1-S2 is presented. OBJECTIVE: To describe the diagnosis and management of this rare spondylitis. SUMMARY OF BACKGROUND DATA: The segment including the first and second sacral vertebrae is not mobile. Therefore, discitis of S1-S2 and adjacent spondylitis is very rare. To the authors' knowledge, this is the first reported case of infectious spondylitis in an immobile segment: S1-S2. methods: In addition to radiography and bone scintigraphy, magnetic resonance imaging was used to confirm the diagnosis. Changes consistent with infectious spondylitis were shown, including an epidural abscess. RESULTS: The patient was treated with laparoscopic drainage and biopsy. staphylococcus aureus was cultured, and adequate antibiotics were administered. Repeat magnetic resonance imaging at approximately 4 months demonstrated normal signal intensity and disappearance of the abscess. CONCLUSION: Findings from this study show that pyogenic spondylitis can occur in immobile S1-S2.- - - - - - - - - - ranking = 0.2keywords = discitis (Clic here for more details about this article) |
7/33. Hematogenous cervical spondylodiscitis after severe burn injury.A 47-year-old man sustained a 31% TBSA burn injury. In spite of early escharectomy and mesh-graft-transplantation the patient suffered a septicaemic phase in the first week, which was treated by a specific antibiotic. Five weeks after the burn injury a cervical spondylodiscitis was diagnosed. Immediate wound debridement, ventral and dorsal spondylodesis with a tricortical bone-graft from the left iliac crest and titanium plates and specific antibiotic therapy led to the stabilization and healing of the cervical spinal column. The spondylodiscitis was microbiologically proved to be hematogenous after spread of staphylococcus aureus from the blood in the early septicaemic phase. Swab culture from the burn surface wound, infected vertebrae and blood during the septicaemic phase revealed coagulase positive S. aureus. The aetiology, predisposing factors and management of this rare, but recognized, complication of major burns are discussed. Case features of this patient are compared with the single site's reported case of hematogenous cervical spondylodiscitis after severe burn injury.- - - - - - - - - - ranking = 3.4478955039204keywords = spondylodiscitis, discitis (Clic here for more details about this article) |
8/33. Three-year outcome in a patient with staphylococcus lugdunensis discitis.The few reported cases of bone and joint infection by staphylococcus lugdunensis indicate that the clinical manifestations are severe, the diagnosis elusive, and the treatment difficult. We report a case of lumbar discitis caused by staphylococcus lugdunensis in a 67-year-old man receiving chemotherapy for stage III IgA lambda multiple myeloma. Treatment was with ofloxacin and pristinamycin for 1 year. Although he started to improve only 5 months after treatment initiation, the outcome was favorable. Follow-up at the time of this writing is 3 years.- - - - - - - - - - ranking = 1keywords = discitis (Clic here for more details about this article) |
9/33. Polysegmental spondylodiscitis and concomitant aortic aneurysm rupture: case report with 3-year follow-up period.STUDY DESIGN: A case report describing a patient with spondylodiscitis of the thoracic and lumbar spine complicated by rupture of an abdominal aortic aneurysm and aggravation of neurologic symptoms is presented. OBJECTIVE: To present a cardiovascular complication worsening the clinical condition during conservative spondylodiscitis therapy, and to describe a minimally invasive treatment regimen for both spondylodiscitis and aortic aneurysm rupture in multimorbid patients at high risk for complications or refusal of surgery. SUMMARY OF BACKGROUND DATA: Few articles describe minimally invasive treatment of spondylodiscitis. Some available reports describe neurologic symptoms resulting from spinal cord ischemia in aortic aneurysm rupture. No data were found describing simultaneous therapy for spondylodiscitis and rupture of aortic aneurysm. methods: Therapy consisted of CT-guided percutaneous drainage of the spondylodiscitis and parenteral antibiotic treatment combined with immobilization and minimally invasive endoluminal exclusion of the aortic aneurysm with a bifurcated stent graft. RESULTS: Effective therapy for polysegmental spondylodiscitis on the one hand and contained rupture of aortic aneurysm on the other are presented. The successful clinical outcome after conservative orthopedic therapy and vascular intervention has been followed for 3 years. CONCLUSIONS: In older patients, spondylodiscitis may be complicated by other underlying diseases. Pain and neurologic symptoms may occur secondarily to concomitant illnesses instead of being caused by the inflammation itself. Minimally invasive therapy is shown to be an effective alternative to surgery in older and multimorbid patients with spondylodiscitis and contained aortic aneurysm rupture.- - - - - - - - - - ranking = 6.4032345072807keywords = spondylodiscitis, discitis (Clic here for more details about this article) |
10/33. A man with backache and renal failure.Backache, a common symptom, is rarely caused by infection of the lumbar discs. The authors present the case of a 60-year-old man with a staphylococcus aureus septicemia and associated lumbar discitis in whom a pauci immune crescentic glomerulonephritis and renal failure developed. Treatment with antibiotics and not immunosuppressive agents resulted in improved renal function with a discharge creatinine level of 1.87 mg/dL (165 micromol/L). This case highlights an association of pauci-immune crescentic glomerulonephritis with discitis that responded to antibiotic therapy alone.- - - - - - - - - - ranking = 0.4keywords = discitis (Clic here for more details about this article) |
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