Cases reported "Discitis"

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1/22. Surgical treatment of aspergillus spondylodiscitis.

    Four cases of aspergillus spondylodiscitis were treated with operative debridement and fusion. In this rarely encountered mycotic infection of the spine in immunocompromised patients rapid destruction of the intervertebral disc and vertebral bodies can occur. In advanced cases antimycotic drug therapy is thought to be ineffective and a forcing indication for surgery exists when the destruction is progressive and spinal cord compression is imminent or manifest. Spinal instrumentation can be of help in maintaining or restoring spinal stability and maintaining spinal alignment. In our four patients the aspergillus spondylodiscitis was successfully eradicated and fusion achieved. In two of three patients with a neurologic deficit, this deficit disappeared. Two patients died within 6 months after the operative treatment, due to complications related to the underlying illness. One patient was left with a subtotal paraplegia.
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2/22. The role of laparoscopic biopsies in lumbar spondylodiscitis.

    Infection of an intervertebral disk is a serious condition. diagnosis often is elusive and difficult. It is imperative to obtain appropriate microbiological specimens before initiation of treatment. The authors describe a 51-year-old woman with lumbar spondylodiscitis that was because of infection after the placement of an epidural catheter for postoperative analgesia. A spinal magnetic resonance imaging confirmed the diagnosis, but computed tomography-guided fine needle biopsy did not provide adequate material for a microbiologic diagnosis. Laparoscopic biopsies of the involved disk provided good specimens and a diagnosis of propionibacterium acnes infection. The authors believe that this minimally invasive procedure should be performed when computed tomography-guided fine needle biopsy does not provide a microbiologic diagnosis in spondylodiscitis.
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3/22. Candida osteomyelitis and diskitis after spinal surgery: an outbreak that implicates artificial nail use.

    Postoperative wound infection after laminectomy is uncommon. In February 1997, 3 patients were confirmed to have postlaminectomy deep wound infections due to candida albicans. No similar case had been seen during the previous 10 years. The infections were indolent, with a mean time from initial operation to diagnosis of 54 days (range, 26-83 days). All patients were successfully treated. Pulsed-field gel electrophoresis revealed the Candida isolates to be identical. A case-controlled study and medical record review revealed that a single operating room technician scrubbed on all 3 infected case patients but on only 32% of the uninfected controls. The technician had worn artificial nails for a 3-month period that included the dates of laminectomy site infections, and C. albicans was isolated from her throat. She was treated with fluconazole and removed from duty. No subsequent cases have occurred during the ensuing 3 years. Artificial nails are known to promote subungual growth of gram-negative bacilli and yeast. This may be clinically relevant, and hospitals should enforce policies to prevent operating room personnel from wearing artificial nails.
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4/22. The role of laparoscopic biopsies in lumbar spondylodiscitis.

    The infection of an intervertebral disk is a serious condition. The diagnosis often is elusive and difficult to make. It is imperative to have appropriate microbiologic specimens before the initiation of treatment. We report the case of a 51-year-old woman with lumbar spondylodiscitis caused by infection after the placement of an epidural catheter for postoperative analgesia. A spinal magnetic resonance imaging (MRI) scan confirmed the diagnosis, but computed tomography (CT)-guided fine-needle biopsy did not yield adequate material for a microbiologic diagnosis. Laparoscopic biopsies of the involved disk provided good specimens and a diagnosis of propionibacterium acnes infection. We believe that this minimally invasive procedure should be performed when CT-guided fine-needle biopsy fails to yield a microbiologic diagnosis in spondylodiscitis.
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5/22. Vertebral osteomyelitis secondary to epidural catheter use: a case report.

    STUDY DESIGN: A case of vertebral osteomyelitis secondary to epidural catheter use is reported. OBJECTIVE: To investigate the occurrence of vertebral osteomyelitis after the use of an epidural catheter. SUMMARY OF BACKGROUND DATA: Vertebral osteomyelitis is a rare but serious complication of epidural catheter use that apparently has not been reported previously in orthopedic literature. methods: A patient underwent abdominal surgery, and an epidural catheter was used for postoperative pain relief. He presented 3 months later with severe midlumbar pain. magnetic resonance imaging and microbiologic examination of a specimen obtained at open biopsy were used in the investigation. RESULTS: magnetic resonance imaging suggested vertebral osteomyelitis involving L1-L3. The patient underwent open debridement and posterior instrument stabilization. Biopsies taken from L3 pedicles yielded pseudomonas aeruginosa, which had been recovered earlier from the epidural catheter tip. CONCLUSION: Vertebral osteomyelitis is a rare but serious complication of epidural catheter use.
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6/22. discitis associated with pregnancy and spinal anesthesia.

    discitis (inflammation of the intervertebral disk) most commonly develops as a rare complication of bacterial infection or chemical or mechanical irritation during spine surgery (1) with a postoperative incidence of 1%-2.8% (2). It is also a complication of discography-the intradiscal injection of saline or contrast material (3). The incidence of postdiscography discitis is 1%-4% (3); no cases have been reported when prophylactic antibiotics have been used, supporting the theory of bacterial contamination (3). Although it is controversial whether discitis can be caused by an aseptic or infectious process, recent data suggest that persistent discitis is almost always bacterial (4). Honan et al. (5) reported 16 cases of spontaneous discitis and reviewed another 52 patients from the literature. In their series, patients tended to have one or more comorbid conditions, such as diabetes, vertebral fracture, or a preexisting spine injury. Spontaneous discitis has also been associated with advanced age, IV drug abuse, IV access contamination, urinary tract infection, and immunocompromised states (5,6). No cases of infectious discitis associated with pregnancy and spinal anesthesia have been reported in the English literature. discitis presents as spasmodic pain in the back that may be referred to the hips or groin (7). The pain may radiate to the lower extremities. The erythrocyte sedimentation rate is usually increased. Radiological changes in discitis include narrowing of the intervertebral disk space, vertebral sclerosis, and erosion of the end plates. The best diagnostic measure may be magnetic resonance imaging (MRI) or a combination of bone and gallium scanning (2). The mainstay for discitis treatment is pain control and antibiotics; surgical intervention is usually not required. Complications of discitis include intervertebral fusion, epidural abscess, and paralysis. IMPLICATIONS: This is a case report of a disk infection (discitis) caused by the bacteria, streptococcus bovis after spinal anesthesia for cesarean delivery. S. bovis rarely causes discitis, and spinal anesthesia for labor and delivery has not been reported as a cause of discitis.
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7/22. Postoperative clostridium perfringens lumbar discitis with septicemia: report of a case with survival.

    This case report describes the successful treatment of a case of clostridium perfringens postoperative discitis and suggests a management protocol for this condition. The medical literature to date reports only one similar case, treated without success. The patient has been well but the affected space later collapsed with mechanical pain and has required fusion. C. perfringens discitis can be treated successfully.
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8/22. Spontaneous fusion of isthmic spondylolisthesis after discitis: a case report.

    This is the first case report of a child with isthmic spondylolisthesis and discitis who had spontaneous fusion develop at an unstable level with relief of symptoms after nonoperative treatment. Although the blood culture was negative, the 14-year-old boy with Grade III isthmic spondylolisthesis of L5 was diagnosed with discitis at the L5-S1 level, based on clinical findings, elevated c-reactive protein, plain radiographs, and magnetic resonance imaging scans. The patient was treated with antibiotics for 19 weeks and bed rest for 4 weeks followed by immobilization in a hip spica cast for 8 weeks and a thoracolumbosacral orthosis for an additional 12 weeks. The lumbar back pain improved and there was a decrease in c-reactive protein to the normal range 3 weeks after onset. Forty months from onset, the patient was free from lumbar back or leg pain and his clinical neurologic examination was normal. Plain radiographs showed spontaneous fusion between L5 and the sacrum. This suggests that nonoperative treatment is acceptable even if discitis occurs at an unstable level.
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9/22. eikenella corrodens discitis after spinal surgery: case report and literature review.

    eikenella corrodens is part of the normal flora of the mouth and upper respiratory tract and is usually associated with dental and head and neck infections. We report a case of Eikenella discitis occurring soon after spinal surgery in an otherwise healthy patient, review the literature on bone and joint infections unrelated to human bites and fist-fight injuries, and stress the importance of definitive diagnosis in post-operative spinal infections.
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10/22. serratia spondylodiscitis after elective lumbar spine surgery: a report of two cases.

    STUDY DESIGN: This report describes two cases of acute spondylodiscitis, caused by, complicating two different conditions: microdiscectomy for herniated nucleus pulposus and decompressing laminotomy for spinal stenosis. OBJECTIVE: To describe a rare and life-threatening spinal infection and discuss its successful management. SUMMARY OF BACKGROUND DATA: To our knowledge, no published reports in the English language have described this potentially devastating infection as a complication of elective noninstrumented discectomy or decompressive laminotomy. methods: Two cases of a very early onset of acute spondylodiscitis, caused by, after minimally invasive lumbar spine surgeries are presented. The elapsed time between these two complications was 1 week. The clinical presentation was characteristically stormy in both cases. On postoperative day 2, the patients developed high fever with intense chills and concomitant acute low back pain rapidly increasing in severity. The overall clinical appearance was alarming. The patients were carefully investigated immediately and scrutinized for possible origin of the infection. Treatment consisted of prompt intravenous antibiotics and surgical debridement. RESULTS: The history and clinical manifestations of postoperative spondylodiscitis were corroborated with magnetic resonance imaging findings and bacteriologic and hematologic laboratory examination. blood cultures revealed as the responsible pathogenic microorganism. The source of the pathogens was contaminated normal saline used for surgical lavage. Both patients were able to completely resume their previous occupations after aggressive surgical debridement/irrigation and 3 months of antibiotic treatment. CONCLUSIONS: may become a potential pathogen, causing severe spinal infection after elective surgery. For prompt diagnosis and effective treatment of this life-threatening infection, one should maintain high index of suspicion and should not procrastinate in initiating treatment, which should consist of appropriate intravenous antibiotics and surgical debridement.
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