An Analysis of Patients with Single and Combined Pyogenic Spinal Infections

Jong Heon Kim; Seung-Pyo Suh; Chang-Nam Kang; Ye-Soo Park

doi:10.4055/jkoa.2008.43.5.560

Journal List > J Korean Orthop Assoc > v.43(5) > 1012828

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Kim, Suh, Kang, and Park: An Analysis of Patients with Single and Combined Pyogenic Spinal Infections

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2008; 43(5): 560-566.

Published online: 31 October 2008

DOI: https://doi.org/10.4055/jkoa.2008.43.5.560

An Analysis of Patients with Single and Combined Pyogenic Spinal Infections

Jong Heon Kim, M.D., Seung-Pyo Suh, M.D., Chang-Nam Kang, M.D.^*, Ye-Soo Park, M.D.

Department of Orthopaedic Surgery, Guri Hospital, Hanyang University College of Medicine, Korea.

^*Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Korea.

Address reprint requests to Ye-Soo Park, M.D. Department of Orthopaedic Surgery, Guri Hospital, Hanyang University College of Medicine, 249-1, Gyomun-dong, Guri 471-701, Korea. Tel: +82.31-560-2316, Fax: +82.31-557-8781, hyparkys@hanyang.ac.kr

Abstract

Purpose

Pyogenic spinal infection encompasses a broad range of clinical entities, treatment and prognosis. We compared the symptoms and treatment efficacy of patients with single and combined spinal infections.

Materials and Methods

Between June 2001 and November 2006, 30 patients with pyogenic spinal infections were treated in our hospital and outcomes were evaluated through ESR, CRP, and clinical improvement. Groups 1 and 2 represented patients with single lesions and patients with combined lesions, respectively.

Results

Group 1 included 7 men and 8 women, and the preoperative mean ESR and CRP were 62.7 mm/hr and 5.7 mg/dl. The most common clinical presentation was back pain. Nine patients in group 1 underwent operation, and two underwent instrumentation. Group 2 included 4 men and 11 women, and the preoperative mean ESR and CRP were 78.5 mm/hr and 16.7 mg/dl. The most common clinical presentations were back pain and fever. Thirteen patients in group 2 underwent operation, and six underwent instrumentation. There were more underlying diseases in group 2.

Conclusion

There were more underlying diseases and higher preoperative inflammatory-reactive laboratory findings in patients with combined spinal infections. Careful attention must be directed to treatment in order to secure favorable clinical outcomes in patients with combined infections.

Keywords: Pyogenic spinal infection, Combined infection

Figures and Tables

Table 1

Details of the Patients

^*, Initial erythrocyte sedimentation rate; ^†, Initial C-reactive protein; ^‡, Spondylodiscitis; ^§, Psoas abscess; ^∥, Epidural abscess.

References

1. Borowski AM, Crow WN, Hadjipavlou AG, et al. Interventional radiology case conference: the University of Texas Medical Branch. Percutaneous management of pyogenic spondylodiskitis. AJR Am J Roentgenol. 1998. 170:1587–1592.

2. Collert S. Osteomyelitis of the spine. Acta Orthop Scand. 1977. 48:283–290.

3. Danner RL, Hartman BJ. Update on spinal epidural abscess: 35 cases and review of the literature. Rev Infect Dis. 1987. 9:265–274.

4. Del Curling O Jr, Gower DJ, McWhorter JM. Changing concepts in spinal epidural abscess: a report of 29 cases. Neurosurgery. 1990. 27:185–192.

5. Digby JM, Kersley JB. Pyogenic non-tuberculous spinal infection: an analysis of thirty cases. J Bone Joint Surg Br. 1979. 61:47–55.

6. Eismont FJ, Bohlman HH, Soni PL, Goldberg VM, Freehafer AA. Pyogenic and fungal vertebral osteomyelitis with paralysis. J Bone Joint Surg Am. 1983. 65:19–29.

7. Emery SE, Chan DP, Woodward HR. Treatment of hematogenous pyogenic vertebral osteomyelitis with anterior debridement and primary bone grafting. Spine. 1989. 14:284–291.

8. Griffiths HE, Jones DM. Pyogenic infection of the spine. A review of twenty-eight cases. J Bone Joint Surg Br. 1971. 53:383–391.

9. Gruenwald I, Abrahamson J, Cohen O. Psoas abscess: case report and review of the literature. J Urol. 1992. 147:1624–1626.

10. Hadjipavlou AG, Katonis PK, Gaitanis IN, Muffoletto AJ, Tzermiadianos MN, Crow W. Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis. Eur Spine J. 2004. 13:707–713.

11. Hlavin ML, Kaminski HJ, Ross JS, Ganz E. Spinal epidural abscess: a ten-year perspective. Neurosurgery. 1990. 27:177–184.

12. Kao PF, Tsui KH, Leu HS, Tsai MF, Tzen KY. Diagnosis and treatment of pyogenic psoas abscess in diabetic patients: usefulness of computed tomography and gallium-67 scanning. Urology. 2001. 57:246–251.

13. Kapeller P, Fazekas F, Krametter D, et al. Pyogenic infectious spondylitis: clinical, laboratory and MRI features. Eur Neurol. 1997. 38:94–98.

14. Kemp HB, Jackson JW, Jeremiah JD, Hall AJ. Pyogenic infections occurring primarily in intervertebral discs. J Bone Joint Surg Br. 1973. 55:698–714.

15. Kim YT, Hwang WY, Han BH. Analysis of pyogenic spondylitis in adults. J Kor Soc Spine Surg. 1996. 3:69–76.

16. Lannelongue OM. On acute osteomyelitis, miscellaneous, pathological, and practical medicine tracts. 1879. Paris: 976.

17. Mackenzie AR, Laing RB, Smith CC, Kaar GF, Smith FW. Spinal epidural abscess: the importance of early diagnosis and treatment. J Neurol Neurosurg Psychiatry. 1998. 65:209–212.

18. Maiuri F, Iaconetta G, Gallicchio B, Manto A, Briganti F. Spondylodiscitis. Clinical and magnetic resonance diagnosis. Spine. 1997. 22:1741–1746.

19. Musher DM, Thorsteinsson SB, Minuth JN, Luchi RJ. Vertebral osteomyelitis. Still a diagnostic pitfall. Arch Intern Med. 1976. 136:105–110.

20. Oblak MR, Oblak C, Stankovic S. Psoas and spinal epidural abscess in a diabetic patient -case report. Diabetes Res Clin Pract. 2005. 68:274–277.

21. Osenbach RK, Hitchon PW, Menezes AH. Diagnosis and management of pyogenic vertebral osteomyelitis in adults. Surg Neurol. 1990. 33:266–275.

22. Rath SA, Neff U, Schneider O, Richter HP. Neurosurgical management of thoracic and lumbar vertebral osteomyelitis and discitis in adults: a review of 43 consecutive surgically treated patients. Neurosurgery. 1996. 38:926–933.

23. Rea GL, McGregor JM, Miller CA, Miner ME. Surgical treatment of the spontaneous spinal epidural abscess. Surg Neurol. 1992. 37:274–279.

24. Redekop GJ, Del Maestro RF. Diagnosis and management of spinal epidural abscess. Can J Neurol Sci. 1992. 19:180–187.

25. Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev. 2000. 23:175–204.

26. Sapico FL, Montgomerie JZ. Vertebral osteomeylitis. Infec Dis Clin North Am. 1990. 4:539–550.

27. Torda AJ, Gottlieb T, Bradbury R. Pyogenic vertebral osteomyelitis: analysis of 20 cases and review. Clin Infect Dis. 1995. 20:320–328.

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