Archive for July 3, 2017

Primary cervical osteomyelitis.

J Chin Med Assoc. 2013 Nov;76(11):640-7.

Tsai CE1, Lee FT, Chang MC, Yu WK, Wang ST, Liu CL.

Abstract

BACKGROUND:

Cervical osteomyelitis accounts for only 3-11% of all cases of spinal osteomyelitis, and the diagnosis may be delayed. The characteristics of different pathogens causing cervical osteomyelitis are not fully understood, and there are few established guidelines for treatment.

METHODS:

The cases of six patients who presented with primary cervical osteomyelitis in the orthopedic department between January 2002 and March 2012 were retrospectively reviewed. All patients had been treated with anterior decompression, instrumentation, and autograft fusion. Data about preoperative and postoperative symptoms, neurological function, pain, C-reactive protein (CRP) levels, and the results of plain film and magnetic resonance imaging were reviewed.

RESULTS:

Intraoperative cultures revealed Staphylococcus aureus in three patients, Propionibacterium acnes in two, and Mycobacterium tuberculosis in one. The mean duration between symptoms and diagnosis was 7.2 weeks (range, 3-12 weeks). Three patients with S. aureus infections had relatively higher preoperative CRP levels (mean, 173 mg/L) than did the patients with P. acnes infections or tuberculosis (mean, 5.5 mg/L). However, bony destruction was less severe in patients with S. aureus infections than in those patients with P. acnes and tuberculosis. All CRP levels returned to normal in 12 weeks, and all six patients had a final stable cervical alignment and fusion. Ultimately, neurological function and pain score improved in all patients.

CONCLUSION:

Cervical osteomyelitis caused by S. aureus has an acute onset, higher CRP level, shorter duration from onset to diagnosis and thus causes less bony destruction. By contrast, cervical osteomyelitis caused by P. acnes and tuberculosis has an indolent course, a low or even normal CRP level, a longer duration from onset to diagnosis, and produces more severe bony destruction. Anterior decompression, instrumentation, and autograft fusion can be successfully used to treat primary cervical osteomyelitis. However, a mesh cage can also be a good alternative to an autograft.

PDF

http://www.jcma-online.com/article/S1726-4901(13)00179-2/pdf

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July 3, 2017 at 3:21 pm

Pyogenic vertebral osteomyelitis: identification of microorganism and laboratory markers used to predict clinical outcome.

Eur Spine J. 2010 Apr;19(4):575-82.                                            

Yoon SH1, Chung SK, Kim KJ, Kim HJ, Jin YJ, Kim HB.

Author information

1 Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea.

Abstract

The aim of this study is to determine the predictive values of laboratory indicators of pyogenic vertebral osteomyelitis (PVO) and a potential cure if the microorganism cannot be identified. Forty-five consecutive patients with PVO were enrolled.

Antibiotic therapy with or without surgery was performed according to microorganism. In the negative-culture (NC) group, cefazolin was administered in cases of hematogenous PVO, and vancomycin was administered in cases of postoperative or procedure-related PVO.

The clinical, laboratory, and radiological findings were followed up with regard to an appropriate response to antimicrobial therapy.

Nine patients were treated with antibiotics alone. We were able to identify the microorganism in 34 cases (75.6%). Ten cases in NC group were cured without recurrence, but one was not. Identification of the microorganisms did not have any significant influence on the treatment outcome, duration of antibiotic administration or normalization of laboratory profiles.

For erythrocyte sedimentation rate (ESR) values over 55 mm/h and C-reactive protein (CRP) values of 2.75 mg/dL at fourth week after antibiotic administration by means of ROC curve analysis, we expect significantly high rates of treatment failure by Pearson chi(2) test (chi(2) = 4.344, Odds ratio = 5.15, p = 0.037, 95% CI 1.004-26.597).

Even in patients with negative culture findings, it is expected that a good outcome will be achieved by the administration of cefazolin or vancomycin for about 6 weeks. It is concluded that antibiotics selected according to the etiological setting can be initiated without the need to start empirical antibiotics.

In every instance at fourth week after the initiation of antibiotic therapy, the values of CRP and ESR can provide meaningful information regarding whether clinicians need to reevaluate the effectiveness of antibiotics by performing follow-up imaging studies and monitoring the patient’s clinical manifestations.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2899831/pdf/586_2009_Article_1216.pdf

July 3, 2017 at 12:48 pm


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