Primary cervical osteomyelitis.

July 3, 2017 at 3:21 pm

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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Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, F.O.D, FIEBRE en el POSTOPERATORIO, Health Care-Associated Infections, Infecciones cabeza y cuello, Infecciones nosocomiales, Infecciones osteo-articulares-musculares, Infecciones relacionadas a prótesis, Infecciones sitio quirurgico, Metodos diagnosticos, REPORTS, Sepsis, Update.

Pyogenic vertebral osteomyelitis: identification of microorganism and laboratory markers used to predict clinical outcome. Vital Signs: Health Care-Associated Legionnaires’ Disease Surveillance Data from 20 States and a Large Metropolitan Area – United States, 2015.


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