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Published in: European Spine Journal 12/2013

01-12-2013 | Review Article

Spinal infection: state of the art and management algorithm

Authors: Rui M. Duarte, Alexander R. Vaccaro

Published in: European Spine Journal | Issue 12/2013

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Abstract

Introduction

Spinal infection is a rare pathology although a concerning rising incidence has been observed in recent years. This increase might reflect a progressively more susceptible population but also the availability of increased diagnostic accuracy. Yet, even with improved diagnosis tools and procedures, the delay in diagnosis remains an important issue. This review aims to highlight the importance of a methodological attitude towards accurate and prompt diagnosis using an algorithm to aid on spinal infection management.

Methods

Appropriate literature on spinal infection was selected using databases from the US National Library of Medicine and the National Institutes of Health.

Results

Literature reveals that histopathological analysis of infected tissues is a paramount for diagnosis and must be performed routinely. Antibiotic therapy is transversal to both conservative and surgical approaches and must be initiated after etiological diagnosis. Indications for surgical treatment include neurological deficits or sepsis, spine instability and/or deformity, presence of epidural abscess and upon failure of conservative treatment.

Conclusions

A methodological assessment could lead to diagnosis effectiveness of spinal infection. Towards this, we present a management algorithm based on literature findings.
Literature
1.
go back to reference Tayles N, Buckley HR (2004) Leprosy and tuberculosis in iron age southeast Asia? Am J Phys Anthropol 125(3):239–256PubMed Tayles N, Buckley HR (2004) Leprosy and tuberculosis in iron age southeast Asia? Am J Phys Anthropol 125(3):239–256PubMed
2.
go back to reference Camillo FX (2008) Infections of the spine. In: Canale ST, Beaty JH (eds) Campbell’s operative orthopaedics. Mosby Elsevier, Philadelphia Camillo FX (2008) Infections of the spine. In: Canale ST, Beaty JH (eds) Campbell’s operative orthopaedics. Mosby Elsevier, Philadelphia
3.
go back to reference Frangen TM et al (2006) Surgical management of spondylodiscitis. An analysis of 78 cases. Unfallchirurg 109(9):743–753PubMed Frangen TM et al (2006) Surgical management of spondylodiscitis. An analysis of 78 cases. Unfallchirurg 109(9):743–753PubMed
4.
go back to reference Sobottke R et al (2008) Current diagnosis and treatment of spondylodiscitis. Dtsch Arztebl Int 105(10):181–187PubMed Sobottke R et al (2008) Current diagnosis and treatment of spondylodiscitis. Dtsch Arztebl Int 105(10):181–187PubMed
5.
go back to reference Butler JS et al (2006) Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center. Spine (Phila Pa 1976) 31(23):2695–2700 Butler JS et al (2006) Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center. Spine (Phila Pa 1976) 31(23):2695–2700
6.
go back to reference Tsiodras S, Falagas ME (2006) Clinical assessment and medical treatment of spine infections. Clin Orthop Relat Res 444:38–50PubMed Tsiodras S, Falagas ME (2006) Clinical assessment and medical treatment of spine infections. Clin Orthop Relat Res 444:38–50PubMed
7.
go back to reference Tyrrell PN, Cassar-Pullicino VN, McCall IW (1999) Spinal infection. Eur Radiol 9(6):1066–1077PubMed Tyrrell PN, Cassar-Pullicino VN, McCall IW (1999) Spinal infection. Eur Radiol 9(6):1066–1077PubMed
8.
go back to reference Krogsgaard MR, Wagn P, Bengtsson J (1998) Epidemiology of acute vertebral osteomyelitis in Denmark: 137 cases in Denmark 1978–1982, compared to cases reported to the National Patient Register 1991–1993. Acta Orthop Scand 69(5):513–517PubMed Krogsgaard MR, Wagn P, Bengtsson J (1998) Epidemiology of acute vertebral osteomyelitis in Denmark: 137 cases in Denmark 1978–1982, compared to cases reported to the National Patient Register 1991–1993. Acta Orthop Scand 69(5):513–517PubMed
9.
go back to reference Mylona E et al (2009) Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum 39(1):10–17PubMed Mylona E et al (2009) Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum 39(1):10–17PubMed
10.
go back to reference Grammatico L et al (2008) Epidemiology of vertebral osteomyelitis (VO) in France: analysis of hospital-discharge data 2002–2003. Epidemiol Infect 136(5):653–660PubMed Grammatico L et al (2008) Epidemiology of vertebral osteomyelitis (VO) in France: analysis of hospital-discharge data 2002–2003. Epidemiol Infect 136(5):653–660PubMed
11.
go back to reference Carragee EJ (1997) Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am 79(6):874–880PubMed Carragee EJ (1997) Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am 79(6):874–880PubMed
12.
go back to reference Fantoni M et al (2012) Epidemiological and clinical features of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):2–7PubMed Fantoni M et al (2012) Epidemiological and clinical features of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):2–7PubMed
13.
go back to reference Afshar M, Reilly RF (2011) Spondylodiscitis in a patient on chronic hemodialysis. Nat Rev Nephrol 7(10):599–604PubMed Afshar M, Reilly RF (2011) Spondylodiscitis in a patient on chronic hemodialysis. Nat Rev Nephrol 7(10):599–604PubMed
14.
go back to reference Jensen AG et al (1997) Increasing frequency of vertebral osteomyelitis following Staphylococcus aureus bacteraemia in Denmark 1980–1990. J Infect 34(2):113–118PubMed Jensen AG et al (1997) Increasing frequency of vertebral osteomyelitis following Staphylococcus aureus bacteraemia in Denmark 1980–1990. J Infect 34(2):113–118PubMed
15.
go back to reference Silber JS et al (2002) Management of postprocedural discitis. Spine J 2(4):279–287PubMed Silber JS et al (2002) Management of postprocedural discitis. Spine J 2(4):279–287PubMed
16.
go back to reference Jimenez-Mejias ME et al (1999) Postoperative spondylodiskitis: etiology, clinical findings, prognosis, and comparison with non-operative pyogenic spondylodiskitis. Clin Infect Dis 29(2):339–345PubMed Jimenez-Mejias ME et al (1999) Postoperative spondylodiskitis: etiology, clinical findings, prognosis, and comparison with non-operative pyogenic spondylodiskitis. Clin Infect Dis 29(2):339–345PubMed
17.
go back to reference Euba G et al (2008) Long-term clinical and radiological magnetic resonance imaging outcome of abscess-associated spontaneous pyogenic vertebral osteomyelitis under conservative management. Semin Arthritis Rheum 38(1):28–40PubMed Euba G et al (2008) Long-term clinical and radiological magnetic resonance imaging outcome of abscess-associated spontaneous pyogenic vertebral osteomyelitis under conservative management. Semin Arthritis Rheum 38(1):28–40PubMed
18.
go back to reference Hadjipavlou AG et al (2000) Hematogenous pyogenic spinal infections and their surgical management. Spine (Phila Pa 1976) 25(13):1668–1679 Hadjipavlou AG et al (2000) Hematogenous pyogenic spinal infections and their surgical management. Spine (Phila Pa 1976) 25(13):1668–1679
19.
go back to reference Lim MR, Lee JY, Vaccaro AR (2006) Surgical infections in the traumatized spine. Clin Orthop Relat Res 444:114–119PubMed Lim MR, Lee JY, Vaccaro AR (2006) Surgical infections in the traumatized spine. Clin Orthop Relat Res 444:114–119PubMed
20.
go back to reference Govender S (2005) Spinal infection. J Bone Joint Surg Br 87 (B):1454–1458 Govender S (2005) Spinal infection. J Bone Joint Surg Br 87 (B):1454–1458
21.
go back to reference Sapico FL (1996) Microbiology and antimicrobial therapy of spinal infections. Orthop Clin North Am 27(1):9–13PubMed Sapico FL (1996) Microbiology and antimicrobial therapy of spinal infections. Orthop Clin North Am 27(1):9–13PubMed
22.
go back to reference Colmenero JD et al (1997) Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases. Ann Rheum Dis 56(12):709–715PubMed Colmenero JD et al (1997) Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases. Ann Rheum Dis 56(12):709–715PubMed
23.
go back to reference Turunc T et al (2007) A comparative analysis of tuberculous, brucellar and pyogenic spontaneous spondylodiscitis patients. J Infect 55(2):158–163PubMed Turunc T et al (2007) A comparative analysis of tuberculous, brucellar and pyogenic spontaneous spondylodiscitis patients. J Infect 55(2):158–163PubMed
24.
go back to reference Ratcliffe JF (1982) An evaluation of the intra-osseous arterial anastomoses in the human vertebral body at different ages. Microarteriographic Study. J Anat 134(Pt 2):373–382 Ratcliffe JF (1982) An evaluation of the intra-osseous arterial anastomoses in the human vertebral body at different ages. Microarteriographic Study. J Anat 134(Pt 2):373–382
25.
go back to reference Ratcliffe JF (1985) Anatomic basis for the pathogenesis and radiologic features of vertebral osteomyelitis and its differentiation from childhood discitis. A microarteriographic investigation. Acta Radiol Diagn (Stockh) 26(2):137–143 Ratcliffe JF (1985) Anatomic basis for the pathogenesis and radiologic features of vertebral osteomyelitis and its differentiation from childhood discitis. A microarteriographic investigation. Acta Radiol Diagn (Stockh) 26(2):137–143
26.
go back to reference Wiley AM, Trueta J (1959) The vascular anatomy of the spine and its relationship to pyogenic vertebral osteomyelitis. J Bone Joint Surg Br 41-B:796–809PubMed Wiley AM, Trueta J (1959) The vascular anatomy of the spine and its relationship to pyogenic vertebral osteomyelitis. J Bone Joint Surg Br 41-B:796–809PubMed
27.
go back to reference Gouliouris T, Aliyu SH, Brown NM (2010) Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother 65 Suppl 3:iii11–iii24PubMed Gouliouris T, Aliyu SH, Brown NM (2010) Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother 65 Suppl 3:iii11–iii24PubMed
28.
go back to reference Babinchak TJ, Riley DK, Rotheram EB Jr (1997) Pyogenic vertebral osteomyelitis of the posterior elements. Clin Infect Dis 25(2):221–224PubMed Babinchak TJ, Riley DK, Rotheram EB Jr (1997) Pyogenic vertebral osteomyelitis of the posterior elements. Clin Infect Dis 25(2):221–224PubMed
29.
go back to reference Kim CJ et al (2010) A comparative study of pyogenic and tuberculous spondylodiscitis. Spine (Phila Pa 197) 35(21):E1096–E1100 Kim CJ et al (2010) A comparative study of pyogenic and tuberculous spondylodiscitis. Spine (Phila Pa 197) 35(21):E1096–E1100
30.
go back to reference Schimmer RC et al (2002) Osteomyelitis of the cervical spine: a potentially dramatic disease. J Spinal Disord Tech 15(2):110–117PubMed Schimmer RC et al (2002) Osteomyelitis of the cervical spine: a potentially dramatic disease. J Spinal Disord Tech 15(2):110–117PubMed
31.
go back to reference Pigrau C et al (2005) Spontaneous pyogenic vertebral osteomyelitis and endocarditis: incidence, risk factors, and outcome. Am J Med 118(11):1287PubMed Pigrau C et al (2005) Spontaneous pyogenic vertebral osteomyelitis and endocarditis: incidence, risk factors, and outcome. Am J Med 118(11):1287PubMed
32.
go back to reference Turgut M (2001) Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients. Neurosurg Rev 24(1):8–13PubMed Turgut M (2001) Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients. Neurosurg Rev 24(1):8–13PubMed
33.
go back to reference Chang MC et al (2006) Tuberculous spondylitis and pyogenic spondylitis: comparative magnetic resonance imaging features. Spine (Phila Pa 1976) 31(7):782–788 Chang MC et al (2006) Tuberculous spondylitis and pyogenic spondylitis: comparative magnetic resonance imaging features. Spine (Phila Pa 1976) 31(7):782–788
34.
go back to reference Roblot F et al (2007) Optimal duration of antibiotic therapy in vertebral osteomyelitis. Semin Arthritis Rheum 36(5):269–277PubMed Roblot F et al (2007) Optimal duration of antibiotic therapy in vertebral osteomyelitis. Semin Arthritis Rheum 36(5):269–277PubMed
35.
go back to reference Zimmerli W (2010) Clinical practice. Vertebral osteomyelitis. N Engl J Med 362(11):1022–1029PubMed Zimmerli W (2010) Clinical practice. Vertebral osteomyelitis. N Engl J Med 362(11):1022–1029PubMed
36.
go back to reference Garron E et al (2002) Nontuberculous spondylodiscitis in children. J Pediatr Orthop 22(3):321–328PubMed Garron E et al (2002) Nontuberculous spondylodiscitis in children. J Pediatr Orthop 22(3):321–328PubMed
37.
go back to reference Fernandez M, Carrol CL, Baker CJ (2000) Discitis and vertebral osteomyelitis in children: an 18-year review. Pediatrics 105(6):1299–1304PubMed Fernandez M, Carrol CL, Baker CJ (2000) Discitis and vertebral osteomyelitis in children: an 18-year review. Pediatrics 105(6):1299–1304PubMed
38.
go back to reference Brown R et al (2001) Discitis in young children. J Bone Joint Surg Br 83(1):106–111PubMed Brown R et al (2001) Discitis in young children. J Bone Joint Surg Br 83(1):106–111PubMed
39.
go back to reference Carragee EJ et al (1997) The clinical use of erythrocyte sedimentation rate in pyogenic vertebral osteomyelitis. Spine (Phila Pa 1976) 22(18):2089–2093 Carragee EJ et al (1997) The clinical use of erythrocyte sedimentation rate in pyogenic vertebral osteomyelitis. Spine (Phila Pa 1976) 22(18):2089–2093
40.
go back to reference Beronius M, Bergman B, Andersson R (2001) Vertebral osteomyelitis in Goteborg, Sweden: a retrospective study of patients during 1990–95. Scand J Infect Dis 33(7):527–532PubMed Beronius M, Bergman B, Andersson R (2001) Vertebral osteomyelitis in Goteborg, Sweden: a retrospective study of patients during 1990–95. Scand J Infect Dis 33(7):527–532PubMed
41.
go back to reference Hsieh PC et al (2004) Surgical strategies for vertebral osteomyelitis and epidural abscess. Neurosurg Focus 17(6):E4PubMed Hsieh PC et al (2004) Surgical strategies for vertebral osteomyelitis and epidural abscess. Neurosurg Focus 17(6):E4PubMed
42.
go back to reference Kang BU et al (2010) Surgical site infection in spinal surgery: detection and management based on serial C-reactive protein measurements. J Neurosurg Spine 13(2):158–164PubMed Kang BU et al (2010) Surgical site infection in spinal surgery: detection and management based on serial C-reactive protein measurements. J Neurosurg Spine 13(2):158–164PubMed
43.
go back to reference Lillie P et al (2008) Healthcare associated discitis in the era of antimicrobial resistance. J Clin Rheumatol 14(4):234–237PubMed Lillie P et al (2008) Healthcare associated discitis in the era of antimicrobial resistance. J Clin Rheumatol 14(4):234–237PubMed
44.
go back to reference Goldstein EJ (1996) Anaerobic bacteremia. Clin Infect Dis 23 Suppl 1:S97–S101PubMed Goldstein EJ (1996) Anaerobic bacteremia. Clin Infect Dis 23 Suppl 1:S97–S101PubMed
45.
go back to reference Lassmann B et al (2007) Reemergence of anaerobic bacteremia. Clin Infect Dis 44(7):895–900PubMed Lassmann B et al (2007) Reemergence of anaerobic bacteremia. Clin Infect Dis 44(7):895–900PubMed
46.
go back to reference Karadimas EJ et al (2008) Spondylodiscitis. A retrospective study of 163 patients. Acta Orthop 79(5):650–659PubMed Karadimas EJ et al (2008) Spondylodiscitis. A retrospective study of 163 patients. Acta Orthop 79(5):650–659PubMed
47.
go back to reference Gasbarrini A et al (2012) Biopsy for suspected spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):26–34PubMed Gasbarrini A et al (2012) Biopsy for suspected spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):26–34PubMed
48.
go back to reference Fucs PM, Meves R, Yamada HH (2012) Spinal infections in children: a review. Int Orthop 36(2):387–395PubMed Fucs PM, Meves R, Yamada HH (2012) Spinal infections in children: a review. Int Orthop 36(2):387–395PubMed
49.
go back to reference Cheng VC et al (2004) Clinical evaluation of the polymerase chain reaction for the rapid diagnosis of tuberculosis. J Clin Pathol 57(3):281–285PubMed Cheng VC et al (2004) Clinical evaluation of the polymerase chain reaction for the rapid diagnosis of tuberculosis. J Clin Pathol 57(3):281–285PubMed
50.
go back to reference Kumar R, Das RK, Mahapatra AK (2010) Role of interferon gamma release assay in the diagnosis of Pott disease. J Neurosurg Spine 12(5):462–466PubMed Kumar R, Das RK, Mahapatra AK (2010) Role of interferon gamma release assay in the diagnosis of Pott disease. J Neurosurg Spine 12(5):462–466PubMed
51.
go back to reference de Lucas EM et al (2009) CT-guided fine-needle aspiration in vertebral osteomyelitis: true usefulness of a common practice. Clin Rheumatol 28(3):315–320PubMed de Lucas EM et al (2009) CT-guided fine-needle aspiration in vertebral osteomyelitis: true usefulness of a common practice. Clin Rheumatol 28(3):315–320PubMed
52.
go back to reference Rankine JJ et al (2004) Therapeutic impact of percutaneous spinal biopsy in spinal infection. Postgrad Med J 80(948):607–609PubMed Rankine JJ et al (2004) Therapeutic impact of percutaneous spinal biopsy in spinal infection. Postgrad Med J 80(948):607–609PubMed
53.
go back to reference Michel SC et al (2006) CT-guided core biopsy of subchondral bone and intervertebral space in suspected spondylodiskitis. AJR Am J Roentgenol 186(4):977–980PubMed Michel SC et al (2006) CT-guided core biopsy of subchondral bone and intervertebral space in suspected spondylodiskitis. AJR Am J Roentgenol 186(4):977–980PubMed
54.
go back to reference Fenollar F, Levy PY, Raoult D (2008) Usefulness of broad-range PCR for the diagnosis of osteoarticular infections. Curr Opin Rheumatol 20(4):463–470PubMed Fenollar F, Levy PY, Raoult D (2008) Usefulness of broad-range PCR for the diagnosis of osteoarticular infections. Curr Opin Rheumatol 20(4):463–470PubMed
55.
go back to reference Fuursted K et al (2008) Broad-range PCR as a supplement to culture for detection of bacterial pathogens in patients with a clinically diagnosed spinal infection. Scand J Infect Dis 40(10):772–777PubMed Fuursted K et al (2008) Broad-range PCR as a supplement to culture for detection of bacterial pathogens in patients with a clinically diagnosed spinal infection. Scand J Infect Dis 40(10):772–777PubMed
56.
go back to reference Delogu G, Zumbo A, Fadda G (2012) Microbiological and immunological diagnosis of tuberculous spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):73–78PubMed Delogu G, Zumbo A, Fadda G (2012) Microbiological and immunological diagnosis of tuberculous spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):73–78PubMed
57.
go back to reference Jevtic V (2004) Vertebral infection. Eur Radiol 14(Suppl 3):E43–E52PubMed Jevtic V (2004) Vertebral infection. Eur Radiol 14(Suppl 3):E43–E52PubMed
58.
go back to reference Ledermann HP et al (2003) MR imaging findings in spinal infections: rules or myths? Radiology 228(2):506–514PubMed Ledermann HP et al (2003) MR imaging findings in spinal infections: rules or myths? Radiology 228(2):506–514PubMed
59.
go back to reference Modic MT et al (1985) Vertebral osteomyelitis: assessment using MR. Radiology 157(1):157–166PubMed Modic MT et al (1985) Vertebral osteomyelitis: assessment using MR. Radiology 157(1):157–166PubMed
60.
go back to reference Leone A et al (2012) Imaging of spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):8–19PubMed Leone A et al (2012) Imaging of spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):8–19PubMed
61.
go back to reference Diehn FE (2012) Imaging of spine infection. Radiol Clin North Am 50(4):777–798PubMed Diehn FE (2012) Imaging of spine infection. Radiol Clin North Am 50(4):777–798PubMed
62.
go back to reference Shah LM, Salzman KL (2011) Imaging of spinal metastatic disease. Int J Surg Oncol 2011:769753PubMed Shah LM, Salzman KL (2011) Imaging of spinal metastatic disease. Int J Surg Oncol 2011:769753PubMed
63.
go back to reference Anley CM, Brandt AD, Dunn R (2012) Magnetic resonance imaging findings in spinal tuberculosis: comparison of HIV positive and negative patients. Indian J Orthop 46(2):186–190PubMed Anley CM, Brandt AD, Dunn R (2012) Magnetic resonance imaging findings in spinal tuberculosis: comparison of HIV positive and negative patients. Indian J Orthop 46(2):186–190PubMed
64.
go back to reference Kowalski TJ et al (2007) Follow-up MR imaging in patients with pyogenic spine infections: lack of correlation with clinical features. AJNR Am J Neuroradiol 28(4):693–699PubMed Kowalski TJ et al (2007) Follow-up MR imaging in patients with pyogenic spine infections: lack of correlation with clinical features. AJNR Am J Neuroradiol 28(4):693–699PubMed
65.
go back to reference Carragee EJ (1997) The clinical use of magnetic resonance imaging in pyogenic vertebral osteomyelitis. Spine (Phila Pa 1976) 22(7):780–785 Carragee EJ (1997) The clinical use of magnetic resonance imaging in pyogenic vertebral osteomyelitis. Spine (Phila Pa 1976) 22(7):780–785
66.
go back to reference Gemmel F, Dumarey N, Palestro CJ (2006) Radionuclide imaging of spinal infections. Eur J Nucl Med Mol Imaging 33(10):1226–1237PubMed Gemmel F, Dumarey N, Palestro CJ (2006) Radionuclide imaging of spinal infections. Eur J Nucl Med Mol Imaging 33(10):1226–1237PubMed
67.
go back to reference Gemmel F et al (2010) Expanding role of 18F-fluoro-d-deoxyglucose PET and PET/CT in spinal infections. Eur Spine J 19(4):540–551PubMed Gemmel F et al (2010) Expanding role of 18F-fluoro-d-deoxyglucose PET and PET/CT in spinal infections. Eur Spine J 19(4):540–551PubMed
68.
go back to reference Kwon JW et al (2011) MRI findings of Aspergillus spondylitis. AJR Am J Roentgenol 197(5):W919–W923PubMed Kwon JW et al (2011) MRI findings of Aspergillus spondylitis. AJR Am J Roentgenol 197(5):W919–W923PubMed
69.
go back to reference Currie S et al (2011) MRI characteristics of tuberculous spondylitis. Clin Radiol 66(8):778–787PubMed Currie S et al (2011) MRI characteristics of tuberculous spondylitis. Clin Radiol 66(8):778–787PubMed
70.
go back to reference James SL, Davies AM (2006) Imaging of infectious spinal disorders in children and adults. Eur J Radiol 58(1):27–40PubMed James SL, Davies AM (2006) Imaging of infectious spinal disorders in children and adults. Eur J Radiol 58(1):27–40PubMed
71.
go back to reference Zarghooni K et al (2012) Treatment of spondylodiscitis. Int Orthop 36(2):405–411PubMed Zarghooni K et al (2012) Treatment of spondylodiscitis. Int Orthop 36(2):405–411PubMed
72.
go back to reference Thwaites G et al (2009) British infection society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect 59(3):167–187PubMed Thwaites G et al (2009) British infection society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect 59(3):167–187PubMed
73.
go back to reference van Ooij A et al (2000) Surgical treatment of aspergillus spondylodiscitis. Eur Spine J 9(1):75–79PubMed van Ooij A et al (2000) Surgical treatment of aspergillus spondylodiscitis. Eur Spine J 9(1):75–79PubMed
74.
go back to reference Friedman JA et al (2002) Spontaneous disc space infections in adults. Surg Neurol 57(2):81–86PubMed Friedman JA et al (2002) Spontaneous disc space infections in adults. Surg Neurol 57(2):81–86PubMed
75.
go back to reference Darley ES, MacGowan AP (2004) Antibiotic treatment of gram-positive bone and joint infections. J Antimicrob Chemother 53(6):928–935PubMed Darley ES, MacGowan AP (2004) Antibiotic treatment of gram-positive bone and joint infections. J Antimicrob Chemother 53(6):928–935PubMed
76.
go back to reference McHenry MC, Easley KA, Locker GA (2002) Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis 34(10):1342–1350PubMed McHenry MC, Easley KA, Locker GA (2002) Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis 34(10):1342–1350PubMed
77.
go back to reference Nolla JM et al (2002) Spontaneous pyogenic vertebral osteomyelitis in nondrug users. Semin Arthritis Rheum 31(4):271–278PubMed Nolla JM et al (2002) Spontaneous pyogenic vertebral osteomyelitis in nondrug users. Semin Arthritis Rheum 31(4):271–278PubMed
78.
go back to reference Baker AS, RG OJ, Baker RA (1992) To decompress or not to decompress–spinal epidural abscess. Clin Infect Dis 15(1):28–29PubMed Baker AS, RG OJ, Baker RA (1992) To decompress or not to decompress–spinal epidural abscess. Clin Infect Dis 15(1):28–29PubMed
79.
go back to reference Chen WH, Jiang LS, Dai LY (2007) Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation. Eur Spine J 16(9):1307–1316PubMed Chen WH, Jiang LS, Dai LY (2007) Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation. Eur Spine J 16(9):1307–1316PubMed
80.
go back to reference Darouiche RO (2006) Spinal epidural abscess. N Engl J Med 355(19):2012–2020PubMed Darouiche RO (2006) Spinal epidural abscess. N Engl J Med 355(19):2012–2020PubMed
81.
go back to reference Yoshimoto M et al (2011) Pyogenic spondylitis in the elderly: a report from Japan with the most aging society. Eur Spine J 20(4):649–654PubMed Yoshimoto M et al (2011) Pyogenic spondylitis in the elderly: a report from Japan with the most aging society. Eur Spine J 20(4):649–654PubMed
82.
go back to reference Pola E et al (2012) Surgical treatment of tuberculous spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):79–85PubMed Pola E et al (2012) Surgical treatment of tuberculous spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):79–85PubMed
83.
go back to reference Linhardt O et al (2007) Long-term results of ventro-dorsal versus ventral instrumentation fusion in the treatment of spondylitis. Int Orthop 31(1):113–119PubMed Linhardt O et al (2007) Long-term results of ventro-dorsal versus ventral instrumentation fusion in the treatment of spondylitis. Int Orthop 31(1):113–119PubMed
84.
go back to reference Schinkel C, Gottwald M, Andress HJ (2003) Surgical treatment of spondylodiscitis. Surg Infect (Larchmt) 4(4):387–391 Schinkel C, Gottwald M, Andress HJ (2003) Surgical treatment of spondylodiscitis. Surg Infect (Larchmt) 4(4):387–391
85.
go back to reference Muckley T et al (2004) The role of thoracoscopic spinal surgery in the management of pyogenic vertebral osteomyelitis. Spine (Phila Pa 1976) 29(11):E227–E233 Muckley T et al (2004) The role of thoracoscopic spinal surgery in the management of pyogenic vertebral osteomyelitis. Spine (Phila Pa 1976) 29(11):E227–E233
86.
go back to reference Lee JS, Suh KT (2006) Posterior lumbar interbody fusion with an autogenous iliac crest bone graft in the treatment of pyogenic spondylodiscitis. J Bone Joint Surg Br 88(6):765–770PubMed Lee JS, Suh KT (2006) Posterior lumbar interbody fusion with an autogenous iliac crest bone graft in the treatment of pyogenic spondylodiscitis. J Bone Joint Surg Br 88(6):765–770PubMed
87.
go back to reference Zhang HQ et al (2012) Two-stage surgical management using posterior instrumentation, anterior debridement and allografting for tuberculosis of the lower lumbar spine in children of elementary school age: minimum 3-year follow-up of 14 patients. Arch Orthop Trauma Surg 132(9):1273–1279PubMed Zhang HQ et al (2012) Two-stage surgical management using posterior instrumentation, anterior debridement and allografting for tuberculosis of the lower lumbar spine in children of elementary school age: minimum 3-year follow-up of 14 patients. Arch Orthop Trauma Surg 132(9):1273–1279PubMed
88.
go back to reference Shousha M, Boehm H (2012) Surgical treatment of cervical spondylodiscitis: a review of 30 consecutive patients. Spine (Phila Pa 1976) 37(1):E30–E36 Shousha M, Boehm H (2012) Surgical treatment of cervical spondylodiscitis: a review of 30 consecutive patients. Spine (Phila Pa 1976) 37(1):E30–E36
89.
go back to reference Masuda T et al (2011) Comparative study on the efficacy of two-staged (posterior followed by anterior) surgical treatment using spinal instrumentation on pyogenic and tuberculotic spondylitis. Arch Orthop Trauma Surg 131(6):765–772PubMed Masuda T et al (2011) Comparative study on the efficacy of two-staged (posterior followed by anterior) surgical treatment using spinal instrumentation on pyogenic and tuberculotic spondylitis. Arch Orthop Trauma Surg 131(6):765–772PubMed
90.
go back to reference Koptan W, Elmiligui Y, Elsharkawi M (2011) Single stage anterior reconstruction using titanium mesh cages in neglected kyphotic tuberculous spondylodiscitis of the cervical spine. Eur Spine J 20(2):308–313PubMed Koptan W, Elmiligui Y, Elsharkawi M (2011) Single stage anterior reconstruction using titanium mesh cages in neglected kyphotic tuberculous spondylodiscitis of the cervical spine. Eur Spine J 20(2):308–313PubMed
91.
go back to reference Erturer E et al (2010) The results of simultaneous posterior-anterior-posterior surgery in multilevel tuberculosis spondylitis associated with severe kyphosis. Eur Spine J 19(12):2209–2215PubMed Erturer E et al (2010) The results of simultaneous posterior-anterior-posterior surgery in multilevel tuberculosis spondylitis associated with severe kyphosis. Eur Spine J 19(12):2209–2215PubMed
92.
go back to reference Chen LH et al (2010) Surgical treatment of infectious spondylitis in patients undergoing hemodialysis therapy. Eur Spine J 19(12):2223–2228PubMed Chen LH et al (2010) Surgical treatment of infectious spondylitis in patients undergoing hemodialysis therapy. Eur Spine J 19(12):2223–2228PubMed
93.
go back to reference Hempelmann RG, Mater E, Schon R (2010) Septic hematogenous lumbar spondylodiscitis in elderly patients with multiple risk factors: efficacy of posterior stabilization and interbody fusion with iliac crest bone graft. Eur Spine J 19(10):1720–1727PubMed Hempelmann RG, Mater E, Schon R (2010) Septic hematogenous lumbar spondylodiscitis in elderly patients with multiple risk factors: efficacy of posterior stabilization and interbody fusion with iliac crest bone graft. Eur Spine J 19(10):1720–1727PubMed
94.
go back to reference Hirakawa A et al (2010) Surgical outcome of 2-stage (posterior and anterior) surgical treatment using spinal instrumentation for tuberculous spondylitis. J Spinal Disord Tech 23(2):133–138PubMed Hirakawa A et al (2010) Surgical outcome of 2-stage (posterior and anterior) surgical treatment using spinal instrumentation for tuberculous spondylitis. J Spinal Disord Tech 23(2):133–138PubMed
95.
go back to reference Okada Y et al (2009) Clinical and radiological outcome of surgery for pyogenic and tuberculous spondylitis: comparisons of surgical techniques and disease types. J Neurosurg Spine 11(5):620–627PubMed Okada Y et al (2009) Clinical and radiological outcome of surgery for pyogenic and tuberculous spondylitis: comparisons of surgical techniques and disease types. J Neurosurg Spine 11(5):620–627PubMed
96.
go back to reference Zaveri GR, Mehta SS (2009) Surgical treatment of lumbar tuberculous spondylodiscitis by transforaminal lumbar interbody fusion (TLIF) and posterior instrumentation. J Spinal Disord Tech 22(4):257–262PubMed Zaveri GR, Mehta SS (2009) Surgical treatment of lumbar tuberculous spondylodiscitis by transforaminal lumbar interbody fusion (TLIF) and posterior instrumentation. J Spinal Disord Tech 22(4):257–262PubMed
97.
go back to reference Lu DC, Wang V, Chou D (2009) The use of allograft or autograft and expandable titanium cages for the treatment of vertebral osteomyelitis. Neurosurgery 64(1):122–129 Discussion 129–30PubMed Lu DC, Wang V, Chou D (2009) The use of allograft or autograft and expandable titanium cages for the treatment of vertebral osteomyelitis. Neurosurgery 64(1):122–129 Discussion 129–30PubMed
98.
go back to reference Robinson Y et al (2008) Successful treatment of spondylodiscitis using titanium cages: a 3-year follow-up of 22 consecutive patients. Acta Orthop 79(5):660–664PubMed Robinson Y et al (2008) Successful treatment of spondylodiscitis using titanium cages: a 3-year follow-up of 22 consecutive patients. Acta Orthop 79(5):660–664PubMed
99.
go back to reference Pee YH et al (2008) Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage. J Neurosurg Spine 8(5):405–412PubMed Pee YH et al (2008) Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage. J Neurosurg Spine 8(5):405–412PubMed
100.
go back to reference Korovessis P et al (2008) Beneficial influence of titanium mesh cage on infection healing and spinal reconstruction in hematogenous septic spondylitis: a retrospective analysis of surgical outcome of twenty-five consecutive cases and review of literature. Spine (Phila Pa 1976) 33(21):E759–E767 Korovessis P et al (2008) Beneficial influence of titanium mesh cage on infection healing and spinal reconstruction in hematogenous septic spondylitis: a retrospective analysis of surgical outcome of twenty-five consecutive cases and review of literature. Spine (Phila Pa 1976) 33(21):E759–E767
101.
go back to reference Hee HT et al (2002) Better treatment of vertebral osteomyelitis using posterior stabilization and titanium mesh cages. J Spinal Disord Tech 15(2):149–156 Discussion 156PubMed Hee HT et al (2002) Better treatment of vertebral osteomyelitis using posterior stabilization and titanium mesh cages. J Spinal Disord Tech 15(2):149–156 Discussion 156PubMed
102.
go back to reference Liljenqvist U et al (2003) Titanium cages in the surgical treatment of severe vertebral osteomyelitis. Eur Spine J 12(6):606–612PubMed Liljenqvist U et al (2003) Titanium cages in the surgical treatment of severe vertebral osteomyelitis. Eur Spine J 12(6):606–612PubMed
103.
go back to reference Korovessis P, Repantis T, Hadjipavlou AG (2012) Hematogenous pyogenic spinal infection: current perceptions. Orthopedics 35(10):885–892PubMed Korovessis P, Repantis T, Hadjipavlou AG (2012) Hematogenous pyogenic spinal infection: current perceptions. Orthopedics 35(10):885–892PubMed
104.
go back to reference Schuster JM et al (2000) Use of structural allografts in spinal osteomyelitis: a review of 47 cases. J Neurosurg 93(1 Suppl):8–14PubMed Schuster JM et al (2000) Use of structural allografts in spinal osteomyelitis: a review of 47 cases. J Neurosurg 93(1 Suppl):8–14PubMed
105.
go back to reference Dimar JR et al (2004) Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion. Spine (Phila Pa 1976) 29(3):326–332 Discussion 332 Dimar JR et al (2004) Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion. Spine (Phila Pa 1976) 29(3):326–332 Discussion 332
106.
go back to reference Rihn JA et al (2009) The use of RhBMP-2 in single-level transforaminal lumbar interbody fusion: a clinical and radiographic analysis. Eur Spine J 18(11):1629–1636PubMed Rihn JA et al (2009) The use of RhBMP-2 in single-level transforaminal lumbar interbody fusion: a clinical and radiographic analysis. Eur Spine J 18(11):1629–1636PubMed
107.
go back to reference O’Shaughnessy BA, Kuklo TR, Ondra SL (2008) Surgical treatment of vertebral osteomyelitis with recombinant human bone morphogenetic protein-2. Spine (Phila Pa 1976) 33(5):E132–E139 O’Shaughnessy BA, Kuklo TR, Ondra SL (2008) Surgical treatment of vertebral osteomyelitis with recombinant human bone morphogenetic protein-2. Spine (Phila Pa 1976) 33(5):E132–E139
108.
go back to reference Allen RT et al (2007) Bone morphogenetic protein-2 (BMP-2) in the treatment of pyogenic vertebral osteomyelitis. Spine (Phila Pa 1976) 32(26):2996–3006 Allen RT et al (2007) Bone morphogenetic protein-2 (BMP-2) in the treatment of pyogenic vertebral osteomyelitis. Spine (Phila Pa 1976) 32(26):2996–3006
109.
go back to reference Jin D et al (2004) One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis. Eur Spine J 13(2):114–121PubMed Jin D et al (2004) One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis. Eur Spine J 13(2):114–121PubMed
110.
go back to reference Oga M et al (1993) Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study. Spine (Phila Pa 1976) 18(13):1890–1894 Oga M et al (1993) Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study. Spine (Phila Pa 1976) 18(13):1890–1894
111.
go back to reference Benli IT et al (2003) Anterior radical debridement and anterior instrumentation in tuberculosis spondylitis. Eur Spine J 12(2):224–234PubMed Benli IT et al (2003) Anterior radical debridement and anterior instrumentation in tuberculosis spondylitis. Eur Spine J 12(2):224–234PubMed
112.
go back to reference Yilmaz C et al (1999) Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg Am 81(9):1261–1267PubMed Yilmaz C et al (1999) Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg Am 81(9):1261–1267PubMed
113.
go back to reference Lu CH et al (2002) Adult spinal epidural abscess: clinical features and prognostic factors. Clin Neurol Neurosurg 104(4):306–310PubMed Lu CH et al (2002) Adult spinal epidural abscess: clinical features and prognostic factors. Clin Neurol Neurosurg 104(4):306–310PubMed
114.
go back to reference Chen SH et al (2011) The clinical characteristics, therapeutic outcome, and prognostic factors of non-tuberculous bacterial spinal epidural abscess in adults: a hospital-based study. Acta Neurol Taiwan 20(2):107–113PubMed Chen SH et al (2011) The clinical characteristics, therapeutic outcome, and prognostic factors of non-tuberculous bacterial spinal epidural abscess in adults: a hospital-based study. Acta Neurol Taiwan 20(2):107–113PubMed
115.
go back to reference Khanna RK et al (1996) Spinal epidural abscess: evaluation of factors influencing outcome. Neurosurgery 39(5):958–964PubMed Khanna RK et al (1996) Spinal epidural abscess: evaluation of factors influencing outcome. Neurosurgery 39(5):958–964PubMed
116.
go back to reference Huang PY et al (2012) Spinal epidural abscess in adults caused by Staphylococcus aureus: clinical characteristics and prognostic factors. Clin Neurol Neurosurg 114(6):572–576PubMed Huang PY et al (2012) Spinal epidural abscess in adults caused by Staphylococcus aureus: clinical characteristics and prognostic factors. Clin Neurol Neurosurg 114(6):572–576PubMed
117.
go back to reference Tang HJ et al (2002) Spinal epidural abscess–experience with 46 patients and evaluation of prognostic factors. J Infect 45(2):76–81PubMed Tang HJ et al (2002) Spinal epidural abscess–experience with 46 patients and evaluation of prognostic factors. J Infect 45(2):76–81PubMed
118.
go back to reference Gonzalez-Lopez JJ et al (2009) Spontaneous epidural abscess: analysis of 15 cases with emphasis on diagnostic and prognostic factors. Eur J Intern Med 20(5):514–517PubMed Gonzalez-Lopez JJ et al (2009) Spontaneous epidural abscess: analysis of 15 cases with emphasis on diagnostic and prognostic factors. Eur J Intern Med 20(5):514–517PubMed
119.
go back to reference Soehle M, Wallenfang T (2002) Spinal epidural abscesses: clinical manifestations, prognostic factors, and outcomes. Neurosurgery 51(1):79–85 Discussion 86–7PubMed Soehle M, Wallenfang T (2002) Spinal epidural abscesses: clinical manifestations, prognostic factors, and outcomes. Neurosurgery 51(1):79–85 Discussion 86–7PubMed
120.
go back to reference Reihsaus E, Waldbaur H, Seeling W (2000) Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev 23(4):175–204 Discussion 205PubMed Reihsaus E, Waldbaur H, Seeling W (2000) Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev 23(4):175–204 Discussion 205PubMed
121.
go back to reference Bostrom A et al (2008) Treatment strategies and outcome in patients with non-tuberculous spinal epidural abscess–a review of 46 cases. Minim Invasive Neurosurg 51(1):36–42PubMed Bostrom A et al (2008) Treatment strategies and outcome in patients with non-tuberculous spinal epidural abscess–a review of 46 cases. Minim Invasive Neurosurg 51(1):36–42PubMed
122.
go back to reference Rigamonti D et al (1999) Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol 52(2):189–196 Discussion 197PubMed Rigamonti D et al (1999) Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol 52(2):189–196 Discussion 197PubMed
Metadata
Title
Spinal infection: state of the art and management algorithm
Authors
Rui M. Duarte
Alexander R. Vaccaro
Publication date
01-12-2013
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 12/2013
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-013-2850-1

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