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INTRODUCTION: Spondylodiscitis (SD) is an infection of the intervertebral disc with involvement of the adjacent vertebral bodies. Diagnostic tests with CT-guided biopsy only provide a positive yield in 14%-48% of cases. Percutaneous endoscopic debridement and drainage (PEDD) has recently shown promise in the treatment of spondylodiscitis. RESEARCH QUESTION: The purpose of this study is to determine differences in pathogen identification and clinical outcomes for PEDD versus CT-guided needle biopsy in SD patients. MATERIALS AND METHODS: We conducted a systematic review of the literature using PRISMA guidelines to determine differences in positive microbiology results, perioperative complications, pain control, and long-term clinical outcomes for PEDD vs. CT-guided needle biopsy in SD patients. RESULTS: 1078 studies were evaluated, 87 of which underwent full review. 15 studies met the inclusion and exclusion criteria, including 7 PEDD, 7 CT-guided biopsy, and 1 CT-guided biopsy vs. PEDD article, for a total of 192 PEDD patients and 604 CT-guided biopsy patients. We found 36.59% of CT-guided biopsy patients had positive microbiology results, compared to 84.38% of PEDD patients. No major perioperative complications occurred as a result of the PEDD procedure. Of the five PEDD studies that reported pain outcomes, greater than 80% of patients experienced relief after intervention. DISCUSSION AND CONCLUSION: These results suggest that PEDD may improve pathogen identification while simultaneously reducing pain compared to CT-guided needle biopsy in SD. Although current treatment guidelines recommend CT-guided biopsy, in patients with severe back pain and suspected SD, PEDD can be considered an alternative intervention.

Background: Tuberculosis (TB) is caused by Mycobacterium tuberculosis (Mtb) and typically infects the lungs. However, extrapulmonary forms of TB can be found in approximately 20% of cases. It is suggested, that up to 10% of extrapulmonary TB affects the musculoskeletal system, in which spinal elements (spinal tuberculosis, STB) are involved in approximately 50% of the cases. STB is a debilitating disease with nonspecific symptoms and diagnosis is often delayed for months to years. In our Spinal TB X Cohort, we aim to describe the clinical phenotype of STB using whole-body 18 F-fluorodeoxyglucose positron emission tomography computed tomography (PET/CT) and to identify a specific gene expression profile for the different stages of dissemination on PET/CT. Here we report on the first patient recruited into our cohort who underwent PET/CT before treatment initiation, at 6-months and at 12-months - time of TB treatment completion. Case presentation: A 27-year-old immunocompetent male presented with severe thoracolumbar back pain for 9 months with severe antalgic gait and night sweats. Magnetic resonance imaging (MRI) of the whole spine revealed multilevel spinal disease (T5/6, T11/12, L3/4) in keeping with STB. After informed consent and recruitment into the Spinal TB X Cohort, the patient underwent PET/CT as per protocol, which revealed isolated multilevel STB (T4-7, T11/12, L3/4) with no concomitant lung or urogenital lesion. However, sputum and urine were Xpert MTB/RIF Ultra positive and Mtb was cultured from the urine sample. CT-guided biopsy of the T11/12 lesion confirmed drug-sensitive Mtb on Xpert MTB/RIF Ultra and the patient was started on TB treatment according to local guidelines for 12 months. The 6-month follow-up PET/CT revealed new and existing spinal lesions with increased FDG-uptake despite significant improvement of clinical features and laboratory markers. After 9 months of treatment, the patient developed an acute urethral stricture, most likely due to urogenital TB, and a suprapubic catheter was inserted. The 12-month PET/CT showed significantly decreased PET/CT values of all lesions, however, significant persistent spinal inflammation was present at the end of TB treatment. Clinically, the patient was considered cured by the TB control program and currently awaits urethroplasty. Conclusions: In our case, PET/CT emerged as a valuable imaging modality for the initial assessment, surpassing MRI by revealing more comprehensive extensive disease. Subsequent PET/CT scans at 6-month uncovered new lesions and increased inflammation in existing ones, while by the end of TB treatment, all lesions exhibited improvement. However, the interpretation of FDG avidity remains ambiguous, whether it correlates with active infection and viable Mtb. or fibro- and osteoblast activity indicative of the healing process. Additionally, the absence of extraspinal TB lesions on PET/CT despite positive microbiology from sputum and urine maybe explained by paucibacillary, subclinical infection of extraspinal organs. The Spinal TB X Cohort endeavours to shed light on whole-body imaging patterns at diagnosis, their evolution midway through TB treatment, and upon treatment completion. Ultimately, this study aims to advance our understanding of the biology of this complex disease. [ABSTRACT FROM AUTHOR]

Background: This study investigates the effects of spondylodiscitis on the inflammation burden in infective endocarditis patients. Methods: A prospective, observational study was conducted between September 2018 and October 2022 in a non-surgical teaching hospital. Patients with a definite or possible and treated as infective endocarditis were recruited from the Alkmaar Endocarditis Team meetings. Spondylodiscitis was diagnosed based on symptoms and radiological findings. The inflammation burden was defined as the area under the C‑reactive protein (CRP) curve. Results: 174 consecutive patients with infective endocarditis were included (mean age 73 years, 34.5% female). Concomitant spondylodiscitis was present in 32 patients (18%), frequently associated with Streptococcus species (38%). At admission, the mean level of CRP was significantly higher in patients with concomitant spondylodiscitis (p = 0.004). The median CRP area under the curve was significantly higher in spondylodiscitis patients (4.2 × 106 min.mg/l [1.2 × 105 − 1.6 × 107 min.mg/l] vs 2.0 × 106 min.mg/l [8.7 × 104 − 1.6 × 107 min.mg/l], p < 0.001). This difference remained during the whole treatment period. At 6 months of follow-up, rates of mortality and relapse of infective endocarditis were not significantly different. Conclusion: The prevalence of spondylodiscitis in non-referred patients with infective endocarditis was 18%. Endocarditis patients with spondylodiscitis had an increased inflammation burden at and during admission. This difference in normalisation of CRP levels was particularly apparent in the final phase of antibiotic treatment but not related to infectious complications. Despite an augmented inflammation burden, spondylodiscitis was not associated with mortality, cardiac surgery or infectious relapse. [ABSTRACT FROM AUTHOR]

Prolonged antibiotic therapy is often recommended for the treatment of spinal infections. This study aimed to evaluate the efficacy and safety of outpatient intravenous (IV) antibiotic therapy for spinal neurosurgery patients with spondylodiscitis. We carried out a retrospective study involving 67 patients who were administered peripherally inserted central catheter (PICC) for IV antibiotic treatment from January 2020 to December 2022. We assessed patient data concerning infections and neurosurgical concerns. Each patient underwent a minimum of 6 weeks of IV antibiotics, both as inpatients and outpatients. The study included 67 patients with a median age of 61 years (SD +/- 14.18 years), with approximately 44% being female. The average hospital stay for inpatient treatment was 20 days (SD +/- 8.8 days). Subsequent outpatient antibiotic therapy lasted an average of 70.32 days (SD +/- 18.24 days), with outpatient IV therapy accounting for 44.74 days (SD +/- 9.15 days). The most common pathogens identified were Staphylococcus epidermidis and methicillin-sensitive Staphylococcus aureus. Microbiological analysis did not detect any pathogens in 18% of patients. Radiographic and laboratory evidence of spondylodiscitis was absent in 99% of patients during the final follow-up. No catheter-related complications occurred. Outpatient IV antibiotic therapy using a PICC line catheter is a safe and effective treatment option for spinal infections, especially in elderly patients. [ABSTRACT FROM AUTHOR]

Patient-reported outcome measures for quality of life (QoL) like the Oswestry-Disability-Index (ODI) are useful for a quick, comprehensive and comparable evaluation of spondylodiscitis treatment. While it is known that even after successful surgical treatment, the QoL of spondylodiscitis patients remains below that of the general population, risk factors for a poor outcome have not been described so far. We did a retrospective post-hoc analysis of 130 surgically treated spondylodiscitis patients from 2008 to 2022. Biographical, clinical und QoL data were prospectively collected before (T0) and one year (T1) after surgery. The primary outcome was QoL at T1. Patients were grouped according to their ODI score at T1 (Group 1: ODI < 35, favorable QoL; Group 2: ODI ≥ 35, poor QoL) and analyzed for risk factors present at T0. Poor QoL at T1 occurred in 51 patients (39%). Multivariate analysis identified a higher preoperative leg pain (odds ratio: 1.2) and the presence of a malignant disease (odds ratio: 1.9) as independent preoperative risk factors for a poor QoL at T1. Spondylodiscitis patients with malignancy and/or preoperative leg pain may be at increased risk for poor QoL after surgical treatment. These results can be used to individualize patient information and provide a better assessment of prognosis before surgery. [ABSTRACT FROM AUTHOR]

Background: Tuberculous spondylitis (TS) and brucellar spondylitis (BS) both cause major long-term morbidity and disability. Though Spondylodiscitis is sensitive to magnetic resonance images, some are difficult to differentiate. This study aims to identify specific bone changes on computed tomography (CT) images, further to differentiate TS from BS. Methods: We retrospectively analyzed and enrolled 70 patients with TS and 65 with BS at our hospital from December 2012 to January 2024. Information of bone destruction and formation, vertebral wall integrity, osteosclerosis, and sequestrum on CT images was collected and compared using the chi-square test or t-test. P < 0.01 was considered statistically significant. Results: Bone destruction was greater in the TS group compared to the BS group (519.55 mm2 vs. 316.00 mm2, t = 6.01, P < 0.001), preferentially involving each third of the vertebral body horizontally (41.22% vs. 16.67%, χ2 = 77.76, P < 0.001; positive predictive value [PPV] = 80.6%) and the area under the endplate and equatorial portion of the vertebra longitudinally (80.53% vs. 28.20%, χ2 = 134.19, P < 0.001, PPV = 82.75%). Patients with BS more frequently exhibited fan-shaped osteosclerosis (12.82% vs. 1.15%, χ2 = 71.30, P < 0.001; PPV = 86.96%), longer bone formation surrounding the vertebra (18.06 mm vs. 1.97 mm, t = 14.28, P < 0.001), and longer anterior bone formation (3.86 mm vs. 0.92 mm, t = 6.51, P < 0.001). Anterior and closed bone formation was more common in the BS group than in the TS group (44.87% vs. 7.63%, χ2 = 152.53, P < 0.001; PPV = 77.78%). Fragmented and blocked sequestrum was more common in the TS group than in the BS group and tended to spread in and out of the erosions (22.14% vs. 0.64%, PPV = 98.31% and 22.14% vs. 0.00%, PPV = 100%, χ2 = 102.43, P < 0.001). Conclusions: TS and BS exhibit specific features of bone formation, bone destruction, and sequestrum on CT imaging. Our findings indicate that bone features on CT can help clinicians distinguish between two spinal infections. [ABSTRACT FROM AUTHOR]

The relationship of spinopelvic parameters with spondylolisthesis is widely explored. However, there is scarce evidence on correlation of tuberculosis of lumbar spine with respect to spinopelvic harmony. The current study aims to find the association between functional outcomes and spinopelvic parameters in lumbar spine tuberculosis treatment. A total of 47 patients with active tuberculosis confined to lumbar spine were prospectively analyzed and divided into 2 groups according to mode of intervention. Group A included 26 operatively managed patients and group B had 21 conservatively managed cases. Functional parameters comprising Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) along with spinopelvic radiologic parameters (pelvic incidence [PI], pelvic tilt [PT], sacral slope [SS], lumbar lordosis [LL], PI-LL, sagittal vertical axis) in both groups were analyzed at 0 and 6 months of follow-up. Both the groups showed significant improvement from initial presentation to final follow-up in ODI (Group A: 85.4 ± 12.1–12.3 ± 3.2, P = 0.02; Group B: 82.5 ± 10.06–36.8 ± 11.9, P = 0.04) and VAS (Group A: 8.1 ± 1.2–1.4 ± 0.9, P = 0.02; Group B: 8.5 ± 0.09–3.5 ± 1.1, P = 0.02). Statistically significant (P < 0.05) difference was observed in both functional outcome parameters between the 2 groups at 2-month and 6-month follow-up, compared with nonsignificant difference (P > 0.05) at presentation. Better improvements of spinopelvic parameters of PT, SS, LL, PI-LL were observed in Group A and in both groups the difference of these parameters correlated with differences of functional outcome parameters, though PI showed no correlation. The spinopelvic parameters played significant role in functional outcome. There is better functional outcome when LL is adequately restored. Surgical correction offered betterment of spinopelvic parameters like PT, SS, an sagittal vertical axis, which in turn leads to improvement in functional outcome. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Brucellosis, especially with osteoarticular involvement, is uncommon and difficult to diagnose, but it should be considered in a case presenting with prolonged fever, joint pain, and back pain. The diagnosis requires a combination of history, serological examinations, and radiographic studies. When the condition is detected and treated early, the prognosis is good. Brucella exploits host immune defenses to establish the chronic infection brucellosis, an endemic zoonotic disease. While human brucellosis affects multiple organs, osteo articular involvement is rare. We report the case of a 41‐year‐old woman with a history of goat farming who presented with fewer associated with low back pain and multiple joint pain for 4 months. Brucellosis was documented by positive serological tests (ELISA). Radiological findings suggested of right sacroiliitis and fracture line on the right sacral ala though had no history of trauma. Treatment consisted of NSAIDs and multiple antibiotic therapy. At follow‐up, her low back pain, joint pain, and fever had subsided. After 4 weeks of follow‐up, her symptoms were completely relieved with no recurrence. Brucellosis with atypical localization should be considered with a high index of suspicion based on detailed history and physical examination to ensure timely diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Purpose: Single‐shot echo‐planar imaging (ss‐EPI) has limited application in vertebral column imaging due to numerous artifacts. Therefore, we aimed to compare readout‐segmented echo‐planar imaging (rs‐EPI) to ss‐EPI and assess its value in the differential diagnosis of vertebral infectious, tumoral infiltrative, and degenerative disorders. Materials and Methods: Sixty‐six adult patients with spondylodiscitis (SD, n = 26), tumoral infiltration (TI, n = 20), or Modic type I degeneration (DE, n = 20) findings on spinal magnetic resonance imaging (MRI) included in this retrospective study. Two radiologists scored images for quality on a 4‐point scale (image resolution, degree of geometric distortion, lesion selectivity, and diagnostic reliability) and measured signal intensity (SI), apparent diffusion coefficient (ADC), signal‐to‐noise ratio (SNR), and contrast‐to‐noise ratio (CNR). DE and SD groups also united to form the benign group. Results: In all groups, rs‐EPI performed better than ss‐EPI in image quality, SNR, and CNR (p < 0.05). The difference between mean pathological ADC (ADCP) in the two sequences was statistically significant (p < 0.05). There was no significant difference between the groups in terms of ADCP in rs‐EPI (p = 0.229), unlike ss‐EPI (p =.025). Pathological SI (SIP) and CNR in rs‐EPI were significantly higher in the malignant group than benign group (p = 0.002, p < 0.001). In rs‐EPI, no significant difference was found between malignant and benign groups' ADCP (p = 0.13). Conclusion: The rs‐EPI is a diffusion‐weighted imaging (DWI) method with higher image quality that diminishes motion‐induced phase errors and increases resolution through phase corrections. However, the distinction of malignant and benign vertebral bone marrow pathologies is unsatisfactory for rs‐EPI compared with ss‐EPI. [ABSTRACT FROM AUTHOR]

Spondylodiscitis is an infection of the intervertebral disc, the adjacent vertebral body, and/or contiguous structures due to the introduction of infectious agent, usually by the hematogenous route. Imaging is crucial in assessing bacterial and tubercular spondylodiscitis, as well as their associated complications. Magnetic resonance imaging in particular can clearly depict osteo-structural changes in the vertebral body and the associated disc, as well as any soft-tissue complications, such as paravertebral abscess and/or epidural abscess, improving disease characterization and helping to recognize the agent involved. Nevertheless, other non-infectious diseases may mimic imaging appearances of spondylodiscitis and one should be aware of these conditions when interpreting MR images, which include Modic type I degenerative changes, ankylosing spondylitis, acute Schmorl's node, porotic fractures, and spinal neuropathy arthropathy. This pictorial review aims at describing imaging findings of bacterial and non-bacterial spondylodiscitis, complications, and those pathologies that mimic these infections. [ABSTRACT FROM AUTHOR]

Spondylodiscitis is a rare and severe condition which can lead to progressive spinal deformities and poor functional outcomes. Clinical management of low-back pain associated with spondylodiscitis has not been reported, as low back pain often persists even after appropriate treatment of spondylodiscitis. A 70-year-old woman with a 4-month history of nonspecific low-back pain and spondylodiscitis presented to the chiropractic clinic for conservative management. The symptoms started with abdominal discomfort, diarrhea, intermittent bilateral gluteal pain, and lowerextremity soreness. Gastritis and urinary tract infection were initially diagnosed. Thoracic radiography, magnetic resonance imaging (MRI), and computed tomography (CT) were indicative of spondylodiscitis at the T10/11 level, and her low-back pain was treated successfully with systemic antibiotics, scraping therapy, and spinal manipulative therapy. As there are limited data to suggest treatment modalities and extend care of spondylodiscitis, we report a case of successful management of low-back pain associated with spondylodiscitis, with multimodal therapy in a faster recovery time. [ABSTRACT FROM AUTHOR]

Mycoplasma hominis can be a part of human urogenital tract microbiome, and it is a frequent cause of urogenital infections. In rare cases, it can also cause extragenital infections, especially in immunocompromised patients. In this case series, we report two cases and provide a literature review of extragenital infections caused by M. hominis in patients with hypogammaglobulinemia. Patient 1 was a 61-year-old woman with diffuse large B-cell lymphoma who, after rituximab-containing chemotherapy and CAR-T therapy, developed M. hominis spondylodiscitis. Patient 2 was a 50-year-old woman with congenital hypogammaglobulinemia who developed disseminated M. hominis infection involving pleura, muscles, and right ankle. Antibiotic therapy with levofloxacin and doxycycline for 10 weeks in patient 1 and with levofloxacin alone for 6 weeks in patient 2 led to infection resolution. The literature review identified 14 additional cases reporting M. hominis extragenital infection in patients with hypogammaglobulinemia. M. hominis should also be suspected as an etiological agent of extragenital infection in patients with B-cell immunodeficiency with a clinical picture of persistent, standard-culture negative infection, particularly with arthritis or abscess formation. Even if M. hominis can grow on standard bacterial medium, in suspected cases molecular methods should be promptly used for correct diagnostic work-up and successful therapy. [ABSTRACT FROM AUTHOR]

Objectives: To retrospectively evaluate the correlation between intradiscal gas and infection in patients percutaneously biopsied for suspected discitis-osteomyelitis. Materials and methods: We retrospectively reviewed all CT-guided discitis-osteomyelitis biopsies performed between 2002 and 2022. Two independent trained musculoskeletal radiologists evaluated for presence of gas on CT and/or MRI within 1 week of the biopsy. Disagreements were resolved by a third musculoskeletal radiologist. CT was considered the gold standard for the detection of intradiscal gas. Pathology, microbiology, and imaging and clinical follow-up were used as the gold standard for presence of infection. Interrater agreement on CT and MRI, sensitivity, and positive predictive value were calculated, using the presence of gas as an indicator (test positive) for "no infection." Results: There were 284 biopsies in 275 subjects (mean age 58 ± 1.0 (range 4–99) years; 101 (37%) females and 174 (63%) males). Of the biopsies, 12 (4%) were cervical, 80 (28%) were thoracic, 192 (68%) were lumbar, and 200 (70%) were considered true discitis-osteomyelitis based on pathology, imaging, and clinical follow-up. Interrater agreement was excellent for CT (kappa = 0.83) and poor for MRI (kappa = − 0.021). The presence of gas had a 94% specificity and 76% negative predictive value for the absence of infection. Conclusion: CT is the preferred method for detecting intradiscal gas. The presence of gas means that discitis-osteomyelitis is unlikely. If intradiscal gas is present in the setting of discitis-osteomyelitis, the gas bubbles tend to be smaller and fewer in number. [ABSTRACT FROM AUTHOR]

Introduction: Conservative and surgical approach timeline in post-operative spondylodiscitis (POS) following lumbar disc herniation (LDH) surgery is ill defined, and patients have a protracted recovery phase with social, psychological, and financial implications. Materials and methods: Retrospective analysis of patients operated by transforaminal lumbar interbody fusion (TLIF) in POS was done. Confirmed clinico-radiological diagnosed POS cases, not responding within three to four weeks were included. Normalisation of CRP and radiological stable reconstruction was assessed for objective clearance of POS and bony union. Results: Ninety-five patients were included in the study with minimum follow-up period of two years. The mean age was 51.63±13.63 years. There were organisms cultured in 55 patients (57.89%). The ODI improvement of the patients was noted to improve from 88.71±5.3 to 20.80±9.7 (8 weeks) and was incremental at 2 years follow-up (10.12±6.41) and maintained further at final follow-up at 9±4.3. Bony union achieved in all with stable reconstruction. The resumption of activities of daily living (ADL) was quick (15.90±8.20 days) and job (3.67±1.31 months) was achieved in all the patients. In poor outcomes, two patients didn’t respond, and one patient died due to uncontrolled infection. Conclusion: Early diagnosis and intervention is the key to effective management of POS. Utilisation of aggressive TLIF yields faster ADL resumption.

Abstract Patient-reported outcome measures for quality of life (QoL) like the Oswestry-Disability-Index (ODI) are useful for a quick, comprehensive and comparable evaluation of spondylodiscitis treatment. While it is known that even after successful surgical treatment, the QoL of spondylodiscitis patients remains below that of the general population, risk factors for a poor outcome have not been described so far. We did a retrospective post-hoc analysis of 130 surgically treated spondylodiscitis patients from 2008 to 2022. Biographical, clinical und QoL data were prospectively collected before (T0) and one year (T1) after surgery. The primary outcome was QoL at T1. Patients were grouped according to their ODI score at T1 (Group 1: ODI

Mycotic aneurysms are a rare but potentially life-threatening complication of infections, particularly those involving the spine. Spondylodiscitis, a bacterial or fungal infection of the intervertebral disc, is a known risk factor for the development of mycotic aneurysms. Early diagnosis and prompt treatment are crucial for improving patient outcomes. We report the case of a 79-year-old patient with a history of diabetes admitted for chronic back pain refractory to medical treatment. A cervico-thoraco-abdomino-pelvic CT scan showed infectious spondylodiscitis at the lumbar level complicated by a mycotic aneurysm of the infrarenal abdominal aorta. This case highlights the diagnostic challenges associated with mycotic aneurysms, particularly when they arise from a contiguous infectious focus. Imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), play a pivotal role in identifying these aneurysms and assessing their extent.The patient underwent surgical management of the spondylodiscitis and the mycotic aneurysm. A stent was placed to reinforce the weakened aortic wall and prevent rupture. Postoperative management included long-term antibiotic therapy to eradicate the infection. The patient experienced a favorable outcome, with resolution of symptoms and improved quality of life.

Tuberculosis Spondylitis, also known as Pott's Disease, is an extrapulmonary form of tuberculosis (TB) that affects the spine. Sternal involvement is rare and accounts for only 0.3 % of cases. Its presentation is usually insidious in onset with many patients having little to no symptoms. Additionally, microbiological and histological results are inconsistent due to paucibacillary load from vertebral biopsies making definitive diagnosis challenging. Due to difficulty obtaining a diagnostic sample, a significant amount of TB spondylitis cases are presumed TB cases from improving clinical symptoms after empiric treatment as was our case. The purpose of this case report is to emphasize the diagnostic challenges of TB as well as present imaging findings over the course of two years with progressive involvement of the spine and sternum. Thus, here we report a case of presumed spinal tuberculosis affecting not only multiple levels of the spinal column but also the sternum in an immunocompetent United States born citizen with an indolent clinical course.

Gout is a crystalline arthropathy associated with prolonged body overload with uric acid. The most common sites are the distal joints of the lower limbs and the spine is rare. We report a case of gout with an initial cervical location of spondylodiscitis with epiduritis in a 62-year-old patient.

Abstract Background Spondylodiscitis is an infection of the vertebral body extending to the intervertebral disc, and possibly the surrounding paraspinal structures. Objectives To evaluate the clinical results of posterior long segment transpedicular screws fixation and decompression of the infected area for management of idiopathic pyogenic spondylodiscitis of the thoracic and lumbar spine. Methods This retrospective study included 14 patients with idiopathic active pyogenic spondylodiscitis of the lumber and thoracic spine between January 2017 and December 2021, with follow-up continuing until December 2022. All patients had posterior long-segment rigid fixation with infection decompression. Results All patients after 6-month follow-up had achieved complete fusion. There was no evidence of postoperative wound infection, and no patient had a recurrence of infection at the lesion site during follow-up. Prior to surgery, the mean VAS score for back pain was 7.6 (range 6–9), however, after surgery, it fell to 1.3 (0–3), a statistically significant improvement (P

A series of conditions can mimic musculoskeletal infections on imaging, complicating their diagnosis and affecting the treatment. Depending on the anatomical location, different conditions can manifest with clinical and imaging findings that mimic infections. Herein we present a wide spectrum of the musculoskeletal disorders of the axial skeleton, long bones, peripheral joints, and soft tissue that may manifest as infectious processes, and we focus on the potential mimics of osteomyelitis, septic arthritis, and infectious spondylodiscitis that are common in clinical practice. We present the typical imaging characteristics of each musculoskeletal infection, followed by mimicking conditions. [ABSTRACT FROM AUTHOR]

Objective Spondylodiscitis is an infectious disease that affects the vertebral body, intervertebral disc, and/or adjacent paraspinal tissue, and it is a significant cause of morbidity, especially in older individuals. This study aims to evaluate cases of spondylodiscitis followed at Suleyman Demirel University Hospital. Material and Method Between January 2017 and December 2021, the medical records and electronic files of patients who began antimicrobial treatment with a diagnosis of spondylodiscitis at Suleyman Demirel University Hospital were retrospectively evaluated. Results A total of 33 patients were included in the study, consisting of 17 females and 16 males. The average age of the patients was 56.0 ± 13.6 years. Twenty patients (60.6%) were hospitalized, while 13 patients (39.4%) were followed as outpatients. Spinal surgery due to discopathy was performed in 9 cases (27.3%), and 4 of these patients had a history of recurrent surgical interventions. The most commonly affected region was the lumbar vertebrae (44.1%). The lumbosacral region (20.6%) and thoracolumbar region (14.7%) followed as the second and third most affected areas, respectively. Brucellosis complications were present in 14 cases (42.4%) of spondylodiscitis. Pyogenic microorganisms and tuberculosis were responsible for the remaining 11 (33,3%), and 2 (6%) patients respectively. In 11 patients (33.3.%), the causative microorganism was identified in tissue/ abscess/blood cultures as methicillin-sensitive Staphylococcus aureus (3), methicillin-resistant coa-gulase-negative Staphylococcus (1), methicillin-resistant S. aureus (1), methicillin-sensitive coagulase-negative Staphylococcus (1), Klebsiella pneumonia (2), Enterococcus faecalis (2), Acinetobacter spp. (1), Escherichia coli (1). Staphylococcus aureus (12%) was the most common pathogen among pyogenic microorganisms. In one case, the identified pathogen was Mycobacterium tuberculosis. One of the patients was considered to have tuberculosis spondylodiscitis based on histopathological evaluation. Conclusion The fact that nearly half of spondylodiscitis cases observed in our hospital were complicated by brucellosis indicates the importance of evaluating patients presenting with back pain for brucellosis. Collaborative training programs with surgical specialities should be periodically repeated to prevent cases of spondylodiscitis that develop after spinal surgeries. [ABSTRACT FROM AUTHOR]

Endoscopic surgery is a minimally invasive procedure that has been shown to relieve intradiscal pressure, irrigation of inflammatory factors, and visual debridement, which are crucial for the successful treatment of spondylodiscitis. This study proposes a systematic review and meta-analysis to evaluate the effectiveness and safety of endoscopic treatment of thoracolumbar spondylodiscitis. Multiple databases were searched for studies involving thoracolumbar spondylodiscitis treated by endoscopic disc drainage with or without additional posterior fixation over the last 20 years. Studies that met the inclusion criteria, which included outcomes related to the percentage of cured infections, patient satisfaction, regression of inflammatory markers, and/or the percentage of adverse event rates, were included in the analysis. For each study, the percentage of patients who showed improvement or experienced an adverse event was abstracted and pooled in a meta-analysis. Based on the search strategy and inclusion criteria, our systematic review and meta-analysis included 20 studies with 546 participants. The success rate was 89.4% (95% CI 83.1%–94.5%). The rate of major adverse events was 0.3%, while that of postoperative transient paresthesia was 2.6% (95% CI 0.8%–5.1%). The recurrence rate was 1.7% (95% CI 0.3%–4.0%), and revision surgery was 8.5% (95% CI 3.8%–14.6%). The causative pathogen diagnosis rate was 73.9% (95% CI 67.7%–79.8%), while progression of deformity was 3.7% (95% CI 0.2%–9.8%), and spontaneous fusion was 40.1% (95% CI 11.0%–73.3%). Endoscopic discectomy for thoracolumbar spondylodiscitis has been shown to be a safe technique with satisfactory clinical outcomes and a high causative pathogen identification rate. [ABSTRACT FROM AUTHOR]

Introduction: This study analysed treatment outcomes in a patient cohort diagnosed with spondylodiscitis, who received adjunct hyperbaric oxygen treatment (HBOT) in addition to antibiotic therapy at our clinic. Important considerations included the timing of HBOT initiation on treatment success, and recurrence rates. Methods: We retrospectively reviewed the records of all patients diagnosed with spondylodiscitis who received HBOT at the Underwater and Hyperbaric Medicine Clinic in Gulhane Training and Research Hospital, between 1 November 2016 and 25 October 2022. The patients received HBOT at 243.2 kPa for a total of 120 minutes per session, once daily for five days a week for a total of 30 sessions. Results: Twenty-five patients with spondylodiscitis were evaluated before and after combination HBOT and targeted antibiotic treatment. After treatment, patients had lower median (range) visual analogue pain scores (8 [4-10] vs 3 [0-7], P < 0.001) and C-reactive protein (22.3 [4.3-79.9] mg·L-1 vs 6.8 [0.1-96.0] mg·L-1, P = 0.002) and lower mean (standard deviation) white blood cell counts (8.8 [3.5] x 109·L-1 vs 6.1 [1.6] x 109·L-1, P = 0.002). When patients were examined (median) 48 months (2-156 months) after the completion of treatment, there were no persistent cases of spondylodiscitis. Conclusions: Combination HBOT with targeted antibiotic therapy effectively managed our cohort of patients diagnosed with spondylodiscitis. Hyperbaric oxygen treatment was safe, with no complications experienced. Moreover, HBOT may have helped to eliminate persistence and recurrence of symptoms with long term follow-up. A randomised controlled study with a larger number of patients is needed for more definitive conclusions. [ABSTRACT FROM AUTHOR]

Background: While MRI is the primary diagnostic tool for the diagnosis of spondylodiscitis, the role of [18F]-fluorodeoxyglucose ([18F]FDG) PET/CT is gaining prominence. This study aimed to determine the frequency of [18F]FDG PET/CT usage and its impact on the in-hospital mortality rate in patients with spondylodiscitis, particularly in the geriatric population. Methods: We conducted a Germany-wide cross-sectional study from 2019 to 2021 using an open-access, Germany-wide database, analyzing cases with ICD-10 codes M46.2-, M46.3-, and M46.4- ('Osteomyelitis of vertebrae', 'Infection of intervertebral disc (pyogenic)', and 'Discitis unspecified'). Diagnostic modalities were compared for their association with in-hospital mortality, with a focus on [18F]FDG PET/CT. Results: In total, 29,362 hospital admissions from 2019 to 2021 were analyzed. Of these, 60.1% were male and 39.9% were female, and 71.8% of the patients were aged 65 years and above. The overall in-hospital mortality rate was 6.5% for the entire cohort and 8.2% for the geriatric subgroup (p < 0.001). Contrast-enhanced (ce) MRI (48.1%) and native CT (39.4%) of the spine were the most frequently conducted diagnostic modalities. [18F]FDG PET/CT was performed in 2.7% of cases. CeCT was associated with increased in-hospital mortality (OR = 2.03, 95% CI: 1.90–2.17, p < 0.001). Cases with documented [18F]FDG PET/CT showed a lower frequency of in-hospital deaths (OR = 0.58, 95% CI: 0.18–0.50; p = 0.002). This finding was more pronounced in patients aged 65 and above (OR = 0.42, 95% CI: 0.27–0.65, p = 0.001). Conclusions: Despite its infrequent use, [18F]FDG PET/CT was associated with a lower in-hospital mortality rate in patients with spondylodiscitis, particularly in the geriatric cohort. This study is limited by only considering data on hospitalized patients and relying on the assumption of error-free coding. Further research is needed to optimize diagnostic approaches for spondylodiscitis. [ABSTRACT FROM AUTHOR]

Infectious spondylodiscitis is a life-threatening disease and has some challenges in terms of diagnostic, differentiative, and therapeutic processes. Therefore, rapid and effective management of infectious spondylodiscitis is necessary. Hematological inflammation indices (HIIs) such as the neutrophil/lymphocyte ratio and aggregate index of systemic inflammation are derived from blood cells and used as diagnostic, prognostic, predictive, and treatment monitoring indicators. This study aimed to evaluate HIIs for discriminating between infectious spondylodiscitis pathogens. This retrospective comparative study included 116 patients with infectious spondylodiscitis. According to the responsible infectious pathogens, three types of infectious spondylodiscitis were defined: Brucella (n = 51), pyogenic (n = 43), and tuberculous (n = 22). The HIIs were derived from baseline complete blood counts. The three types of infectious spondylodiscitis were statistically compared for the HII scores. We found that the Brucella group had significantly lower HII scores than the pyogenic group (p < 0.05). Also, the Brucella group had significantly lower HII scores than the tuberculous group (p < 0.05). However, no significant differences were found between the pyogenic and tuberculous groups regarding HIIs (p > 0.05). In conclusion, the HIIs may be considered in the differentiation between Brucella spondylodiscitis and other types of infectious spondylodiscitis. [ABSTRACT FROM AUTHOR]

Background: Spondylodiscitis is an infection of the vertebral body extending to the intervertebral disc, and possibly the surrounding paraspinal structures. Objectives: To evaluate the clinical results of posterior long segment transpedicular screws fixation and decompression of the infected area for management of idiopathic pyogenic spondylodiscitis of the thoracic and lumbar spine. Methods: This retrospective study included 14 patients with idiopathic active pyogenic spondylodiscitis of the lumber and thoracic spine between January 2017 and December 2021, with follow-up continuing until December 2022. All patients had posterior long-segment rigid fixation with infection decompression. Results: All patients after 6-month follow-up had achieved complete fusion. There was no evidence of postoperative wound infection, and no patient had a recurrence of infection at the lesion site during follow-up. Prior to surgery, the mean VAS score for back pain was 7.6 (range 6–9), however, after surgery, it fell to 1.3 (0–3), a statistically significant improvement (P < 0.001) during the last follow-up. According to the Kirkaldy-Willis criteria, the functional prognosis was excellent in 11 individuals, good in two, and fair in one. Conclusions: Posterior long-segment fixation in conjunction with decompression of the affected area effectively resolved bacterial spinal infection and restored neurological impairment. [ABSTRACT FROM AUTHOR]

Objective: Spondylodiscitis refers to infection of the intervertebral disk and neighboring structures. Outcomes based on instrumentation type are not well reported in the literature, but are important in establishing guidelines for surgical management of spondylodiscitis. This study aims to clarify the effect of instrumentation material selection on clinical and radiographic outcomes in patients with spondylodiscitis. Methods: Studies that evaluated the use of polyetheretherketone (PEEK), titanium, allograft, and/or autologous bone grafts for spondylodiscitis were identified in the literature. Radiographic and clinical data were analyzed using a meta-analysis of proportions, with estimated risk and confidence intervals reported for our primary study outcomes. Results: Thirty-two retrospective studies totaling 1088 patients undergoing surgical management of spondylodiscitis with PEEK, TTN, allograft, and autologous bone graft instrumentation were included. There were no differences in fusion rates (p-interaction = 0.55) with rates of fusion of 93.4% with TTN, 98.6% with allograft, 84.2% with autologous bone graft, and 93.9% with PEEK. There were no differences in screw loosening (p-interaction = 0.52) with rates of 0.33% with TTN, 0% with allograft, 1.3% with autologous bone graft, and 8.2% with PEEK. There were no differences in reoperation (p-interaction = 0.59) with rates of 2.64% with TTN, 0% with allograft, 1.69% with autologous bone graft, and 3.3% with PEEK. Conclusions: This meta-analysis demonstrates that the choice of instrumentation type in the surgical management of spondylodiscitis resulted in no significant differences in rate of radiographic fusion, screw loosening, or reoperation. Future comparative studies to optimize guidelines for the management of spondylodiscitis are needed. [ABSTRACT FROM AUTHOR]

Cross-modality image generation from magnetic resonance (MR) to positron emission tomography (PET) using the generative model can be expected to have complementary effects by addressing the limitations and maximizing the advantages inherent in each modality. This study aims to generate synthetic PET/MR fusion images from MR images using a combination of generative adversarial networks (GANs) and conditional denoising diffusion probabilistic models (cDDPMs) based on simultaneous 18F-fluorodeoxyglucose (18F-FDG) PET/MR image data. Retrospective study with prospectively collected clinical and radiological data. This study included 94 patients (60 men and 34 women) with thoraco-lumbar pyogenic spondylodiscitis (PSD) from February 2017 to January 2020 in a single tertiary institution. Quantitative and qualitative image similarity were analyzed between the real and synthetic PET/ T2-weighted fat saturation MR (T2FS) fusion images on the test data set. We used paired spinal sagittal T2FS and PET/T2FS fusion images of simultaneous 18F-FDG PET/MR imaging examination in patients with PSD, which were employed to generate synthetic PET/T2FS fusion images from T2FS images using a combination of Pix2Pix (U-Net generator + Least Squares GANs discriminator) and cDDPMs algorithms. In the analyses of image similarity between the real and synthetic PET/T2FS fusion images, we adopted the values of mean peak signal to noise ratio (PSNR), mean structural similarity measurement (SSIM), mean absolute error (MAE), and mean squared error (MSE) for quantitative analysis, while the discrimination accuracy by three spine surgeons was applied for qualitative analysis. Total of 2,082 pairs of T2FS and PET/T2FS fusion images were obtained from 172 examinations on 94 patients, which were randomly assigned to training, validation, and test data sets in 8:1:1 ratio (1664, 209, and 209 pairs). The quantitative analysis revealed PSNR of 30.634 ± 3.437, SSIM of 0.910 ± 0.067, MAE of 0.017 ± 0.008, and MSE of 0.001 ± 0.001, respectively. The values of PSNR, MAE, and MSE significantly decreased as FDG uptake increased in real PET/T2FS fusion image, with no significant correlation on SSIM. In the qualitative analysis, the overall discrimination accuracy between real and synthetic PET/T2FS fusion images was 47.4%. The combination of Pix2Pix and cDDPMs demonstrated the potential for cross-modal image generation from MR to PET images, with reliable quantitative and qualitative image similarities. [ABSTRACT FROM AUTHOR]

Purpose: Since an increase in the occurrence of native vertebral osteomyelitis (VO) is expected and reliable projections are missing, it is urgent to provide a reliable forecast model and make it a part of future health care considerations. Methods: Comprehensive nationwide data provided by the Federal Statistical Office of Germany were used to forecast total numbers and incidence rates (IR) of VO as a function of age and gender until 2040. Projections were done using autoregressive integrated moving average model on historical data from 2005 to 2019 in relation to official population projections from 2020 to 2040. Results: The IR of VO is expected to increase from 12.4 in 2019 to 21.5 per 100,000 inhabitants [95% CI 20.9–22.1] in 2040. The highest increase is predicted in patients over 75 years of age for both men and women leading to a steep increase in absolute numbers, which is fourfold higher compared to patients younger than 75 years. While the IR per age group will not increase any further after 2035, the subsequent increase is due to a higher number of individuals aged 75 years or older. Conclusions: Our data suggest that increasing IR of VO will seriously challenge healthcare systems, particularly due to demographic change and increasing proportions of populations turning 75 years and older. With respect to globally fast aging populations, future health care policies need to address this burden by anticipating limitations in financial and human resources and developing high-level evidence-based guidelines for prevention and interdisciplinary treatment. [ABSTRACT FROM AUTHOR]

Primary bone lymphoma of the spine (PBL) is a rare entity that may be misdiagnosed due to its atypical location and clinical and imaging features mimicking certain pathologies as infectious processes, which complicates and delays diagnosis. Our case reports a patient in her sixties who had been suffering from chronic low back pain for a year, and had gradually started to develop cruralgia. She underwent a blood sample, magnetic resonance imaging (MRI), and positron emission tomography (18F-FDG-PET/CT) which revealed inflammatory syndrome, and an image of spondylodiscitis of the lumbar spine associated with a morphological and metabolical widespread invasion posteriorly suggesting epiduritis. No other lesions were found on the rest of the body. Neurosurgical management was performed and a biopsy was made. Histological results showed aggressive and diffuse large B-cell lymphoma, suggesting a diagnosis of PBL. This case highlights the first case of spondylodiscitis mimicking PBL in the lumbar spine, the intricacies of the diagnostic work-up, and the complexity of discriminating with an infectious process in the spine, as both have a similar, non-specific clinical presentation, while morphological and metabolic findings can be alike. [ABSTRACT FROM AUTHOR]

Background: Brucellosis is a zoonotic infectious disease. It is estimated that the number of cases reported today is much less than the actual number. We still have difficulty in diagnosing the disease and its organ involvement. In this sense, new approaches that can be useful in clinical practice are required, and we aimed to evaluate this situation in our study. Methods: 171 of 213 patients followed in our center between January 2021 and April 2024 were included in the study. A total of 150 patients were included in the study as a control group. Rose Bengal test (RBT), Coombs gel test (CGT), enzyme-linked immunosorbent assay (ELISA), and automated blood culture were used for diagnosing brucellosis. Complete blood count, sedimentation, C-reactive protein, and biochemical parameters were obtained. Inflammation markers such as neutrophil–lymphocyte ratio, platelet–lymphocyte ratio, systemic immune-inflammation index, and systemic inflammation response index were calculated. Results: The most successful results in the diagnosis were ELISA (89.4%), RBT (88.3%), CGT (83%), and blood culture (34.8%). For diagnosing sacroiliitis and spondylodiscitis, instead of resorting to expensive methods like magnetic resonance, a combination of ELISA positivity with elevated acute phase reactants and inflammatory markers could be significantly instructive. Conclusions: Optimizing diagnostic algorithms and exploring novel diagnostic approaches, such as inflammatory markers, hold promise for improving diagnosis and management. [ABSTRACT FROM AUTHOR]

The purpose of this study is to report a case of Parvimonas micra-related spondylodiscitis (PMSD) and conduct a systematic review of the literature to identify clinical, microbiologic, and radiographic assessment and treatment outcomes. This research was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic review of the Literature indexed in PubMed, MEDLINE, and Scopus databases was performed from 1970 to December 2023 using search terms "vertebral," "spinal," "infection," "spondylodiscitis," "discitis," "osteomyelitis," "Parvimonas," and "micra." The systematic review identified 34 cases of PMSD in addition to the reported case after the screening of 472 titles and abstracts. Patients reported several clinical presentations, with back pain being the most common symptom. Treatment strategies included antibiotic therapy alone or in combination with surgery, resulting in favorable outcomes for the majority of patients. However, challenges such as delayed diagnosis and lack of standardized treatment protocols were observed. The P. micra is an emerging pathogen in spinal infections, particularly in patients with predisposing factors. This study highlights the need for heightened awareness among healthcare providers regarding the potential role of anaerobic bacteria in spondylodiscitis. Standardized diagnostic and treatment protocols are warranted to improve outcomes for patients with PMSD. [ABSTRACT FROM AUTHOR]

Introduction: spondylodiscitis is an infection of the intervertebral disc and adjacent vertebral plates. According to data from the available literature, men are affected three times more often than women, and the disease most often occurs between the sixth and eighth decade of life. Etiologically, various microbiological agents can be found in the substrate. Often the etiology is not known. The clinical presentation is often nonspecific, and symptoms and signs include back pain, fever, nausea, and weight loss. Aim: to characterize the clinical picture and identify the etiology, comorbidities and therapeutic modes of spondylodiscitis that were treated at the Clinic of Infectious Disease of the Clinical Center University of Sarajevo in the period from 2012 to 2022. Materials and methods: a retrospective study was conducted in which cases of spondylodiscitis were identified. The data was collected by looking at the patients' medical histories. Results: in the 10 year period, 60 patients met the criteria for inclusion in the study. On average, it took 5 months from the onset of symptoms to the verification of the diagnosis. The average number of hospital days was 32 days and ranged from 15 days to 69 days. Blood cultures were positive in 22 patients (36.6%). Brucellosis was the most common cause of spondylodiscitis in our patients, where as many as 42 patients (70%) had it. A total of 50 patients (83.4%) had an etiological diagnosis. The main source of infection was not identified in 10 patients (16.6%). Simultaneous psoas muscle abscesses were also observed in 10 patients (16.6%), paravertebral abscesses in 4 patients (6.6%) and epidural abscesses in 2 patients ( 3.3%). Among brucellosis spondylodiscitis, 35 (83.3%) patients were diagnosed with acute brucellosis, 4 (16.8%) with subacute brucellosis and 3 (7.1%) with chronic brucellosis. All patients reported back pain in their anamnestic history. 38 (90.4%) patients reported positive epidemiological data on contact with animals, consumption of dairy products. Conclusion: despite prolonged and microbiologically targeted antibiotic therapy, spondylodiscitis is associated with significantly more severe effects including prolonged hospital stay, persistence of symptoms. Complications with the formation of vertebral abscesses are common. The data from our study show limited possibilities of conservative treatment, therefore we emphasize the need for further research and evaluation of the impact of timely surgical interventions on the course and outcome of the disease. [ABSTRACT FROM AUTHOR]

OBJECTIVES To date, there are no standardized treatment algorithms or recommendations for patients with infective endocarditis (IE) and concomitant spondylodiscitis (SD). Therefore, our aim was to analyse whether the sequence of surgical treatment of IE and SD has an impact on postoperative outcome and to identify risk factors for survival and postoperative recurrence. METHODS Patients with IE underwent surgery in 4 German university hospitals between 1994 and 2022. Univariable and multivariable analyses were performed to identify possible predictors of 30-day/1-year mortality and recurrence of IE and/or SD. RESULTS From the total IE cohort (n  = 3991), 150 patients (4.4%) had concomitant SD. Primary surgery for IE was performed in 76.6%, and primary surgery for SD in 23.3%. The median age was 70.0 (64.0–75.6) years and patients were mostly male (79.5%). The most common pathogens detected were enterococci and Staphylococcus aureus followed by streptococci , and coagulase-negative Staphylococci. If SD was operated on first, 30-day mortality was significantly higher than if IE was operated on 1st (25.7% vs 11.4%; P  = 0.037) and we observed a tendency for a higher 1-year mortality. If IE was treated 1st, we observed a higher recurrence rate within 1 year (12.2% vs 0%; P  = 0.023). Multivariable analysis showed that primary surgery for SD was an independent predictor of 30-day mortality. CONCLUSIONS Primary surgical treatment for SD was an independent risk factor for 30-day mortality. When IE was treated surgically 1st, the recurrence rate of IE and/or SD was higher. [ABSTRACT FROM AUTHOR]

Background and Objectives: Differentiation between brucella spondylodiscitis and Modic type I changes (MC1) includes difficulties. Hematological inflammatory indices (HII) such as neutrophil to lymphocyte ratio (NLR) and aggregate index of systemic inflammation (AISI) are suggested as indicators of inflammation and infection and have diagnostic, prognostic, and predictive roles in various diseases. This study aimed to evaluate differences between brucella spondylodiscitis and MC1 in terms of HII. Materials and Methods: Thirty-five patients with brucella spondylodiscitis and thirty-seven with MC1 were enrolled in the study. Brucella spondylodiscitis and MC1 were diagnosed by microbiological, serological, and radiological diagnostic tools. HII (NLR, MLR, PLR, NLPR, SII, SIRI, AISI) were derived from baseline complete blood count. Results: The two groups were similar for age (p = 0.579) and gender (p = 0.092), leukocyte (p = 0.127), neutrophil (p = 0.366), lymphocyte (p = 0.090), and monocyte (p = 0.756) scores. The Brucella spondylodiscitis group had significantly lower pain duration (p < 0.001), higher CRP and ESR levels (p < 0.001), and lower platelet count (p = 0.047) than the MC1 group. The two groups had similarity in terms of HII: NLR (p = 0.553), MLR (p = 0.294), PLR (p = 0.772), NLPR (p = 0.115), SII (p = 0.798), SIRI (p = 0.447), and AISI (p = 0.248). Conclusions: Increased HII can be used to differentiate infectious and non-infectious conditions, but this may be invalid in brucellosis. However, pain duration, CRP and ESR levels, and platelet count may be useful to distinguish brucella spondylodiscitis from MC1. [ABSTRACT FROM AUTHOR]

Spondylodiscitis is a severe spinal infection that requires an effective antibiotic treatment. Therefore, we sought to analyse the causative pathogens from intraoperative specimen in patients with spondylodiscitis and a need for surgery. To this end, we performed a retrospective study of all patients with spondylodiscitis and a need for operative treatment admitted to our hospital between January 2020 and December 2022. A total of 114 cases with spondylodiscitis were identified. A total of 120 different pathogens were detected. Overall, 76.7% of those microorganisms were Gram-positive bacteria. The most common causative pathogen was Staphylococcus aureus (n = 32; 26.6%), followed by coagulase-negative staphylococci (n = 28; 23.4%), of which Staphylococcus epidermidis (n = 18; 15%) was the most frequently detected, as well as enterococci (n = 10; 8.4%) and Streptococcus spp. (n = 11; 9.2%). Moreover, 19.1% (n = 22) and 3.4% (n = 4) of all detected isolates were Gram-negative pathogens or fungi, respectively. Overall, 42.8% of all coagulase-negative staphylococci were oxacillin-resistant, while none of them were vancomycin-resistant. In summary, 50% of the pathogens could be identified as staphylococci. The results of our study highlight the important burden of oxacillin-resistant Gram-positive bacteria as an aetiological cause of spondylodiscitis, providing a relevant finding for antimicrobial stewardship programmes. [ABSTRACT FROM AUTHOR]

Key Clinical Message Brucellosis, especially with osteoarticular involvement, is uncommon and difficult to diagnose, but it should be considered in a case presenting with prolonged fever, joint pain, and back pain. The diagnosis requires a combination of history, serological examinations, and radiographic studies. When the condition is detected and treated early, the prognosis is good. Abstract Brucella exploits host immune defenses to establish the chronic infection brucellosis, an endemic zoonotic disease. While human brucellosis affects multiple organs, osteo articular involvement is rare. We report the case of a 41‐year‐old woman with a history of goat farming who presented with fewer associated with low back pain and multiple joint pain for 4 months. Brucellosis was documented by positive serological tests (ELISA). Radiological findings suggested of right sacroiliitis and fracture line on the right sacral ala though had no history of trauma. Treatment consisted of NSAIDs and multiple antibiotic therapy. At follow‐up, her low back pain, joint pain, and fever had subsided. After 4 weeks of follow‐up, her symptoms were completely relieved with no recurrence. Brucellosis with atypical localization should be considered with a high index of suspicion based on detailed history and physical examination to ensure timely diagnosis and treatment.

Objective This study aimed to compare and analyze differences in clinical and magnetic resonance imaging (MRI) findings between tuberculous spondylodiscitis (TbS) and pyogenic spondylodiscitis (PyS), and to develop and validate a simplified multiparameter MRI-based scoring system for differentiating TbS from PyS. Methods We compared predisposing factors in 190 patients: 123 with TbS and 67 with PyS, confirmed by laboratory tests, culture, or pathology. Data encompassing patient demographics, clinical characteristics, laboratory results, and MRI findings were collected between 2015 and 2020. Data were analyzed using logistic regression methods, and selected coefficients were transformed into an MRI-based scoring system. Internal validation was performed using bootstrapping method. Results Univariate analysis revealed that the significant risk factors associated with TbS included thoracic lesions, vertebral destruction > 50%, intraosseous abscess, thin-walled abscess, well-defined paravertebral abscess, subligamentous spreading, and epidural abscess. Multivariate analysis revealed that only thoracic lesions, absence of epidural phlegmon, subligamentous spreading, intraosseous abscesses, well-defined paravertebral abscesses, epidural abscesses, and absence of facet joint arthritis were independent predictive factors for TbS (all p < 0.05). These potential predictors were used to derive an MRI scoring system. Total scores ≥ 14/29 points significantly predicted the probability of TbS, with a sensitivity of 97.58%, specificity of 92.54%, and an area under the curve of 0.96 (95% confidence interval, 125.40–3,257.95). Conclusion This simplified MRI-based scoring system for differentiating TbS from PyS helps guide appropriate treatment when the causative organism is not identified.

Abstract Background Tuberculosis (TB) is one of the top ten causes of death worldwide, with approximately 10 million cases annually. Focus has been on pulmonary TB, while extrapulmonary TB (EPTB) has received little attention. Diagnosis of EPTB remains challenging due to the invasive procedures required for sample collection. Spinal TB (STB) accounts for 10% of EPTB and often leads to lifelong debilitating disease due to devastating spinal deformation and compression of neural structures. Little is known about the extent of disease, although both isolated STB and a disseminated form of STB have been described. In our Spinal TB X cohort study, we aim to describe the clinical phenotype of STB using whole-body 18FDG-PET/CT, identify a specific gene expression profile for different stages of dissemination and compare findings to previously described gene expression signatures for latent and active pulmonary TB. Methods A single-centre, prospective cohort study will be established to describe the distributional pattern of STB detected by whole-body 18FDG-PET/CT and gene expression profile of patients with suspected STB on magnetic resonance imaging (MRI) at point of diagnosis, six months, and 12 months. Blood biobanking will be performed at these time points. Specimens for microbiology will be obtained from sputum/urine, from easily accessible sites of disease (e.g., lymph nodes, abscess) identified in the first 18FDG-PET/CT, from CT-guided biopsy and/or surgery. Clinical parameters and functional scores will be collected at every physical visit. Data will be entered into RedCap® database; data cleaning, validation and analysis will be performed by the study team. The University of Cape Town Ethics Committee approved the protocol (243/2022). Discussion The Spinal TB X cohort study is the first prospective cohort study using whole-body 18FDG-PET/CT scans in patients with microbiologically confirmed spinal tuberculosis. Dual imaging techniques of the spine using 18FDG-PET/CT and magnetic resonance imaging as well as tissue diagnosis (microbiology and histopathology) will allow us to develop a virtual biopsy model. If successful, a distinct gene-expression profile will aid in blood-based diagnosis (point of care testing) as well as treatment monitoring and would lead to earlier diagnosis of this devastating disease. Trial registration: The study has been registered on ClinicalTrials.gov (NCT05610098).

Abstract Background Spontaneous spondylodiscitis (SD) is an inflammation of the vertebral endplate and the intervertebral disc with no prior surgery or intervention. The treatment of spontaneous pyogenic SD mainly consists of systemic antibiotics and rest. Some cases require surgery due to failure of medical treatment or due to neurological compromise. Due to the disease heterogeneity, there are no standardized, widely adopted treatment protocols. We conducted this study to assess the clinical outcome of the different treatment modalities. Results This is a retrospective analysis of prospectively collected data of patients with spontaneous non-tuberculous spondylodiscitis. Thirty-eight patients were identified, including 14 males and 24 females. The mean age was 49 years. Twenty-three patients underwent surgery from the start while 15 patients received conservative medical treatment. Among the latter, 8 patients showed disease progression and required surgical intervention. The ODI/NDI at 1 year (mean = 8) was significantly better than before treatment (mean = 18). Among 11 patients with motor deficit at presentation, 8 improved and 3 remained stable. There were 14 complications, including 11 minor and 3 major, requiring one revision surgery. Conclusions Surgical decompression and debridement with or without instrumented fusion for complicated SD cases is a safe and effective treatment modality. Close follow-up is needed in case of conservative treatment for early detection of treatment failure and disease progression. Baseline characteristic variabilities in patients with spontaneous pyogenic SD could predict conservative treatment failure, but this needs to be validated in larger series.

Background: Spondylodiscitis (SD) is an inflammatory condition affecting the intervertebral discs and adjacent structures, often leading to serious complications, including epidural abscesses. This study aimed to differentiate postoperative SD from spontaneous cases caused by osteoporotic defects and associated pathologies, evaluating the frequency of SD in spinal diseases at a single center. Materials and Methods: A retrospective observational study involving 25 patients was conducted, analyzing variations between postoperative revisions in SD patients and spontaneous SD due to concurrent pathology and osteoporotic defects. The effects of postoperative wound healing following transforaminal lumbar interbody fusion and decompressive hemilaminectomy with pedicle screws were also investigated. Ethical guidelines were strictly followed during the study, conducted from January 2023 to September 2023 at Moscow City Clinical Hospital No. 68, Demikhova V.P. Results: Among the 25 patients with spontaneous SD, 15 females and 10 males were included, with only two undergoing surgical revision. Predominant purulent inflammatory foci were observed at specific spinal levels, and demographics revealed prevalent comorbidities such as arterial hypertension (80%) and type 2 diabetes mellitus (60%). Postoperative complications included paravertebral abscesses and wound-related issues. Structural observations indicated vertebral destruction, joint gaps, and localized spinal canal narrowing, revealing complexities in SD cases. Conclusion: Surgical intervention remains crucial for addressing SD-related vertebral complications, while antimicrobial therapy tailored to specific pathogens is pivotal. Concurrent conditions necessitate comprehensive management, often involving cardiological interventions. Postoperatively, a combined approach of conservative therapy and calcium phosphate adjuncts is recommended, especially considering the observed low bone density, aiming to optimize patient recovery and spinal stability.

Salmonella species are associated with bacteraemia, diarrhoea, as well as focal infections. Salmonella Typhi is the most pathogenic species. Salmonella Paratyphi B commonly affects immunocompromised hosts. The present case series showcases six cases of infection caused by typhoidal Salmonellae with unusual clinical scenarios. The first case report explains a case of neonatal meningitis where the causative agent was S. Paratyphi B. A case of lumbar spondylodiscitis is also reported where the aetiology was found to be Salmonella Typhi. Case three reports S. Typhi infection in a patient with Pre-B cell Acute Lymphoblastic Leukemia (ALL). S. Paratyphi B was isolated from a blood culture of a patient on haemodialysis and also from ascitic fluid from a case of Chronic Liver Disease (CLD). S. Typhi was isolated from the pleural fluid of a patient with carcinoma of the prostate.

Study Design This was a retrospective study. Purpose This study aimed to assess the value of the Spinal Infection Treatment Evaluation (SITE) score, Brighton Spondylodiscitis Score (BSDS), and Pola classification to predict the need for surgical intervention in patients with spondylodiscitis. Overview of Literature Spondylodiscitis is a rare disease, and the prediction of its outcome is crucial in the decision-making process. Methods All case records were assessed to extract information on the American Spinal Injury Association (ASIA), Visual Analog Scale (VAS), and Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores before and after surgery. The SITE score, Pola classification, and BSDS were recorded. The receiver-operating characteristic (ROC) curve analysis and the area under the curve (AUC) were applied to estimate the predictive ability of the scoring systems. Patients’ satisfaction with surgery outcomes was evaluated using the VAS, ASIA, JOABPEQ, and Likert scale for quality-of-life evaluation. Results In all 148 patients, case records were reviewed. The mean±standard deviation age of the patients was 54.6±14.7 years. Of these, 112 patients underwent surgery. The AUC scores were 0.86, 0.81, and 0.73 for the SITE score, BSDS, and Pola classification, respectively. In the comparison of the AUC of ROC curves, SITE score vs. BSDS showed a significantly greater AUC, 0.13 (Z=2.1, p=0.037); SITE score vs. Pola classification, 0.05 (Z=0.82, p=0.412); and Pola classification vs. BSDS, 0.08 (Z=1.22, p=0.219). The optimal cutoff score was 8.5 (sensitivity, 80.6%; specificity, 81.2%) for the SITE score and 9.5 (sensitivity, 52.8%; specificity, 83.0%) for the BSDS in the decision to surgery. VAS back pain and JOABPEQ subscales showed a significant difference when compared with preoperative scores. According to ASIA grading, none of the patients experienced neurological deterioration. Overall, patients’ satisfaction was observed. Conclusions The findings suggest that the SITE score is a useful measure and helps clinicians make clinically sound decisions in patients with spondylodiscitis.

Introduction: Head and neck cancer is an umbrella term for tumor manifestations across the head and neck regions, including the oral cavity, pharynx (including the naso, oro, and hypopharynx), larynx, and sinuses. Treatment options for head and neck cancer include surgery, radiation therapy, chemotherapy, and immunotherapy, with specific treatment plans depending upon individual tumor location and staging, together with overall patient health status. Furthermore, definitive chemoradiotherapy (CRT) has emerged as a highly effective therapeutic option for locoregional advanced head and neck squamous cell cancer. However, such therapy has also been linked to the development of spondylodiscitis. Spondylodiscitis consists of an infection starting at the vertebral endplates and spreading into the intervertebral discs, typically manifesting in adults. Case Presentation and Conclusion: This case report describes our clinical team’s experience in managing three separate cases of spondylodiscitis following CRT for head and neck tumors that presented at our clinic for diagnosis and treatment in order to identify predisposing factors that underlie the link between CRT and spondylodiscitis.