178 results on '"Thoracic Vertebrae microbiology"'
Search Results
2. Detection Ewingella americana from a patient with Andersson lesion in ankylosing spondylitis by metagenomic next-generation sequencing test: a case report.
- Author
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Wu H, Wu X, Wu T, Miao X, Zheng S, Huang G, and Cheng X
- Subjects
- Humans, Male, Adult, Metagenomics, Thoracic Vertebrae diagnostic imaging, Thoracic Vertebrae microbiology, Thoracic Vertebrae pathology, Thoracic Vertebrae surgery, Spondylitis, Ankylosing diagnosis, Spondylitis, Ankylosing complications, Spondylitis, Ankylosing microbiology, High-Throughput Nucleotide Sequencing
- Abstract
Background: Andersen's lesion (AL) is a rare complication of ankylosing spondylitis (AS), characterized by nonneoplastic bone destruction, typically manifested as bone destruction and sclerosis in the vertebral body and/or intervertebral disc area. At present, there is no consensus on the pathology and etiology of AL. Repeated trauma, inflammation in essence and part of the natural history of Ankylosing spondylitis itself are the most widely recognized theories of the etiology of AL. However, positive bacteria cultured in bone biopsy of Andersen's lesion (AL) in Ankylosing spondylitis patients are extremely rare. Herein, we report a rare case of detecting Ewingella americana from a patient with Andersson lesion in ankylosing spondylitis by Metagenomic Next-Generation Sequencing (mNGS) Test., Case Presentation: This case involved a 39-year-old male with a history of AS for 11 years, who developed AL (T11/12) in the thoracic vertebrae. After sufficient preoperative preparation, we successfully performed one-stage posterior approach corrective surgery and collected bone biopsies samples for examination. Cultured bacteria were not found, and pathological histology indicated infiltration of inflammatory cells. However, it is worth noting that we discovered a gram-negative bacterium, the Ewingella americana, through mNGS testing. Further histopathological examination suggests chronic inflammatory cell infiltration. After one-stage posterior approach corrective surgery, the patient's condition significantly improved. At the 6-month follow-up, the pain significantly decreased, and the patient returned to normal life., Conclusion: We detected Ewinia americana in the bone biopsies of Andersson lesion (AL) in ankylosing spondylitis patient by mNGS., (© 2024. The Author(s).)
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- 2024
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3. Efficacy analysis of one-stage posterior-only surgical treatment for thoracic spinal tuberculosis in the T4-6 segments with minimum 5-year follow-up.
- Author
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Zhan Y, Kang X, Gao W, Zhang X, Kong L, Hao D, and Wang B
- Subjects
- Adult, Feasibility Studies, Female, Follow-Up Studies, Humans, Kyphosis diagnostic imaging, Kyphosis microbiology, Kyphosis physiopathology, Male, Middle Aged, Postoperative Complications etiology, Recovery of Function, Therapeutic Irrigation, Thoracic Vertebrae diagnostic imaging, Thoracic Vertebrae microbiology, Thoracic Vertebrae physiopathology, Time Factors, Treatment Outcome, Tuberculosis, Spinal diagnostic imaging, Tuberculosis, Spinal microbiology, Tuberculosis, Spinal physiopathology, Bone Transplantation adverse effects, Debridement adverse effects, Kyphosis surgery, Spinal Fusion adverse effects, Thoracic Vertebrae surgery, Tuberculosis, Spinal surgery
- Abstract
In recent years, with the in-depth research on spinal tuberculosis, posterior surgery alone has been praised highly by more and more surgeons due to the better correction of kyphosis, better maintenance of spinal physiological curvature, smaller surgical trauma and fewer surgical complications. However, there is currently lack of relevant reports about the efficacy of posterior surgery alone in the treatment of tuberculosis in the T4-6 segments. This study aimed to evaluate the clinical study efficacy and feasibility of one-stage posterior-only surgical treatment for thoracic spinal tuberculosis in the T4-6 segments. 67 patients with tuberculosis in T4-6 segments who underwent one-stage posterior-only surgery were included in this study. The clinical efficacy was evaluated using statistical analysis based on the data about erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Oswestry Dability Index (ODI) score, Visual Analogue Scale (VAS) score and Cobb angle before surgery, after surgery and at the last follow-up. All patients completed fusion during the follow-up period of 6-9 months. ESR and CRP were returned to normal for all patients at 6 months follow-up. In the meanwhile, among the 27 patients combined with neurological impairment, neurological functions of 22 cases (81.48%) recovered completely at the last follow-up (P < 0.05). Cobb angle of the kyphosis was improved from preoperative 34.8 ± 10.9° to postoperative 9.6 ± 2.8°, maintaining at 11.3 ± 3.2° at the last follow-up, The ODI and VAS scores were improved by 77.10% and 81.70%, respectively. This 5-year follow-up study shows that better clinical efficacy can be achieved for tuberculosis in T4-6 segments using one-stage posterior-only approach by costotransverse debridement in combination with bone graft and internal fixation. The posterior surgical method cannot only effectively accomplish debridement, obtain satisfactory clinical results, but also well correct kyphotic deformity and maintain it., (© 2022. The Author(s).)
- Published
- 2022
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4. Differentiating brucella spondylitis from tuberculous spondylitis by the conventional MRI and MR T2 mapping: a prospective study.
- Author
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Guo H, Lan S, He Y, Tiheiran M, and Liu W
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- Adolescent, Adult, Aged, Brucellosis microbiology, Diagnosis, Differential, Humans, Lumbar Vertebrae microbiology, Male, Middle Aged, Prospective Studies, Spondylitis microbiology, Thoracic Vertebrae microbiology, Tuberculosis, Spinal microbiology, Young Adult, Brucella isolation & purification, Brucellosis diagnosis, Diagnostic Imaging methods, Magnetic Resonance Imaging methods, Spondylitis diagnosis, Tuberculosis, Spinal diagnosis
- Abstract
Background: Brucella spondylitis (BS) and tuberculous spondylitis (TS), caused initially by bacteremia, are the two leading types of granulomatous spinal infections. BS is easy to miss or may be misdiagnosed as TS. Our purpose aims to differentiate BS from TS in conventional MR imaging and MR T2 mapping., Methods: We performed on 26 BS and 27 TS patients conventional MR imaging and MR T2 mapping. We analyzed the features in conventional MR imaging and measured T2 values of the lesion vertebrae (LV) and unaffected adjacent vertebrae (UAV) in BS and TS patients, respectively., Results: There were no significant differences in sex, age, national between BS and TS. There was significantly lower severity of vertebral destruction, vertebral posterior convex deformity, dead bone, and abscess scope in BS when compared to TS (p < 0.001, p = 0.048, p < 0.001, p < 0.001, respectively). The vertebral hyperplasia was significantly higher in BS when compared to TS (p < 0.001). The T2 value of the LV with BS was markedly higher than that in the UAV with BS and that in the LV and UAV with TS (p < 0.001, p < 0.037, p < 0.001, respectively). The T2 value of the LV with TS was significantly higher than that of the UAV in TS and BS (p < 0.001, p < 0.001, respectively). There were no significant differences in the T2 value of the UAV between BS and TS (p = 0.568)., Conclusions: The qualitative and quantitative evaluation may differentiate BS from TS. The conventional MR imaging helps to distinguish BS from TS by several distinctive features. MR T2 mapping has the additional potential to provide quantitative information between BS and TS., (© 2021. The Author(s).)
- Published
- 2021
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5. A rare case of thoracic brucellosis misdiagnosed as malignant tumor and literature review.
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Fengzhen Y, Lihua J, Jinying W, and Maoli Y
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- Anti-Bacterial Agents therapeutic use, Brucellosis drug therapy, Brucellosis pathology, China, Doxycycline therapeutic use, Female, Humans, Middle Aged, Positron Emission Tomography Computed Tomography, Rifampin therapeutic use, Spondylitis microbiology, Spondylitis pathology, Streptomycin therapeutic use, Thoracic Diseases diagnosis, Thoracic Diseases microbiology, Thoracic Diseases pathology, Thoracic Vertebrae microbiology, Brucellosis diagnosis, Diagnostic Errors, Neoplasms diagnosis, Spondylitis diagnosis, Thoracic Vertebrae pathology
- Abstract
Brucellosis remains a major public health problem worldwide. It is commonly found in most developed and developing countries, such as the Mediterranean region, the Middle East, and Latin America. In China, brucellosis is mainly distributed in some of the northern provinces and is relatively rare in Shandong province. Brucellosis has a variety of clinical manifestations, with fever, sweating, fatigue, and migratory joint pain being the most common. Because of the non-specific clinical symptoms, brucellosis is often misdiagnosed as other diseases. Here, we report a rare case of brucellosis of thoracic vertebrae misdiagnosed as thoracic malignant tumor and present a review of related literature.
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- 2021
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6. Clinical Efficacy of Three Surgical Approaches for the Treatment of Cervicothoracic Tuberculosis: A Multicenter Retrospective Study.
- Author
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Wu WJ, Tang Y, Lyu JT, Yang S, Wang DG, Zhang Q, Liu X, Deng JZ, Luo F, Hou TY, Xu JZ, and Zhang ZH
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- Adolescent, Adult, Child, Child, Preschool, Female, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Young Adult, Cervical Vertebrae microbiology, Cervical Vertebrae surgery, Spinal Fusion methods, Thoracic Vertebrae microbiology, Thoracic Vertebrae surgery, Tuberculosis, Spinal surgery
- Abstract
Objective: To evaluate the efficacy of three surgical approaches for the treatment of cervicothoracic tuberculosis., Methods: This is a multicenter retrospective study. We analyzed 74 patients with cervicothoracic tuberculosis who were treated in six institutions between January 2000 and January 2015. There were 37 male and 37 female patients, with an average age of 24 years (range, 5-62 years). The operative method was selected according to the indications. A total of 33 patients underwent one-stage anterior surgery (group A); 16 underwent a combined anterior and posterior surgery (group B) and 25 underwent one-stage posterior surgery (group C). Clinical outcomes, laboratory indexes, and radiological results were analyzed., Results: All cases were followed up for approximately 36-96 months post-surgery (average, 39 months). At the last follow-up, patients in all three groups had achieved bone fusion, with pain relief and neurological recovery. No major vessel and nerve injuries were found during the operation. There were significant differences before and after treatment for visual analogue scale (VAS), neck disability index (NDI), and Japanese Orthopedic Association (JOA) score (P < 0.001). Three surgical strategies significantly improved kyphosis (P < 0.001)., Conclusion: The choice of operation for cervicothoracic tuberculosis should be selected based on the pathological changes, scope, and general physical condition of the patient. The indication for a posterior approach is narrow and it should be used selectively. The combined anterior and posterior approach involved a longer operating time, larger blood loss, and greater trauma, and also required a higher level of surgical skill. Therefore, the indications for this approach should be strictly controlled. Anterior approach surgery for the treatment of cervicothoracic tuberculosis showed excellent efficacy and fewer complications., (© 2019 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.)
- Published
- 2020
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7. An unusual Staphylococcus saccharolyticus spondylodiscitis post kyphoplasty: a case report.
- Author
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Trojani MC, Lamy B, Ruimy R, Amoretti N, Risso K, and Roux C
- Subjects
- Amoxicillin administration & dosage, Amoxicillin therapeutic use, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents therapeutic use, Coagulase metabolism, Cross Infection drug therapy, Cross Infection microbiology, Discitis drug therapy, Discitis microbiology, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Postoperative Complications drug therapy, Postoperative Complications microbiology, Staphylococcal Infections drug therapy, Staphylococcal Infections microbiology, Staphylococcus enzymology, Thoracic Vertebrae diagnostic imaging, Treatment Outcome, Cross Infection diagnosis, Discitis diagnostic imaging, Kyphoplasty adverse effects, Postoperative Complications diagnosis, Staphylococcal Infections diagnosis, Staphylococcus isolation & purification, Thoracic Vertebrae microbiology
- Abstract
Background: Staphylococcus saccharolyticus is a rarely encountered coagulase-negative, which grows slowly and its strictly anaerobic staphylococcus from the skin. It is usually considered a contaminant, but some rare reports have described deep-seated infections. Virulence factors remain poorly known, although, genomic analysis highlights pathogenic potential., Case Presentation: We report a case of Staphylococcus saccharolyticus spondylodiscitis that followed kyphoplasty, a procedure associated with a low rate but possible severe infectious complication (0.46%), and have reviewed the literature. This case specifically stresses the risk of healthcare-associated S. saccharolyticus infection in high-risk patients (those with a history of alcoholism and heavy smoking)., Conclusion: S. saccharolyticus infection is difficult to diagnose due to microbiological characteristics of this bacterium; it requires timely treatment, and improved infection control procedure should be encouraged for high-risk patients.
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- 2020
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8. Minimally invasive surgery for paravertebral or psoas abscess with spinal tuberculosis - a long-term retrospective study of 106 cases.
- Author
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Zhang Z, Hao Y, Wang X, Zheng Z, Zhao X, Wang C, Zhang X, and Zhang X
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- Beijing, Debridement, Disability Evaluation, Drainage, Female, Humans, Longitudinal Studies, Lumbar Vertebrae microbiology, Lumbar Vertebrae surgery, Magnetic Resonance Imaging, Male, Psoas Abscess microbiology, Retrospective Studies, Thoracic Vertebrae microbiology, Thoracic Vertebrae surgery, Tomography, X-Ray Computed, Tuberculosis, Spinal therapy, Visual Analog Scale, Antitubercular Agents therapeutic use, Minimally Invasive Surgical Procedures, Psoas Abscess surgery, Radiography, Interventional, Tuberculosis, Spinal complications
- Abstract
Background: Minimally invasive surgery (MIS) is a common treatment option for paravertebral or psoas abscesses (PAs) in patients with spinal tuberculosis (ST). However, its efficacy remains controversial. The aim of the study was to evaluate the efficacy of MIS for PA with ST combined with anti-tuberculous chemotherapy., Methods: A total of 106 consecutive patients who underwent MIS for ST with PA from January 2002 to Oct 2012 were reviewed. The MIS involved computed tomography (CT)-guided percutaneous catheter drainage and percutaneous catheter infusion chemotherapy. Clinical outcomes were evaluated based on the changes observed on preoperative and postoperative physical examination, inflammatory marker testing, and magnetic resonance imaging (MRI)., Results: The mean follow-up period was 7.21 ± 3.15 years. All surgeries were successfully completed under CT-guidance without intraoperative complications and all patients experienced immediate relief of their symptoms, which included fever and back pain. The preoperatively elevated erythrocyte sedimentation rate and C-reactive protein values returned to normal at a mean period of 3 months postoperatively. Solid bony union was observed in 106 patients and no abscesses were found on MRI examination., Conclusion: MIS carries advantages in terms of less invasiveness, precise drainage, and enhanced local drug concentration. While the technique has not been fully characterized and clinically prove, its use in addition to conservative chemotherapy and open debridement and instrumental fixation may be recommended for patients with ST and PA.
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- 2020
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9. Establishment and Initial Testing of a Medium-Sized, Surgically Feasible Animal Model for Brucellar Spondylodiscitis: A Preliminary Study.
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Cai X, Xu T, Xun C, Abulizi Y, Liu Q, Sheng W, Han Z, Gao L, and Maimaiti M
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- Animals, Bacterial Vaccines immunology, Brucella melitensis immunology, Disease Models, Animal, Female, Lumbar Vertebrae microbiology, Rabbits, Thoracic Vertebrae microbiology, Thoracic Vertebrae pathology, Brucella melitensis pathogenicity, Brucellosis microbiology, Brucellosis pathology, Discitis microbiology, Discitis pathology
- Abstract
Brucellar spondylodiscitis, the most prevalent and significant osteoarticular presentation of human Brucellosis, is difficult to diagnose and usually yields irreversible neurologic deficits and spinal deformities. However, no animal models of Brucellar spondylodiscitis exist, allowing for preclinical investigations. The present study investigated whether intraosseous injection of attenuated Brucella melitensis vaccine into rabbits' lumbar vertebrae imitates the radiographic and histopathological characteristics of human Brucellar spondylodiscitis. Radiographic and histopathological analyses at 8 weeks postoperatively revealed radiographic changes within vertebral bodies and intervertebral discs, abscesses formation within the paravertebral soft tissue, and typical prominent inflammation response without caseous necrosis, which were largely comparable to human Brucellar spondylodiscitis. Such a medium-sized, surgically feasible rabbit model provides a promising in vivo setting for further preclinical investigation of Brucellar spondylodiscitis., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2019 Xiaoyu Cai et al.)
- Published
- 2019
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10. A travel-loving woman in her eighties with lower back pain and weight loss.
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Leknesund SH, Finjord T, and Jordal S
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- Aged, 80 and over, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents therapeutic use, Aortic Aneurysm, Thoracic diagnostic imaging, Coxiella burnetii isolation & purification, Female, Humans, Low Back Pain microbiology, Lumbar Vertebrae diagnostic imaging, Lumbar Vertebrae microbiology, Magnetic Resonance Imaging, Medical History Taking, Norway, Osteomyelitis diagnostic imaging, Thoracic Vertebrae diagnostic imaging, Thoracic Vertebrae microbiology, Tomography, X-Ray Computed, Travel-Related Illness, Weight Loss, Aortic Aneurysm, Thoracic microbiology, Osteomyelitis microbiology, Q Fever complications, Q Fever diagnosis, Q Fever drug therapy
- Abstract
Background: This case report presents one of the first documented incidents of chronic Q-fever (C. burnetii) in Norway. A comprehensive workup resulted in an unexpected finding., Case Presentation: A Norwegian woman in her eighties presented to a district general hospital with lower back pain, decreased general condition and weight loss. Computer tomography (CT) revealed a large thoracic aortic aneurysm presumed to be of mycotic origin, and later magnetic resonance imaging (MRI) scans revealed osteomyelitis in the surrounding vertebrae. Conventional diagnostic workup did not identify the causative agent. After more than 6 months of different examinations, surgery, exhausting invasive procedures and antimicrobial treatment, we were ultimately successful in determining the microbial cause of chronic mycotic aneurism and osteomyelitis to be C. Burnetii (Q-fever) through serological and PCR analysis., Interpretation: An increasing proportion of the population in all age groups travel abroad, and clinicians should be aware of the increasing incidence of imported infectious diseases. Obtaining a thorough medical history is still an important tool in the diagnostic process.
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- 2019
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11. A case of Klebsiella pneumoniae spondylitis and bacteremia potentially due to inflammation around a fecalith.
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Inagaki A, Moriyama Y, Morioka S, Wakimoto Y, Shida Y, and Ohmagari N
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- Aged, 80 and over, Anti-Bacterial Agents therapeutic use, Colitis complications, Colon diagnostic imaging, Colon microbiology, Discitis diagnostic imaging, Fecal Impaction complications, Humans, Klebsiella Infections diagnostic imaging, Magnetic Resonance Imaging, Male, Thoracic Vertebrae diagnostic imaging, Thoracic Vertebrae microbiology, Tomography, X-Ray Computed, Treatment Outcome, Bacteremia microbiology, Colitis microbiology, Discitis microbiology, Fecal Impaction microbiology, Klebsiella Infections microbiology, Klebsiella pneumoniae isolation & purification
- Abstract
We herein report a case of Klebsiella pneumoniae (K. pneumoniae) spondylitis and bacteremia in a 90-year-old man with diabetes mellitus who had undergone sigmoidectomy and had a fecalith. Two months prior to admission, he had received antimicrobial treatment for 2 weeks for K. pneumoniae bacteremia whose entry was unclear and he was readmitted to our hospital owing to fever and stomachache. K. pneumoniae was isolated from two sets of blood cultures, and computed tomography and magnetic resonance imaging revealed inflammation and destruction of the 8th and 9th thoracic vertebra. The diagnosis was spondylodiscitis secondary to K. pneumoniae bacteremia. Although the entry point for K. pneumoniae was unclear, we suggest that inflammation of the mucosa around the fecalith might have caused the Enterobacteriaceae bacteremia., (Copyright © 2019 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2019
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12. Can a posterior approach effectively heal thoracic and lumbar tuberculosis? Microbiology outcomes of the operative area.
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Zhao C, Pu X, Zhou Q, Huang X, Zhang C, Luo L, Zhang Z, Hou T, Luo F, Dai F, and Xu J
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- Adult, Drainage methods, Female, Humans, Lumbar Vertebrae microbiology, Lumbar Vertebrae surgery, Male, Middle Aged, Postoperative Care methods, Prospective Studies, Spinal Fusion methods, Surgical Wound diagnostic imaging, Surgical Wound microbiology, Thoracic Vertebrae microbiology, Thoracic Vertebrae surgery, Treatment Outcome, Tuberculosis, Spinal microbiology, Tuberculosis, Spinal surgery, Young Adult, Debridement methods, Lumbar Vertebrae diagnostic imaging, Thoracic Vertebrae diagnostic imaging, Tuberculosis, Spinal diagnostic imaging
- Abstract
Background: There was a controversy about surgery approach of thoracic and lumbar tuberculosis (TB) treatment. The aim of this study was to compare the microbiology outcomes of the drainage liquid and the clinical outcomes of a posterior and anterior approach in the treatment of thoracic and lumbar TB., Materials and Methods: A total of 105 patients were enrolled in this prospective study from February 2011 to September 2015. Patients were divided into two groups: group A (51 patients, posterior approach surgery) and group B (54 patients, anterior approach surgery). Intraoperative TB samples were sent for Mycobacterium tuberculosis culture (MTBC). Drainage fluid was postoperatively collected for polymerase chain reaction (PCR), acid-fast strains (AFS), MTBC, and DNA molecular detection (DNAMD) analyses. Compare the drainage liquid positive rate of the two groups and estimate relationship between the positive results of drainage fluid and the lesion region. In addition, the clinical outcomes including the bony fusion, relapse rate, complications, and neurological status were collected., Results: There was no significant difference in the positive rate of AFS, PCR, DNAMD, MTBC, or any positive rate (APR) of drainage liquid between the two groups (P > 0.05). In both groups, the MTBC-positive rate of postoperative drainage fluid was significantly lower than that of the intraoperative sample (P < 0.01). There was no significant relationship between APR and the lesion region (P > 0.05). All the patients had at least 2 years of follow-up, with an average of 34.4 ± 15.8 months. There were four patients in group A and two patients in group B who had recurrent spine TB, and the rest of the patients had fusion in the surgical area. There was no significant difference in the incidence of TB recurrence or other complications between the two groups (P > 0.05). All the patients with neurological dysfunction had improved after surgery., Conclusion: Compared with anterior approach surgery, posterior approach surgery had equal effectiveness of debridement. The two kinds of surgery can effectively clear the lesions surrounding the spine and heal thoracic and lumbar TB.
- Published
- 2019
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13. Minimally invasive direct lateral interbody fusion in the treatment of the thoracic and lumbar spinal tuberculosisMini-DLIF for the thoracic and lumbar spinal tuberculosis.
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Gan F, Jiang J, Xie Z, Huang S, Li Y, Chen G, and Tan H
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- Adult, Aged, Antitubercular Agents therapeutic use, Bone Transplantation, Debridement, Female, Humans, Lumbar Vertebrae diagnostic imaging, Lumbar Vertebrae microbiology, Lumbar Vertebrae physiopathology, Magnetic Resonance Imaging, Male, Middle Aged, Minimally Invasive Surgical Procedures, Recovery of Function, Spinal Fusion adverse effects, Thoracic Vertebrae diagnostic imaging, Thoracic Vertebrae microbiology, Thoracic Vertebrae physiopathology, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Tuberculosis, Spinal diagnostic imaging, Tuberculosis, Spinal microbiology, Tuberculosis, Spinal physiopathology, Lumbar Vertebrae surgery, Spinal Fusion methods, Thoracic Vertebrae surgery, Tuberculosis, Spinal surgery
- Abstract
Background: To investigate the clinical efficacy of minimally invasive direct lateral approach debridement, interbody bone grafting, and interbody fusion in the treatment of the thoracic and lumbar spinal tuberculosis., Methods: From January 2013 to January 2016, 35 cases with thoracic and lumbar spinal tuberculosis received direct lateral approach debridement, interbody bone grafting, and interbody fusion. Of the 35 cases, 16 patients were male and 19 were female and the median age was 55.2 (range 25-83). The affected segments were single interspace, and the involved vertebral bodies included: 15 cases of thoracic vertebrae (1 cases of T
5/6 , 2 cases of T6/7 , 4 cases of T7/8 , 3 cases of T8/9 , 5 cases of T9/10 ) and 20 cases of lumbar spine (2 cases of L1/2 , 6 cases of L2/3 , 6 cases of L3/4 , 6 cases of L4/5 ). After MIDLIF operation, all the patients received medication of four anti-tubercular drugs for 12 to18 months., Results: The patients were followed up for 7 to 40 months with an average of 18.5 months. The visual analogue scale (VAS) at the last follow-up was 2.8 ± 0.5, which was significantly different from the preoperative VAS (8.2 ± 0.7). After MIDLIF, there was 5 cases occurred with transient numbness in one side of the thigh or inguinal region, and 10 cases suffered from flexion hip weakness. All the bone grafts were fused within 6~ 18 months (average of 11.5 months) after the operation., Conclusion: Minimally invasive lateral approach interbody fusion technology have the advantage of less injury and quick recovery after surgery, which is the effective and safe treatment for thoracic and lumbar spinal tuberculosis.- Published
- 2018
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14. Vertebral Osteomyelitis Caused by Helicobacter cinaedi Identified Using Broad-range Polymerase Chain Reaction with Sequencing of the Biopsied Specimen.
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Hase R, Hirooka T, Itabashi T, Endo Y, and Otsuka Y
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- Aged, Biopsy, Helicobacter genetics, Humans, Low Back Pain microbiology, Magnetic Resonance Imaging, Male, RNA, Ribosomal, 16S genetics, Thoracic Vertebrae microbiology, Helicobacter Infections diagnosis, Osteomyelitis diagnosis, Osteomyelitis microbiology, Polymerase Chain Reaction, Sequence Analysis, RNA
- Abstract
A 65-year-old man presented with gradually exacerbating low back pain. Magnetic resonance imaging revealed vertebral osteomyelitis in the Th11-L2 vertebral bodies and discs. The patient showed negative findings on conventional cultures. Direct broad-range polymerase chain reaction (PCR) with sequencing of the biopsied specimen had the highest similarity to the 16S rRNA gene of Helicobacter cinaedi. This case suggests that direct broad-range PCR with sequencing should be considered when conventional cultures cannot identify the causative organism of vertebral osteomyelitis, and that this method may be particularly useful when the pathogen is a fastidious organism, such as H. cinaedi.
- Published
- 2018
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15. Treatment of tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis: A case series and a literature review.
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Xue J, Yao Y, and Liu L
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- Adult, Combined Modality Therapy methods, Female, Humans, Magnetic Resonance Imaging methods, Male, Middle Aged, Tomography, X-Ray Computed methods, Treatment Outcome, Aneurysm, False diagnosis, Aneurysm, False etiology, Aneurysm, False physiopathology, Aneurysm, False surgery, Antitubercular Agents therapeutic use, Aortitis diagnosis, Aortitis etiology, Aortitis therapy, Spinal Fusion methods, Thoracic Vertebrae microbiology, Thoracic Vertebrae pathology, Tuberculosis, Cardiovascular complications, Tuberculosis, Cardiovascular diagnosis, Tuberculosis, Spinal diagnosis, Tuberculosis, Spinal drug therapy, Tuberculosis, Spinal physiopathology, Tuberculosis, Spinal surgery, Vascular Surgical Procedures methods
- Abstract
Rationale: Tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis is a rare disease but with very high mortality. We review the literature and find 19 reports with 22 patients. Here we report three cases with vertebral tuberculosis, who also have tuberculous pseudoaneurysm of the aorta. These patients were treated by different methods. We try to analyze the epidemiology, pathogenesis, presentation, and management of this disease to find the best treatment., Patient Concerns: The patients presented with different symptoms such as pain (chest, abdominal or back), fever, blood volume reduction or hemorrhagic shock symptoms. Large mass also could be observed by imaging. In addition to clinical manifestations, enhanced computed tomography or magnetic resonance imaging could also help the diagnosis of this disease., Diagnoses: Tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis., Interventions: Three patients were treated with anti-tuberculosis(TB) drugs or combined with different sequences surgical treatment: Case 1 refused to receive pseudoaneurysm surgery and only had anti-TB drug treatment; Case 2 received thoracic spinal surgery first; Case 3 received endovascular stent grafting., Outcomes: Two patients (case 1 and case 2) who refused to undergo aneurysm surgery died. The last patient (case 3) underwent endovascular repair and antibiotic therapy for tuberculosis, and the postoperative course was uneventful; the patient recovered and survived., Lessons: Once the diagnosis of tuberculous pseudoaneurysm is confirmed, surgical treatment should be provided immediately combined with anti-tuberculosis drugs. The aim of the treatment is to save lives, prevent relapse, and facilitate the return to normal life, regardless of the size of the pseudoaneurysm. The pseudoaneurysm should be treated first to prevent aneurysm rupture before the vertebral tuberculosis surgery.
- Published
- 2018
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16. [Research progress of surgical treatment of thoracolumbar spinal tuberculosis].
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Gao Y, Ou Y, Quan Z, and Jiang D
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- Humans, Ilium transplantation, Lumbar Vertebrae surgery, Lumbosacral Region, Plastic Surgery Procedures, Research, Ribs transplantation, Spinal Fusion, Thoracic Vertebrae surgery, Transplants, Treatment Outcome, Tuberculosis, Spinal microbiology, Bone Transplantation methods, Lumbar Vertebrae microbiology, Thoracic Vertebrae microbiology, Tuberculosis, Spinal surgery
- Abstract
Objective: To review the progress of surgical treatment for the thoracolumbar spinal tuberculosis., Methods: The related literature of surgical treatment for the thoracolumbar spinal tuberculosis was reviewed and analyzed from the aspects such as surgical approach, fixed segments, fusion ranges, bone graft, and bone graft material research progress., Results: Most scholars prefer anterior or combined posterior approach for surgical treatment of thoracic and lumbar tuberculosis because it possessed advantage of precise effectiveness. In recent years, a simple posterior surgery achieved satisfactory effectiveness. The fixation segments are mainly composed of short segments or intervertebral fixation. The interbody fusion is better for the bone graft fusion range and manner, and the bone graft materials is most satisfied with autologous iliac Cage or titanium Cage filled with autologous cancellous bone., Conclusion: The perfect strategy for treating the thoracolumbar spinal tuberculosis has not yet been developed, and the personalized therapy for different patients warrants further study.
- Published
- 2018
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17. Histoplasmosis mimicking metastatic spinal tumour.
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Liu B, Qu L, Zhu J, Yang Z, and Yan S
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- Aged, Diagnosis, Differential, Histoplasma cytology, Histoplasmosis microbiology, Histoplasmosis surgery, Humans, Magnetic Resonance Imaging, Male, Spinal Neoplasms secondary, Thoracic Vertebrae microbiology, Thoracic Vertebrae surgery, Tomography, X-Ray Computed, Back Pain diagnostic imaging, Histoplasmosis diagnostic imaging, Spinal Neoplasms diagnostic imaging, Thoracic Vertebrae diagnostic imaging
- Abstract
Histoplasmosis is an infection caused by a fungus called Histoplasma. Diagnosis of histoplasmosis is based on the culture of biological samples and detection of fungus in tissues. Histoplasmosis can mimic malignant lesions. We report a 65-year-old, immunocompetent, male patient with back pain. We describe the main clinical and radiological characteristics in our patient who had vertebral histoplasmosis that mimicked cancer. A computed tomography scan showed lytic lesions of the right side of T4, T5, and T6 vertebral bodies. Magnetic resonance imaging displayed abnormal marrow signals in T4, T5, and T6 vertebral bodies (low signal on T1, high on T2 and short time inversion recovery (STIR)). Which was mimicking malignancy, such as haematological malignancy and metastatic bone cancer. Therefore, thoracic spinal surgery using the anterior approach was performed. An intraoperative frozen section examination and routine postoperative pathology showed thoracic histoplasmosis infection. Treatment of histoplasmosis was performed with oral itraconazole. The lesions did not progress and the patient symptomatically improved at a follow-up of 26 months.
- Published
- 2017
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18. Serum procalcitonin measurement is not a useful biomarker in the detection of primary infectious spondylodiscitis.
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Dubost JJ, Lopez J, Pereira B, Couderc M, Tournadre A, and Soubrier M
- Subjects
- Aged, Aged, 80 and over, Biomarkers blood, Cervical Vertebrae microbiology, Cervical Vertebrae physiopathology, Cohort Studies, Discitis diagnosis, Discitis drug therapy, Female, Humans, Lumbar Vertebrae microbiology, Lumbar Vertebrae physiopathology, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Assessment, Sensitivity and Specificity, Severity of Illness Index, Thoracic Vertebrae microbiology, Thoracic Vertebrae physiopathology, Discitis blood, Discitis microbiology, Procalcitonin blood
- Published
- 2017
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- View/download PDF
19. [Large cervicodorsal epidural abscess].
- Author
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Lafoeste H, Le Meur M, Mezhari I, Macovei G, and Thyrault M
- Subjects
- Anti-Bacterial Agents therapeutic use, Cervical Vertebrae diagnostic imaging, Consciousness Disorders etiology, Epidural Abscess complications, Epidural Abscess diagnostic imaging, Epidural Abscess drug therapy, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Organ Failure etiology, Remission Induction, Staphylococcal Infections complications, Staphylococcal Infections diagnostic imaging, Staphylococcal Infections drug therapy, Thoracic Vertebrae diagnostic imaging, Cervical Vertebrae microbiology, Epidural Abscess diagnosis, Staphylococcal Infections diagnosis, Thoracic Vertebrae microbiology
- Published
- 2017
- Full Text
- View/download PDF
20. Spinal Infections Among Patients With Long-Term Central Venous Catheters for Home Parenteral Nutrition.
- Author
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Topan R, Ambrose T, Small M, Lightman E, Nightingale J, and Gabe SM
- Subjects
- Aged, Anti-Infective Agents therapeutic use, Back Pain prevention & control, Bacteremia blood, Bacteremia drug therapy, Bacteremia microbiology, Bacteremia physiopathology, Catheter-Related Infections drug therapy, Catheter-Related Infections microbiology, Catheter-Related Infections physiopathology, Cervical Vertebrae diagnostic imaging, Cervical Vertebrae drug effects, Cervical Vertebrae microbiology, Cohort Studies, Female, Humans, London, Magnetic Resonance Imaging, Male, Middle Aged, Retrospective Studies, Spine diagnostic imaging, Spine microbiology, Spondylitis drug therapy, Spondylitis microbiology, Spondylitis physiopathology, Thoracic Vertebrae diagnostic imaging, Thoracic Vertebrae drug effects, Thoracic Vertebrae microbiology, Treatment Outcome, Back Pain etiology, Catheter-Related Infections diagnostic imaging, Catheterization, Central Venous adverse effects, Parenteral Nutrition, Home adverse effects, Spondylitis diagnostic imaging
- Abstract
Spinal infections are a rare yet serious metastatic complication of bacteremia among patients with long-term central venous catheters (CVCs) for which clinicians must remain vigilant. We performed a retrospective review of all cases of spinal infection occurring in the context of a CVC for long-term parenteral nutrition (PN) managed in our department between January 2010 and October 2013, a cohort of 310 patients over this time period. Six patients were identified (mean age, 65 years; 5 male). One hundred percent of patients presented with spinal pain (5/6 cervical, 1/6 thoracic). Organisms were cultured from the CVC in 5 of 6 patients. In all cases, the white blood cell count was normal, and in 5 of 6, C-reactive protein was normal. All diagnoses were confirmed on magnetic resonance imaging (MRI), and in 3 of 6 cases, an MRI was repeated (on the advice of neurosurgical colleagues) to confirm resolution of changes after a period of antimicrobial therapy. There was no clear correlation between duration of PN or number of days following CVC insertion and onset of infection. The CVC was replaced in 4 of 6 patients at the time of diagnosis, delayed removal in 1 of 6, and salvaged in the remaining case. Although rare, a high index of suspicion is needed in patients receiving long-term PN who present with spinal pain. Peripheral inflammatory markers may not be elevated. MRI should be performed and patients should be treated with antibiotics alongside involvement of local microbiology and neurosurgical teams. Multidisciplinary discussion on CVC salvage in these cases is important, especially in cases of challenging vascular anatomy.
- Published
- 2017
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21. Pathogenesis of Enterococcal Spondylitis Caused by Enterococcus cecorum in Broiler Chickens.
- Author
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Borst LB, Suyemoto MM, Sarsour AH, Harris MC, Martin MP, Strickland JD, Oviedo EO, and Barnes HJ
- Subjects
- Animals, Chickens microbiology, Gram-Positive Bacterial Infections complications, Gram-Positive Bacterial Infections microbiology, Intestines microbiology, Paralysis etiology, Paralysis microbiology, Paralysis veterinary, Phylogeny, Poultry Diseases etiology, Poultry Diseases mortality, Spleen microbiology, Spondylitis microbiology, Thoracic Vertebrae microbiology, Enterococcus genetics, Gram-Positive Bacterial Infections veterinary, Poultry Diseases microbiology, Spondylitis veterinary
- Abstract
Enterococcal spondylitis (ES) is a disease of commercial broiler chickens, with a worldwide distribution. Symmetrical hind limb paralysis typical of ES results from infection of the free thoracic vertebra (FTV) by pathogenic strains of Enterococcus cecorum . To determine the pathogenesis of ES, birds with natural and experimental ES were studied over time. In natural disease, case birds (n = 150) from an affected farm and control birds (n = 100) from an unaffected farm were evaluated at weeks 1-6. In control birds, intestinal colonization by E. cecorum began at week 3. In case birds, E. cecorum was detected in intestine and spleen at week 1, followed by infection of the FTV beginning at week 3. E. cecorum isolates recovered from intestine, spleen, and FTV of case birds had matching genotypes, confirming that intestinal colonization with pathogenic strains precedes bacteremia and infection of the FTV. Clinical intestinal disease was not required for E. cecorum bacteremia. In 1- to 3-week-old case birds, pathogenic E. cecorum was observed within osteochondrosis dissecans (OCD) lesions in the FTV. To determine whether OCD of the FTV was a risk factor for ES, 214 birds were orally infected with E. cecorum, and the FTV was evaluated histologically at weeks 1-7. Birds without cartilage clefts of OCD in the FTV did not develop ES; while birds with OCD scores ≥3 were susceptible to lesion development. These findings suggest that intestinal colonization, bacteremia, and OCD of the FTV in early life are crucial to the pathogenesis of ES.
- Published
- 2017
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- View/download PDF
22. Salmonella spondylodiscitis of the thoracic vertebrae mimicking spine tuberculosis.
- Author
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Muhamad Effendi F, Ibrahim MI, and Mohd Miswan MF
- Subjects
- Anti-Bacterial Agents therapeutic use, Ceftriaxone therapeutic use, Diagnosis, Differential, Discitis drug therapy, Female, Humans, Magnetic Resonance Imaging, Middle Aged, Salmonella, Salmonella Infections drug therapy, Tomography, X-Ray Computed, Discitis diagnosis, Discitis microbiology, Salmonella Infections diagnosis, Thoracic Vertebrae diagnostic imaging, Thoracic Vertebrae microbiology, Tuberculosis, Spinal
- Abstract
Extraintestinal Salmonella infection involving the thoracic spine is very rare. It commonly presents with non-specific chronic back pain and can occur with no gastrointestinal manifestation. Blood test results and imaging findings are often indistinguishable from more common chronic spine infections such as spine tuberculosis. Culture studies remain the key to establishing a definitive diagnosis and subsequently successful treatment. We report a case in which a patient presented with symptoms and signs suggestive of spine tuberculosis, yet the culture examination revealed otherwise., (2016 BMJ Publishing Group Ltd.)
- Published
- 2016
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23. Anterior debridement may not be necessary in the treatment of tuberculous spondylitis of the thoracic and lumbar spine in adults: a retrospective study.
- Author
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Wang ST, Ma HL, Lin CP, Chou PH, Liu CL, Yu WK, and Chang MC
- Subjects
- Adult, Aged, Aged, 80 and over, Antitubercular Agents therapeutic use, Decompression, Surgical, Drug Therapy, Combination, Ethambutol therapeutic use, Humans, Isoniazid therapeutic use, Kyphosis etiology, Kyphosis surgery, Laminectomy, Lumbar Vertebrae microbiology, Middle Aged, Pyrazinamide therapeutic use, Retrospective Studies, Rifampin therapeutic use, Spinal Fusion, Spondylitis microbiology, Thoracic Vertebrae microbiology, Lumbar Vertebrae surgery, Spondylitis therapy, Thoracic Vertebrae surgery, Tuberculosis, Spinal therapy
- Abstract
Aim: Many aspects of the surgical treatment of patients with tuberculosis (TB) of the spine, including the use of instrumentation and the types of graft, remain controversial. Our aim was to report the outcome of a single-stage posterior procedure, with or without posterior decompression, in this group of patients., Patients and Methods: Between 2001 and 2010, 51 patients with a mean age of 62.5 years (39 to 86) underwent long posterior instrumentation and short posterior or posterolateral fusion for TB of the thoracic and lumbar spines, followed by anti-TB chemotherapy for 12 months. No anterior debridement of the necrotic tissue was undertaken. Posterior decompression with laminectomy was carried out for the 30 patients with a neurological deficit., Results: The mean kyphotic angle improved from 26.1° (- 1.8° to 62°) to 15.2° (-25° to 51°) immediately after the operation. At a mean follow-up of 68.8 months (30 to 144) the mean kyphotic angle was 16.9° (-22° to 54°), with a mean loss of correction of 1.6° (0° to 10°). There was a mean improvement in neurological status of 1.2 Frankel grades in those with a neurological deficit. Bony union was achieved in all patients, without recurrent infection., Conclusions: Long posterior instrumentation with short posterior or posterolateral fusion is effective in the treatment of TB spine. It controls infection, corrects the kyphosis, and maintains correction and neurological improvement over time., Take Home Message: With effective anti-TB chemotherapy, a posterior only procedure without debridement of anterior lesion is effective in the treatment of TB spondylitis, and an anterior procedure can be reserved for those patients who have not improved after posterior surgery. Cite this article: Bone Joint J 2016;98-B:834-9., (©2016 The British Editorial Society of Bone & Joint Surgery.)
- Published
- 2016
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24. Use of PET/CT in the early diagnosis of implant related wound infection and avoidance of wound debridement.
- Author
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Wang Y, Cheung JP, and Cheung KM
- Subjects
- Adult, Early Diagnosis, Female, Humans, Prosthesis-Related Infections microbiology, Pseudomonas Infections diagnosis, Scoliosis surgery, Thoracic Vertebrae microbiology, Bone Screws adverse effects, Positron Emission Tomography Computed Tomography, Prosthesis-Related Infections diagnostic imaging, Spinal Fusion instrumentation, Thoracic Vertebrae diagnostic imaging
- Abstract
Purpose: Delayed infections after spinal instrumentation typically require complete implant removal and extensive wound debridement due to the difficulties in establishing an early diagnosis. We report a case of occult late infection after posterior spinal instrumentation that was detected early using PET/CT and therefore was successfully treated with antibiotics alone., Methods: A 26-year-old woman who underwent posterior spinal instrumentation and fusion for scoliosis correction had superficial pseudomonal infection that healed with ceftazidime and levofloxacin and was admitted 4 months later with mild back pain. She had no fever and the surgical wound healed well. Laboratory tests were compatible with late infection but radiographs showed no signs of implant infection. The patient was suspected of having ongoing occult late infection and thus, underwent a PET/CT., Results: PET/CT revealed a significant pathological FDG uptake at the T5 vertebral body and the area surrounding proximal end of the T5 instrumentation. The maximal standardized uptake value (SUV) was 7.9 for the T5 vertebra and only 2.3 for the patient's liver, suggesting an infection pathology. A conclusive diagnosis of delayed onset infection after spinal instrumentation was established and the patient was immediately started on oral anti-pseudomonal treatment. The scoliosis correction was well maintained 10 months after the index surgery and she had no signs of implant infection., Conclusions: PET/CT provides detailed diagnostic information for occult infections in the absence of morphological changes and thus, is valuable for an early diagnosis of late infection after spinal instrumentation. It is possible to retain the instrumentation in the case of late infection, if early detection and efficacious treatment can be achieved timely.
- Published
- 2016
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25. Polymicrobial vertebral osteomyelitis after oesophageal biopsy: a case report.
- Author
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Giger A, Yusuf E, Manuel O, Clerc O, and Trampuz A
- Subjects
- Aged, Anti-Bacterial Agents therapeutic use, Antifungal Agents therapeutic use, Candida albicans isolation & purification, Gemella isolation & purification, Humans, Magnetic Resonance Imaging, Male, Osteomyelitis drug therapy, Osteomyelitis microbiology, Radiography, Spine diagnostic imaging, Streptococcus mitis isolation & purification, Thoracic Vertebrae microbiology, Osteomyelitis diagnosis
- Abstract
Background: While most cases of polymicrobial vertebral osteomyelitis are secondary to hematogenous seeding, direct inoculation during spinal surgery and contiguous spread from adjacent soft tissue are also potential routes whereby pathogens may infect the spine., Case Presentation: A 74 year-old man presented with an exacerbation of back pain after a fall. His past medical history included hepatocellular and oesophageal carcinoma. Three months earlier he had undergone an endoscopic biopsy of the oesophagus for routine follow-up of his oesophagus carcinoma. He also underwent a vertebroplasty due to suspected pathologic fracture. On admission to hospital, magnetic resonance imaging revealed an infiltrative process at the level of the 5th and 6th thoracic vertebrae. Blood cultures were positive for both Streptococcus mitis and Gemella morbillorum. During his course of antibiotic therapy he developed an abscess at the level of 8th thoracic vertebrae and culture of this abscess grew Candida albicans. He was treated with antibiotics and antifungal drugs and recovered fully., Conclusion: Vertebral osteomyelitis may be caused by direct spread following an oesophageal procedure. Microbiological diagnosis is essential to target the specific pathogen, especially in cases of polymicrobial infection.
- Published
- 2016
- Full Text
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26. Thoracolumbar Scoliosis Due to Cryptococcal Osteomyelitis: A Case Report and Review of the Literature.
- Author
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Li Z, Liang J, Shen J, Qiu G, and Weng X
- Subjects
- Adolescent, Cryptococcosis surgery, Cryptococcus neoformans, Debridement, Female, Humans, Lumbar Vertebrae microbiology, Lumbar Vertebrae surgery, Osteomyelitis microbiology, Osteomyelitis surgery, Scoliosis surgery, Thoracic Vertebrae microbiology, Thoracic Vertebrae surgery, Cryptococcosis complications, Osteomyelitis complications, Scoliosis microbiology
- Abstract
Cryptococcus neoformans causes opportunistic infections in immunocompromised patients, with vertebral osteomyelitis being a very rare involvement.This study is to present a case of thoracolumbar scoliosis occurring in the setting of cryptococcal osteomyelitis.Pharmacological intervention with anticryptococcal medicine and medical management of immune hemolytic anemia were administered. After initial acute stabilization, she underwent spinal debridement and fusion on October 29, 2008. She eventually recovered fully from this episode with no subsequent mechanical instability or neurological deficits on subsequent clinic follow-ups.To the best of our knowledge, there have been no reports describing the onset of spinal cryptococcal osteomyelitis along with immune hemolytic anemia. We suggest a comprehensive algorithm for the diagnosis of vertebral cryptococcal osteomyelitis.
- Published
- 2016
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27. Bug on the back: vertebral osteomyelitis secondary to fluoroquinolone resistant Salmonella typhi in an immunocompetent patient.
- Author
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Shrestha P, Mohan S, and Roy S
- Subjects
- Abscess diagnosis, Abscess surgery, Drug Resistance, Microbial, Humans, Male, Middle Aged, Osteomyelitis complications, Osteomyelitis drug therapy, Salmonella Infections complications, Salmonella Infections drug therapy, Spinal Cord Compression etiology, Spinal Cord Compression surgery, Travel, Treatment Outcome, Anti-Bacterial Agents therapeutic use, Levofloxacin therapeutic use, Osteomyelitis diagnosis, Salmonella Infections diagnosis, Salmonella typhi drug effects, Thoracic Vertebrae microbiology
- Abstract
Although Salmonella osteomyelitis is commonly seen in immunocompromised patients, it may occasionally affect an immunocompetent host. Symptoms are usually non-specific, such as fever, abdominal or back pain; hence it should be considered in the differential diagnosis of patients with a history of travel to endemic regions. Fluoroquinolone resistance is rising and non-responsive patients should be treated with ampicillin, trimethoprim-sulfamethoxazole and ceftriaxone. We present a case of acute T8-T11 osteomyelitis with cord compression caused by a fluoroquinolone resistant strain of Salmonella typhi., (2015 BMJ Publishing Group Ltd.)
- Published
- 2015
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28. [EFFECTIVENESS OF POSTERIOR UNILATERAL TRANSPEDICULAR DEBRIDEMENT, BONE GRAFT FUSION, AND PEDICLE SCREW FIXATION FOR THORACOLUMBAL TUBERCULOSIS].
- Author
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Wu P, Ou Y, Liu D, Zhu Y, Zhao Z, and Jiang D
- Subjects
- Antitubercular Agents therapeutic use, Debridement, Humans, Lumbar Vertebrae, Operative Time, Pain Measurement, Postoperative Period, Spinal Fusion, Thoracic Vertebrae surgery, Treatment Outcome, Tuberculosis, Spinal diagnosis, Tuberculosis, Spinal microbiology, Bone Transplantation methods, Fracture Fixation, Internal methods, Pedicle Screws, Plastic Surgery Procedures methods, Thoracic Vertebrae microbiology, Tuberculosis, Spinal surgery
- Abstract
Objective: To explore the effectiveness of posterior unilateral transpedicular debridement, bone graft fusion, and pedicle screw fixation for thoracolumbar tuberculosis., Methods: Between January 2009 and January 2013, 97 patients with thoracolumbar tuberculosis were treated with posterior unilateral transpedicular debridement, bone graft fusion, and pedicle screw fixation in 53 cases (group A), and with traditional posterior operation in 44 cases (group B). There was no significant difference in age, sex, disease duration, affected segments, Frankel grade, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), sagittal Cobb angle, visual analogue scale (VAS), and Oswestry disability index (ODI) between 2 groups (P > 0.05). The surgery and follow-up results were compared between 2 groups., Results: The patients were followed up 24-60 months. All patients achieved intervertebral bone fusion after operation. The bone graft fusion time of groups A and B was (6.79 ± 1.68) months and (6.89 ± 2.00) months respectively, showing no significant difference (t = -0.251, P = 0.802). There was no significant difference in operation time, intraoperation blood loss, and postoperative hospitalization time between 2 groups (P > 0.05); the postoperative drainage volume of group A was significantly less than that of group B (P < 0.05). The CRP and ESR at 1 year and the VAS score at last follow-up were significantly decreased when compared with preoperative values in 2 groups (P < 0.05), but no significant difference was found between 2 groups (P > 0.05). The Cobb angle at 1 week and at last follow-up and ODI at 3 months and at last follow-up were significantly improved in 2 groups (P < 0.05), but there was no significant difference between the time points after operation (P > 0.05). At 3 months after operation, the ODI of group A was significantly lower than that of group B (t = -2.185, P = 0.027), but no significant difference was found in Cobb angle, Cobb angle loss, and ODI at other time points between 2 groups (P > 0.05). At last follow-up, the Frankel classification of nerve function was improved 1-2 grades in 2 groups, showing no significant difference between 2 groups (Z = -0.180, P = 0.857). No complication of internal fixation breakage or loosening was observed., Conclusion: The effectiveness of posterior unilateral transpedicular debridement, bone graft fusion, and pedicle screw fixation in the treatment of thoracolumbar tuberculosis is satisfactory, with the advantages of less trauma, strong spinal stability, and fast function recovery.
- Published
- 2015
29. Spinal infections caused by Parvimonas micra.
- Author
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Gahier M, Cozic C, Bourdon S, Guimard T, and Cormier G
- Subjects
- Abscess etiology, Abscess microbiology, Aged, 80 and over, Anti-Bacterial Agents therapeutic use, Discitis complications, Discitis drug therapy, Female, Fractures, Spontaneous etiology, Gram-Positive Bacterial Infections complications, Gram-Positive Bacterial Infections drug therapy, Granuloma etiology, Granuloma microbiology, Humans, Low Back Pain etiology, Middle Aged, Neck Pain etiology, Osteomyelitis complications, Osteomyelitis drug therapy, Spinal Cord Compression etiology, Spondylitis complications, Spondylitis drug therapy, Cervical Vertebrae microbiology, Discitis microbiology, Firmicutes isolation & purification, Gram-Positive Bacterial Infections microbiology, Lumbar Vertebrae microbiology, Osteomyelitis microbiology, Spondylitis microbiology, Thoracic Vertebrae microbiology
- Published
- 2015
- Full Text
- View/download PDF
30. [A rare cause of back pain and fever].
- Author
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Jelin G, Lasselin-Boyard P, Boulet PO, and Goëb V
- Subjects
- Aged, Back Pain etiology, Esophageal Perforation diagnosis, Fever etiology, Gemella isolation & purification, Gram-Positive Bacterial Infections diagnosis, Humans, Magnetic Resonance Imaging, Male, Spondylitis diagnosis, Spondylitis microbiology, Thoracic Vertebrae microbiology, Esophageal Perforation etiology, Gram-Positive Bacterial Infections complications, Spondylitis complications, Thoracic Vertebrae pathology
- Published
- 2015
- Full Text
- View/download PDF
31. Septic arthritis of the facet joint.
- Author
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André V, Pot-Vaucel M, Cozic C, Visée E, Morrier M, Varin S, and Cormier G
- Subjects
- Adult, Aged, Aged, 80 and over, Arthritis, Infectious diagnosis, Arthritis, Infectious epidemiology, Arthritis, Infectious etiology, Back Pain etiology, Bacteremia complications, Bacteremia microbiology, Early Diagnosis, Female, France epidemiology, Gram-Negative Bacterial Infections diagnosis, Gram-Negative Bacterial Infections epidemiology, Gram-Negative Bacterial Infections etiology, Gram-Positive Bacterial Infections diagnosis, Gram-Positive Bacterial Infections epidemiology, Gram-Positive Bacterial Infections etiology, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Osteolysis etiology, Risk Factors, Spondylitis diagnosis, Spondylitis epidemiology, Spondylitis etiology, Thoracic Vertebrae microbiology, Tomography, X-Ray Computed, Arthritis, Infectious microbiology, Lumbar Vertebrae microbiology, Spondylitis microbiology, Zygapophyseal Joint microbiology
- Abstract
Objective: Septic arthritis of the facet joint is a rare clinical entity. We report 11 cases of facet joint infections diagnosed in our institution., Patients and Method: Patients were identified via the computerized patients record (PMSI). Their features were collected and compared with published data., Results: The clinical symptoms are similar to those of infectious spondylodiscitis: back pain with stiffness (11/11), fever (9/11), radicular pain (5/11), and asthenia. Ten patients presented with lumbar infection and 1 with dorsal infection. An inflammatory syndrome was observed in every case. A rapid access to spine MRI allowed making the diagnosis in every case, and assessing a potential extension of infection (epidural extension 5/11, paraspinal extension 5/11). Blood culture (8/11) or culture of spinal samples allowed identifying the causative bacterium in every case and adapting the antibiotic treatment. The bacteria identified in our series were different from previously reported ones, with less staphylococci. The origin of the infection was found in 4 cases. Another localization of infection was observed in 4 cases. The outcome was favorable with medical treatment in 10 cases. An abscess was surgically drained in 1 case. None of our patients presented with neurological complications, probably because of the rapid diagnosis., Conclusion: Assessing the facet joint is essential in case of inflammatory back pain, and the radiologist must be asked to perform this examination., (Copyright © 2015. Published by Elsevier SAS.)
- Published
- 2015
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32. [Miliary tuberculosis with pulmonary, meningeal and bone involvement].
- Author
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Sánchez-Muñoz LA, Mayor-Toranzo E, Nogueira-González B, and Sánchez-Lite I
- Subjects
- Aged, Humans, Magnetic Resonance Imaging, Male, Tomography, X-Ray Computed, Tuberculosis, Meningeal diagnostic imaging, Tuberculosis, Miliary diagnostic imaging, Tuberculosis, Osteoarticular diagnostic imaging, Tuberculosis, Pulmonary diagnostic imaging, Thoracic Vertebrae diagnostic imaging, Thoracic Vertebrae microbiology, Tuberculosis, Meningeal diagnosis, Tuberculosis, Miliary diagnosis, Tuberculosis, Osteoarticular diagnosis, Tuberculosis, Pulmonary diagnosis
- Published
- 2015
- Full Text
- View/download PDF
33. Postoperative wound infection after posterior spinal instrumentation: analysis of long-term treatment outcomes.
- Author
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Chen SH, Lee CH, Huang KC, Hsieh PH, and Tsai SY
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents therapeutic use, Bone Screws microbiology, Combined Modality Therapy, Debridement, Device Removal, Female, Follow-Up Studies, Gram-Negative Bacterial Infections diagnosis, Gram-Positive Bacterial Infections diagnosis, Humans, Lumbar Vertebrae microbiology, Lumbar Vertebrae surgery, Male, Middle Aged, Prosthesis-Related Infections diagnosis, Retrospective Studies, Salvage Therapy, Surgical Wound Infection diagnosis, Thoracic Vertebrae microbiology, Thoracic Vertebrae surgery, Treatment Outcome, Young Adult, Bone Screws adverse effects, Gram-Negative Bacterial Infections therapy, Gram-Positive Bacterial Infections therapy, Prosthesis-Related Infections therapy, Spinal Fusion instrumentation, Surgical Wound Infection therapy
- Abstract
Purpose: Postoperative spinal implant infection (PSII) places patients at risk for pseudarthrosis, correction loss, spondylodiscitis, adverse neurological sequelae, and even death; however, prognostic factors that predict long-term treatment outcomes have not been clearly investigated. In addition, few studies concerning the feasibility of reconstructing the failed spinal events have been published., Methods: We performed a cohort study of 51 patients who contracted PSII in the posterolateral thoracolumbar region at a single tertiary center between March 1997 and May 2007. Forty-seven patients (92.2 %) had one or more medical problems. Isolated bacterial species, infection severity, treatment timing, and hosts' defense response were evaluated to assess their relationship with management outcomes. The use of implant salvage, or removal subsequent with a revision strategy depended on the patient's general conditions, infection control, and implant status for fusion., Results: The most common infective culprit was Staphylococcus spp. found in 35 of 60 (58.3 %) isolates, including 20 methicillin-resistant species. Gram-negative bacilli and polymicrobial infection were found significantly in patients presenting early-onset, deep-site infection and myonecrosis. Prompt diagnosis and aggressive therapy were responsible for implant preservation in 41 of 51 cases (80.4 %), while implant removal noted in 10 cases (19.6 %) was attributed to delayed treatment and uncontrolled infection with implant loosening, correction loss, or late infection with spondylodesis. The number of employed debridements alone was not significantly correlated with successful implant preservation. Delayed treatment for infection >3 months significantly led to implant removal (p < 0.05) and a higher number of failed spinal events. Patients with significant comorbidities, malnutrition, severe trauma, neurological deficits, long-level instrumentation, and delayed treatment had poor outcomes. Sixteen patients (31.4 %) exhibited probable nonunion or pseudarthrosis, and eight symptomatic patients among them underwent successful revision surgery., Conclusions: Retention of the mechanically sound implants in early-onset infection permits fusion to occur, while delayed treatment, severe malnutrition and multiple comorbidities will most likely result in a lack of effectiveness in eradicating the infecting pathogens. Restoring optimal physiological conditions is imperative in high-risk patients to allow for further healing. When loosened screws cause peridiscal erosion and incapacitating motion pain, premature implant removal possibly results in failed fusion and correction loss. Reconstruction for a failed spinal event is feasible following infection control.
- Published
- 2015
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34. Thoracic spinal cord intramedullary aspergillus invasion and abscess.
- Author
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McCaslin AF, Lall RR, Wong AP, Lall RR, Sugrue PA, and Koski TR
- Subjects
- Abscess microbiology, Abscess pathology, Antifungal Agents therapeutic use, Fatal Outcome, Female, Fever etiology, Humans, Muscle Weakness etiology, Neuroaspergillosis drug therapy, Osteomyelitis microbiology, Osteomyelitis pathology, Precursor T-Cell Lymphoblastic Leukemia-Lymphoma complications, Suction, Voriconazole therapeutic use, Young Adult, Neuroaspergillosis microbiology, Neuroaspergillosis pathology, Spinal Cord microbiology, Spinal Cord pathology, Thoracic Vertebrae microbiology, Thoracic Vertebrae pathology
- Abstract
Invasive central nervous system aspergillosis is a rare form of fungal infection that presents most commonly in immunocompromised individuals. There have been multiple previous reports of aspergillus vertebral osteomyelitis and spinal epidural aspergillus abscess; however to our knowledge there are no reports of intramedullary aspergillus infection. We present a 19-year-old woman with active acute lymphoblastic leukemia who presented with several weeks of fevers and bilateral lower extremity weakness. She was found to have an intramedullary aspergillus abscess at T12-L1 resulting from adjacent vertebral osteomyelitis and underwent surgical debridement with ultra-sound guided aspiration and aggressive intravenous voriconazole therapy. To our knowledge this is the first reported case of spinal aspergillosis invading the intramedullary cavity. Though rare, this entity should be included in the differential for immunocompromised patients presenting with fevers and neurologic deficit. Early recognition with aggressive neurosurgical intervention and antifungal therapy may improve outcomes in future cases., (Copyright © 2014 Elsevier Ltd. All rights reserved.)
- Published
- 2015
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35. A thoracic tuberculous spondylodisctis after intravesical BCG immunotherapy of bladder cancer - Case report and literature review.
- Author
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Dąbrowska M, Drabarek T, Muraszko-Klaudel A, and Sławek J
- Subjects
- Administration, Intravesical, Aged, Humans, Male, Thoracic Vertebrae microbiology, Thoracic Vertebrae pathology, Discitis etiology, Immunotherapy adverse effects, Mycobacterium bovis pathogenicity, Tuberculosis, Spinal etiology, Urinary Bladder Neoplasms therapy
- Abstract
We report a rare case of tuberculosis of the thoracic spine caused by Mycobacterium bovis infection as a complication of BCG (Bacillus Calmette-Guérin) intravesical immunotherapy, which is a well known and acknowledged treatment of superficial bladder cancers applied since 1976. Although this therapy is broadly used in urology and considered to be safe and well tolerated, one should be aware of the potential local and systemic side effects as in the case of our patient, who developed tuberculous spondylodiscitis after intravesical BCG therapy., (Copyright © 2015 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)
- Published
- 2015
- Full Text
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36. [Spinal epidural abscesses are rare and warrant fast intervention].
- Author
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Skaaby T, Fink J, and Dragsted UB
- Subjects
- Adult, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents therapeutic use, Early Medical Intervention, Epidural Abscess diagnostic imaging, Epidural Abscess drug therapy, Humans, Magnetic Resonance Imaging, Male, Staphylococcal Infections diagnosis, Staphylococcal Infections drug therapy, Staphylococcus aureus isolation & purification, Thoracic Vertebrae diagnostic imaging, Epidural Abscess microbiology, Staphylococcal Infections complications, Thoracic Vertebrae microbiology
- Abstract
A spinal epidural abscess is a rare infectious disease that warrants urgent treatment. Symptoms involve a classic triad of fever, backache and neurological deficits but all the symptoms are rarely seen at the first contact. The low incidence and the non-specific symptoms can delay the diagnosis, resulting in grave neurological sequelae and death. Common risk factors are diabetes mellitus and intravenous drug abuse. Successful treatment relies on a multidisciplinary approach. We describe a case of spinal epidural abscesses in a previously healthy young man without known risk factors.
- Published
- 2014
37. [Comparison of effectiveness between two surgical methods in treatment of thoracolumbar brucella spondylitis].
- Author
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Yang X, Zuo X, Jia Y, Chang Y, Zhang P, and Ren Y
- Subjects
- Anti-Bacterial Agents therapeutic use, Arthrodesis, Bone Transplantation, Debridement, Fractures, Bone, Humans, Kyphosis, Operative Time, Retrospective Studies, Spinal Fusion, Spine, Thoracic Vertebrae surgery, Treatment Outcome, Brucella abortus isolation & purification, Brucellosis diagnosis, Fracture Fixation, Internal, Spondylitis microbiology, Spondylitis therapy, Thoracic Vertebrae microbiology
- Abstract
Objective: To compare the effectiveness between the method of simple posterior debridement combined with bone grafting and fusion and internal fixation and the method of one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in the treatment of thoracolumbar brucella spondylitis so as to provide the reference for the clinical treatment., Methods: A retrospective analysis was made on the clinical data of 148 cases of thoracolumbar brucella spondylitis between January 2002 and January 2012. Simple posterior debridement combined with bone grafting and fusion and internal fixation was used in 78 cases (group A), and one-stage anterior radical debridement combined with bone grafting and fusion and posterior internal fixation in 70 cases (group B). There was no significant difference in gender, age, disease duration, involved vertebral segments, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) score, neural function grade of America Spinal Injury Association (ASIA), and kyphosis Cobb angle before operation between 2 groups (P > 0.05). The peri operation period indexes (hospitalization time, operation time, and intraoperative blood loss) and the clinical effectiveness indexes (VAS score, ASIA grade, Cobb angle, and ESR) were compared; the bone fusion and the internal fixation were observed., Results: Incision infection and paravertebral and/or psoas abscess occurred in 2 and 3 cases of group A respectively. All incisions healed by first intention and 2 cases had pneumothorax in group B. The operation time and the hospitalization time of group A were significantly shorter than those of group B (P < 0.05), and the intraoperative blood loss of group A was significantly lower than that of group B (P < 0.05). All of the cases in 2 groups were followed up 14- 38 months, 25 months on average. The VAS, ESR, and Cobb angle were significantly decreased at each time point after operation when compared with preoperative ones in 2 groups (P < 0.05), but no significant difference was found between 2 groups (P > 0.05). The neurological function was significantly improved at 3 months after operation; there were 1 case of ASIA grade C, 14 cases of grade D, and 63 cases of grade E in group A, and there were 1 case of grade C, 11 cases of grade D, and 58 cases of grade E in group B; and difference was not significant (Z = 0.168, P = 0.682). The grafting bone fusion was observed in both groups. The fusion time was (8.7 ± 0.3) months in group A and (8.6 ± 0.4) months in group B, showing no significant difference (t = 0.591, P = 0.601) was found. At last follow-up, no loosening or fracture of internal fixation was found., Conclusion: Based on regular medicine therapy, the effectiveness of the two methods is satisfactory in the treatment of thoracolumbar brucella spondylitis as long as the operation indications should be controlled strictly.
- Published
- 2014
38. Minimally invasive surgical approaches in the management of tuberculosis of the thoracic and lumbar spine.
- Author
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Garg N and Vohra R
- Subjects
- Adult, Aged, Bone Screws, Debridement, Decompression, Surgical, Female, Humans, Laminectomy, Lumbar Vertebrae diagnostic imaging, Lumbar Vertebrae microbiology, Lumbar Vertebrae physiopathology, Magnetic Resonance Imaging, Male, Middle Aged, Minimally Invasive Surgical Procedures, Orthopedic Procedures instrumentation, Postoperative Complications etiology, Radiography, Plastic Surgery Procedures, Recovery of Function, Retrospective Studies, Thoracic Vertebrae diagnostic imaging, Thoracic Vertebrae microbiology, Thoracic Vertebrae physiopathology, Thoracotomy, Time Factors, Treatment Outcome, Tuberculosis, Spinal diagnosis, Tuberculosis, Spinal microbiology, Tuberculosis, Spinal physiopathology, Young Adult, Lumbar Vertebrae surgery, Orthopedic Procedures methods, Thoracic Vertebrae surgery, Tuberculosis, Spinal surgery
- Abstract
Background: Spinal tuberculosis is the most common form of skeletal tuberculosis. Various approaches have been described for surgical management of spinal tuberculosis, but many entail wide exposures with attendant morbidity; whether minimally invasive surgical (MIS) approaches are suitable is unknown., Questions/purposes: We evaluated (1) neurologic results, (2) radiographic results, and (3) complications in patients with thoracic and lumbar spinal tuberculosis treated with two MIS approaches., Methods: We retrospectively evaluated 22 patients with thoracic and lumbar tuberculosis managed surgically from October 2008 to February 2011 using MIS methods; one patient was lost to followup, leaving 21 patients with a minimum followup of 15 months (mean, 30 months; range, 15-59 months) for analysis. MIS approaches were used for patients with disease below D6 and minimum pedicle diameters of 4.5 mm to permit percutaneous screw placement. The MIS approach was divided into two groups depending on the extent of destruction of the vertebral body: a posterior-only group (n = 9), where posterior transpedicular decompression sufficed, and the hybrid group (n = 12), requiring anterior débridement and ventral-column reconstruction by conventional or mini-open thoracotomy. All but two patients with more than two contiguous bodies involvement underwent MIS posterior fixation by percutaneous transpedicular screws. Plain radiographs were evaluated for deformity correction and correction maintenance. Neurologic recovery and complications were ascertained by chart review., Results: All patients with neurologic deficits recovered completely with no motor deficits at followup; 13% improved by three grades, 53% by two grades, and 33% by one grade. Mean correction was 2.5° (thoracic) and 8° (lumbar) in the posterior-only group and 4.2° in the hybrid group. Some correction loss occurred with healing (2° and 1.6° in the posterior-only and hybrid groups, respectively), but in none of those who had fixation did this progress to more than preoperative status. Two of 22 patients (9%) had complications. One had a malposition of L5 screw causing painful radiculopathy without motor deficit and required repositioning. The other had an intraoperative dural tear repaired by onlay fascial patch and cerebrospinal fluid diversion. There were no approach-related complications, neurologic deterioration, or implant fatigue at last followup., Conclusions: We found evidence of neurologic recovery, avoidance of deformity progression, and few complications with these MIS approaches. Comparative trials are called for between open and MIS approaches for patients with spinal tuberculosis., Level of Evidence: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
- Published
- 2014
- Full Text
- View/download PDF
39. [Rare, but significant complication after BCG instillation therapy after urothelial carcinoma].
- Author
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Stahl T, Engelhardt F, and Layer G
- Subjects
- Adjuvants, Immunologic therapeutic use, Administration, Intravesical, BCG Vaccine therapeutic use, Carcinoma, Transitional Cell pathology, Diagnosis, Differential, Humans, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Thoracic Vertebrae microbiology, Tuberculosis, Spinal pathology, Urinary Bladder Neoplasms pathology, Adjuvants, Immunologic adverse effects, BCG Vaccine adverse effects, Carcinoma, Transitional Cell drug therapy, Image Enhancement methods, Magnetic Resonance Imaging methods, Mycobacterium tuberculosis, Neoplasm Recurrence, Local drug therapy, Thoracic Vertebrae pathology, Tuberculosis, Spinal chemically induced, Tuberculosis, Spinal diagnosis, Urinary Bladder Neoplasms drug therapy
- Published
- 2013
- Full Text
- View/download PDF
40. Thoracic vertebral osteomyelitis caused by Burkholderia cepacia in an immunocompetent adult.
- Author
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Hsieh CT, Hsu SK, and Chang CJ
- Subjects
- Aged, Anti-Bacterial Agents therapeutic use, Fatal Outcome, Female, Humans, Immunocompetence, Magnetic Resonance Imaging, Osteomyelitis diagnosis, Osteomyelitis therapy, Spondylitis diagnosis, Spondylitis therapy, Burkholderia Infections, Burkholderia cepacia, Osteomyelitis microbiology, Spondylitis microbiology, Thoracic Vertebrae microbiology
- Published
- 2013
- Full Text
- View/download PDF
41. [Tuberculous spondylitis of vertebra with fracture, paraparesis and pleural empyema complications--case report].
- Author
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Ruzicić RD, Jakovljević V, Zivković V, Vujić S, Varagić P, and Nikodijević P
- Subjects
- Aged, Early Diagnosis, Empyema, Tuberculous prevention & control, Humans, Male, Paraparesis microbiology, Paraparesis prevention & control, Spinal Fractures microbiology, Spinal Fractures prevention & control, Spondylitis microbiology, Spondylitis prevention & control, Thoracic Vertebrae microbiology, Tuberculosis, Spinal complications, Empyema, Tuberculous diagnosis, Paraparesis diagnosis, Spinal Fractures diagnosis, Spondylitis diagnosis, Thoracic Vertebrae injuries, Tuberculosis, Spinal diagnosis
- Abstract
Introduction: Spine tuberculosis is caused by Micobacterium tuberculosis. It is localized in the vertebral body or intervertebral disc. Its diagnosis is often delayed because of nonspecific symptoms and neglected presence of tuberculosis, which leads to serious complications., Case Report: This paper presents a case of tuberculous spondylitis, which was complicated with the fracture of vertebra, paraparesis of lower extremities and pleural empyema. The treatment with antituberculous drugs started after the fracture of 10th and 11th thoracic vertebras. The therapy brought some improvement but paraparesis of lower extremities remained. In the further course of disease, inflammatory process affected the pleura. Antibiotic and antitubercular therapy with puncture of pleura were not very effective. Operation was performed on December 20th 2011: Thoracotomia lat. dex. Decorticatio pulmonum lat.dex. Seven months after surgery, the patient was without symptoms., Conclusion: Tuberculous spondylitis occurs relatively frequently in clinical practice. Early diagnosis and adequate therapy of this disease can prevent the occurrence of its serious complications.
- Published
- 2013
- Full Text
- View/download PDF
42. Failure modes in conservative and surgical management of infectious spondylodiscitis.
- Author
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Valancius K, Hansen ES, Høy K, Helmig P, Niedermann B, and Bünger C
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents therapeutic use, Bone Screws microbiology, Child, Child, Preschool, Debridement methods, Female, Humans, Infant, Lumbar Vertebrae microbiology, Lumbar Vertebrae surgery, Male, Middle Aged, Retrospective Studies, Thoracic Vertebrae microbiology, Thoracic Vertebrae surgery, Treatment Failure, Young Adult, Bacterial Infections therapy, Discitis microbiology, Discitis therapy, Staphylococcal Infections therapy
- Abstract
Purpose and Methods: We reviewed the management, failure modes, and outcomes of 196 patients treated for infectious spondylodiscitis between January 1, 2000 and December 31, 2010, at the Spinal Unit, Aarhus University Hospital, Aarhus, Denmark. Patients with infectious spondylodiscitis at the site of previous spinal instrumentation, spinal metastases, and tuberculous and fungal spondylodiscitis were excluded., Results: Mean age at the time of treatment was 59 (range 1-89) years. The most frequently isolated microorganism was Staphylococcus aureus. The lumbosacral spine was affected in 64% of patients and the thoracic in 21%. In 24% of patients, there were neurologic compromise, four had the cauda equina syndrome and ten patients were paraplegic. Ninety-one patients were managed conservatively. Treatment failed in 12 cases, 7 patients required re-admission, 3 in-hospital deaths occurred, and 5 patients died during follow-up. Posterior debridement with pedicle screw instrumentation was performed in 75, without instrumentation in 19 cases. Seven patients underwent anterior debridement alone, and in 16 cases, anterior debridement was combined with pedicle screw instrumentation, one of which was a two-stage procedure. Re-operation took place in 12 patients during the same hospitalization and in a further 12 during follow-up. Two in-hospital deaths occurred, and five patients died during follow-up. Patients were followed for 1 year after treatment. Eight (9%) patients treated conservatively had a mild degree of back pain, and one (1%) patient presented with mild muscular weakness. Among surgically treated patients, 12 (10%) had only mild neurological impairment, one foot drop, one cauda equine dysfunction, but 4 were paraplegic. Twenty-seven (23%) complained of varying degrees of back pain., Conclusions: Conservative measures are safe and effective for carefully selected patients without spondylodiscitic complications. Failure of conservative therapy requires surgery that can guarantee thorough debridement, decompression, restoration of spinal alignment, and correction of instability. Surgeons should master various techniques to achieve adequate debridement, and pedicle screw instrumentation may safely be used if needed.
- Published
- 2013
- Full Text
- View/download PDF
43. Salmonella spinal infection: a rare case in a patient with advanced AIDS.
- Author
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Berngard SC and Miller M
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, Anti-Bacterial Agents therapeutic use, Humans, Male, Middle Aged, Ofloxacin therapeutic use, Osteomyelitis drug therapy, Salmonella Infections drug therapy, Salmonella enterica isolation & purification, AIDS-Related Opportunistic Infections microbiology, Cervical Vertebrae microbiology, Osteomyelitis microbiology, Salmonella Infections diagnosis, Thoracic Vertebrae microbiology
- Abstract
We present an unusual case of nontyphoidal Salmonella causing an epidural abscess and vertebral osteomyelitis in a severely immunocompromised patient with AIDS as well as a review of the literature. Salmonella vertebral osteomyelitis is exceptionally rare, and this is the first case report in a patient with AIDS.
- Published
- 2013
- Full Text
- View/download PDF
44. Rare manifestations of coccidioidomycosis.
- Author
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Angelo KM and Nnedu ON
- Subjects
- Antifungal Agents therapeutic use, Coccidioidomycosis drug therapy, Humans, Immunocompetence, Magnetic Resonance Imaging, Male, Middle Aged, Spinal Diseases diagnosis, Spinal Diseases drug therapy, Coccidioidomycosis diagnosis, Spinal Diseases microbiology, Thoracic Vertebrae microbiology
- Abstract
Involvement of the central nervous system and extrapulmonary sites by Coccidioides immitis is reported primarily in patients with cell-mediated immune deficiency. We present a case of a patient with no prior history of immunosuppression who presented to a public hospital in New Orleans with disseminated Coccidioides infection.
- Published
- 2013
45. Solitary thoracic vertebral body cysticercosis presenting with progressive compressive myelopathy.
- Author
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Furtado SV, Dadlani R, Ghosal N, and Rao AS
- Subjects
- Adult, Animals, Cysticercosis complications, Cysticercosis parasitology, Diagnosis, Differential, Disease Progression, Female, Humans, Severity of Illness Index, Spinal Cord Compression parasitology, Spinal Cord Diseases etiology, Spinal Cord Diseases parasitology, Spinal Cord Diseases surgery, Taenia solium pathogenicity, Thoracic Vertebrae microbiology, Thoracic Vertebrae surgery, Cysticercosis pathology, Spinal Cord Compression physiopathology, Spinal Cord Diseases pathology, Thoracic Vertebrae pathology
- Abstract
Common bony spinal pathologies that could present with progressive spasticity include vertebral body tumors or chronic infections of the spine. Cysticercosis of the spine commonly has an intramedullary occurrence. The authors discuss the presentation and management of a rare case of solitary vertebral cysticercosis that presented with lower-limb spasticity and sphincter involvement.
- Published
- 2013
- Full Text
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46. Vertebral osteomyelitis and epidural abscess due to Aspergillus nidulans resulting in spinal cord compression: case report and literature review.
- Author
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Jiang Z, Wang Y, Jiang Y, Xu Y, and Meng B
- Subjects
- Adult, Epidural Abscess pathology, Female, Frozen Sections, Humans, Magnetic Resonance Imaging, Osteomyelitis pathology, Spinal Cord Compression pathology, Thoracic Vertebrae microbiology, Aspergillus nidulans physiology, Epidural Abscess complications, Epidural Abscess microbiology, Osteomyelitis complications, Osteomyelitis microbiology, Spinal Cord Compression etiology, Thoracic Vertebrae pathology
- Abstract
Vertebral osteomyelitis caused by Aspergillus nidulans is rare and usually affects immunocompromised patients. This report presents a case of thoracic vertebral osteomyelitis with epidural abscesses due to A. nidulans in a 40-year-old immunocompetent female who presented with back pain, numbness and weakness of both lower limbs. Magnetic resonance imaging demonstrated osteomyelitis involving the thoracic (T)1-T3 vertebral bodies with epidural abscesses, resulting in spinal compression. The patient underwent a decompression laminectomy of T1-T3 and debridement of the thoracic epidural inflammatory granuloma. Histopathology revealed fungal granulomatous inflammation. The patient received 6 mg/kg voriconazole every 12 h (loading dose on day 1) followed by 4 mg/kg voriconazole twice daily for 1 month, administered intravenously. The patient returned with recurrent back pain 16 months after initial presentation. A. nidulans was identified by fungal culture and polymerase chain reaction. The patient showed no evidence of recurrence 1 year after a 6-month course of oral voriconazole. The key to the effective treatment of Aspergillus osteomyelitis is not to excise the abscess, but to administer systemic antifungal drug therapy.
- Published
- 2013
- Full Text
- View/download PDF
47. A staged treatment algorithm for spinal infections.
- Author
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Stüer C, Stoffel M, Hecker J, Ringel F, and Meyer B
- Subjects
- Adult, Aged, Aged, 80 and over, Cervical Vertebrae microbiology, Cervical Vertebrae surgery, Disease Management, Female, Follow-Up Studies, Humans, Lumbar Vertebrae microbiology, Lumbar Vertebrae surgery, Male, Middle Aged, Retrospective Studies, Thoracic Vertebrae microbiology, Thoracic Vertebrae surgery, Treatment Outcome, Algorithms, Neurosurgical Procedures methods, Spinal Diseases microbiology, Spinal Diseases surgery
- Abstract
Background and Study Aim: Spinal pyogenic infections occur frequently in today's neurosurgical routine. Conservative therapy often proves to be insufficient against an aggressive disease that affects patients who tend to be elderly and debilitated with complex comorbidity. Treatment, or lack of treatment, carries risks of persistent disability, sepsis, and death. In this study, we propose a tailored and staged algorithm for treating such spinal infections and present results of this approach., Patients and Methods: We retrospectively analyzed 52 patients (33 male, 19 female; median age: 68 years) who had undergone cervical, thoracic, or lumbar surgery for spinal infections according to the proposed staged treatment algorithm., Results: Most of the 52 patients were severely disabled (35% with quadri- or paraparesis, 31% with sepsis and catecholamine dependency, 17% with a single motor deficit, and 10% with meningitis). We surgically treated multilevel and multisegmental spinal infections via 23 nonstabilizing and 57 stabilizing ventral or dorsal approaches to the cervical, thoracic, or lumbar spine. The mean follow-up time was 24 months. Overall mortality was 19%. Surgery-related complications occurred in 11.5% of patients; recurrence of infection occurred in 3.8%. Motor function improved in 61.7%; bladder and sphincter dysfunction remitted completely in 50.0%., Conclusions: Depending on the patient's health status and neurological condition, surgery in complex spinal infections provides a good outcome in most cases. Nevertheless, indication must be individualized; for this, the proposed algorithm seems to be an excellent tool. We find that surgery should be discussed as a treatment of first choice for today's often complex spinal infections., (Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2013
- Full Text
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48. [Spondylodiscitis associated to Neisseria sicca endocarditis].
- Author
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Olivier V, Brière M, Bouillot P, Sotto A, and Lechiche C
- Subjects
- Aged, Anti-Bacterial Agents therapeutic use, Aortic Valve microbiology, Ceftriaxone therapeutic use, Ciprofloxacin therapeutic use, Discitis drug therapy, Endocarditis, Bacterial drug therapy, Humans, Intervertebral Disc Degeneration complications, Male, Neisseria sicca enzymology, Neisseriaceae Infections drug therapy, Penicillinase metabolism, Discitis microbiology, Endocarditis, Bacterial microbiology, Neisseria sicca isolation & purification, Neisseriaceae Infections microbiology, Thoracic Vertebrae microbiology
- Published
- 2013
- Full Text
- View/download PDF
49. Surgical results of long posterior fixation with short fusion in the treatment of pyogenic spondylodiscitis of the thoracic and lumbar spine: a retrospective study.
- Author
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Lin CP, Ma HL, Wang ST, Liu CL, Yu WK, and Chang MC
- Subjects
- Aged, Aged, 80 and over, Anti-Bacterial Agents therapeutic use, Back Pain microbiology, Back Pain surgery, Bone Transplantation, Decompression, Surgical, Discitis diagnosis, Discitis microbiology, Discitis physiopathology, Female, Humans, Intervertebral Disc diagnostic imaging, Intervertebral Disc microbiology, Intervertebral Disc pathology, Intervertebral Disc physiopathology, Kyphosis microbiology, Kyphosis surgery, Laminectomy, Lumbar Vertebrae diagnostic imaging, Lumbar Vertebrae microbiology, Lumbar Vertebrae pathology, Lumbar Vertebrae physiopathology, Magnetic Resonance Imaging, Male, Middle Aged, Neurologic Examination, Pain Measurement, Pain, Postoperative diagnosis, Pain, Postoperative etiology, Predictive Value of Tests, Radiography, Recovery of Function, Retrospective Studies, Spinal Fusion adverse effects, Spinal Fusion instrumentation, Taiwan, Thoracic Vertebrae diagnostic imaging, Thoracic Vertebrae microbiology, Thoracic Vertebrae pathology, Thoracic Vertebrae physiopathology, Time Factors, Treatment Outcome, Discitis surgery, Intervertebral Disc surgery, Lumbar Vertebrae surgery, Spinal Fusion methods, Thoracic Vertebrae surgery
- Abstract
Study Design: A single-institution, single-surgeon retrospective review., Objective: To evaluate the clinical results of long posterior instrumentation with short posterior or posterolateral fusion for pyogenic spondylodiscitis of the thoracic and lumbar spine retrospectively., Summary of Background Data: There are controversies concerning the optimal treatment for pyogenic spondylodiscitis, in terms of approach, grafting, and instrumentation. Reports of long posterior fixation with short fusion without debridement of infected tissue for pyogenic spondylodiscitis are rare., Methods: From June 1997 to June 2007, 48 patients with pyogenic spondylodiscitis were treated. The indications for surgery were neurological compromise, significant vertebral body destruction with kyphosis and segmental instability, failure of medical treatment, and the need for tissue diagnosis. All patients received long posterior instrumentation with or without posterior decompression, depending on whether the patients had neurological deficit. During operation, no debridement of infected tissue was done. Clinical outcomes were assessed using the criteria of Kirkaldy-Willis and the visual analogue scale for pain. The neurological outcome was graded using Frankel grading system. Segmental kyphotic angle and fusion were recorded and analyzed., Results: The average follow-up time was 64 months. The visual analogue scale scores improved from an average of 7.2 before surgery to 2.2 after surgery. Twenty-eight patients with initial neurological impairment had an average improvement of 1.03 grades, using the Frankel grading system, at the final follow-up. The segmental kyphotic deformity improved by an average of 8.5° immediately after operation and lost an average correction of 3.0° at the final follow-up. No relapse of infection was found among these 48 patients., Conclusion: The posterior approach with long segmental fixation and short posterior or posterolateral fusion without debridement of the infected tissue was effective for pyogenic spondylodiscitis of the thoracic and lumbar spine.
- Published
- 2012
- Full Text
- View/download PDF
50. Successful treatment of azole-resistant Candida spondylodiscitis with high-dose caspofungin monotherapy.
- Author
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Kelesidis T and Tsiodras S
- Subjects
- Adult, Antifungal Agents therapeutic use, Candida albicans isolation & purification, Candidiasis complications, Caspofungin, Discitis microbiology, Dose-Response Relationship, Drug, HIV Infections complications, HIV Infections immunology, Humans, Immunocompromised Host, Lipopeptides, Male, Treatment Outcome, Azoles therapeutic use, Candidiasis drug therapy, Discitis drug therapy, Drug Resistance, Fungal, Echinocandins therapeutic use, Thoracic Vertebrae microbiology
- Published
- 2012
- Full Text
- View/download PDF
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