Search Results (72)

Background/Objectives: The treatment of Hematogenous Primary Septic Spinal Infection (HPSSI) typically involves either conservative management or surgical intervention. Previous studies have suggested that conservative treatment with antibiotics is the mainstay conventional procedure in treating HPSSI, but relevant conclusions remain controversial regarding mortality, recurrence, and hospital stay. There is a lack of systematic reviews and meta-analyses comparing conservative vs. surgical treatment specifically in non-TBC, non-fungal, and non-postsurgical HPSSI in adults. This systematic review and meta-analysis aim to systematically evaluate the therapeutic effectiveness of conservative versus surgical intervention for the management of HPSSI, through a meta-analysis of key outcomes including mortality, recurrence, and length of hospital stay. Methods: A comprehensive literature search was performed across four major databases: PubMed, Cochrane, Science Direct, and Scopus. Using defined inclusion and exclusion criteria, we identified twelve studies encompassing 1199 patients with hematogenous, primary, septic spinal infection, which was not post-surgical, not due to TBC, and not fungal, who were treated conservatively (n = 519) or surgically (n = 680) for inclusion in the meta-analysis. PRISMA guidelines were used for this analysis. The primary outcome analyzed was mortality; secondary outcomes were infection recurrence and length of hospital stay, comparing conservative treatment versus operative intervention for HPSSI. Results: Mortality rates for surgical versus conservative treatment varied across five studies. Some studies reported significantly lower mortality with surgical intervention vs. conservative treatment (2.3–6% vs. 17.8–18%), while others showed no difference (11% for both treatments). This meta-analysis indicates that surgical treatment does not significantly alter mortality rates compared to conservative management, although study heterogeneity is considerable. Infection recurrence was reported in three studies, with rates ranging from 5 to 16.4% for conservative treatment and 5 to 11.6% for surgical intervention. These differences were not statistically significant in studies that provided group-specific data. Findings on hospital length of stay were mixed: two studies reported shorter stays for surgical patients (23.9–33.4 days vs. 40.5–51.2 days), while another study found no meaningful difference between the groups. Across multiple studies, advanced age, frailty, higher comorbidity burden, and neurological impairment were consistently identified as independent predictors of increased mortality, irrespective of treatment modality. Although some data suggest a short-term survival advantage associated with surgical intervention, the overall mortality outcomes remain heterogeneous across the literature. Conclusions: Overall, the findings of this meta-analysis remain inconclusive regarding which treatment—surgical or conservative—is more advantageous in reducing mortality, infection recurrence, and hospital stay. The variability across studies highlights the influence of patient selection, treatment protocols, and local clinical practices. To enhance our understanding and improve outcomes in HPSSI, future randomized controlled trials are essential. These studies should incorporate clear selection criteria, standardized terminology for spinal infection subgroups, and homogenous patient populations with well-defined comorbidities to allow for meaningful data comparisons. Additionally, emphasis should be placed on early diagnosis, rapid identification of causative pathogens, using modern diagnostic tools, and timely initiation of appropriate treatment—whether surgical or conservative—to optimize patient outcomes, including reduced mortality, lower recurrence rates, and shorter hospitalizations. Full article

Bone and joint infections remain therapeutic challenges, usually requiring prolonged intravenous therapy and hospitalization. Dalbavancin, a long-acting lipoglycopeptide, offers a simplified alternative. We retrospectively analysed 83 patients treated with dalbavancin for osteomyelitis, spondylodiscitis, septic arthritis, or prosthetic joint infection in two tertiary Greek hospitals (2022–2024). Mean age was 69 ± 16 years; 56.6% were male; Charlson Comorbidity Index averaged 4 ± 2.25. Common comorbidities included diabetes (28.9%) and coronary artery disease (18.1%). Infections were vertebral osteomyelitis/spondylodiscitis (48.2%), non-vertebral osteomyelitis (38.5%), prosthetic joint infection (10.8%), and septic arthritis (8.4%). Microbiological diagnosis was established in 62.6%; predominant pathogens were Staphylococcus aureus (38.4%: 30.7% MSSA, 7.7% MRSA) and enterococci (25%, including 5.7% VRE). Dalbavancin was administered as monotherapy (32.4%) or combined with other antibiotics (67.6%), mainly fluoroquinolones (63.6%) and minocycline (23.6%). Mean dosing was 2 ± 2.36 administrations (4 ± 4.38 g total). Surgical debridement was performed in 36.1% of patients. Clinically significant adverse events occurred in 4 patients (4.8%): acute kidney injury (n = 2), angioedema (n = 1), and Clostridioides difficile colitis (n = 1). Clinical cure was achieved in 90.4% at day 90 and 92.8% at day 180. Clinical cure rates were comparable between dalbavancin monotherapy and combination therapy, suggesting that the efficacy observed was primarily attributable to dalbavancin itself. Relapse at one year occurred in 10.8%, mainly due to inadequate source control. Dalbavancin demonstrated high efficacy, favourable safety, and treatment simplification in complex bone and joint infections. Its long half-life and reduced need for prolonged IV access support its role in minimizing hospitalization and catheter-related complications, particularly in regions with limited outpatient parenteral therapy infrastructure. Full article

Background: The increasing incidence of spondylodiscitis and its potentially severe consequences when not promptly diagnosed highlight the need for further research to improve treatment guidelines, reduce mortality and morbidity and improve the quality of life in patients who suffer from persistent physical limitations. Methods: We collected data from 103 patients, with 8 patients lost to follow-up, who were diagnosed with vertebral osteomyelitis, disk infection or discitis between 2009 and 2018. The primary outcome was the 1-year mortality rate in patients treated with either conservative or surgical intervention, with both groups receiving antibiotic treatment. A standardized questionnaire was used to assess health-related quality of life after treatment by evaluating the European Quality of Life 5 Dimension 5 Level version (EQ-5D-5L) and the European Quality of Life Visual Analog Scale (EQ-VAS). In addition, we used the Oswestry Disability Index (ODI) and the Parker Mobility Score to identify backpain-related limitations after treatment. Results: The group receiving surgical treatment had a significantly lower 1-year mortality rate (22%) than did those who were treated conservatively, who had a 4-fold greater risk for death after a year following first diagnosis of SD and treatment. With respect to quality of life, 39 patients answered the standardized questionnaires during follow-up, and the questionnaire results revealed no significant difference in limitations in daily life or in health-related quality of life, with a median Parker Mobility Score of 9 for the conservatively treated patients compared with 7.5 for the surgically treated patients. This difference between the groups was not statistically significant, with a p value of 0.216 > α. A similar result was obtained in the evaluation of the ODI, with a medial index of 30% in the conservatively treated group compared with 24% in the surgical group, which was not statistically significant as indicated by a p value of 0.360 > α. Conclusions: The early surgical approach when treating spondylodiscitis is advantageous for identifying the underlying infection and initiating appropriate antibiotic therapy, therefore reducing mortality and resulting in a greater likelihood of full recovery than the conservative treatment does. Full article

Candidozyma auris (formerly known as Candida auris) is an emerging multidrug-resistant fungal pathogen that has become increasingly implicated in healthcare-associated infections; however, its involvement in spondylodiscitis is exceedingly rare. We report the case of a 65-year-old Saudi male with multiple comorbidities who presented with altered mental status and was subsequently diagnosed with Candidozyma auris spondylodiscitis and bilateral psoas abscesses. Despite broad-spectrum antifungal therapy and multidisciplinary management, the patient’s condition rapidly deteriorated. This case highlights the significant challenges in diagnosing and managing multidrug-resistant C. auris infections and underscores the need for early suspicion, effective source control, and novel antifungal strategies in high-risk populations. Full article

Background and Objectives: Pyogenic spondylodiscitis (SD) is a severe spinal infection involving the intervertebral disc and adjacent vertebrae and is often associated with significant morbidity. Identifying the causative microorganism is crucial for targeted treatment; however, the microbiological yield from blood or tissue cultures varies widely due to factors such as prior antibiotic use and biopsy technique. In this study, we aimed to investigate the clinical, laboratory, and radiological predictors of microbiological yield, particularly from tissue biopsy specimens. Materials and Methods: This retrospective cohort study included adult patients diagnosed with pyogenic SD between January 2023 and July 2025 at a tertiary care hospital. Demographics, comorbidities, laboratory markers (CRP, ESR, ALP, albumin), radiological findings (abscess presence, anatomical location, claw sign), prior antibiotic use, and microbiological results were analyzed. Tissue specimens were obtained through either surgical sampling or needle biopsy. Univariable and multivariable logistic regression were performed to determine the predictors of positive tissue cultures. Results: Of the 159 patients screened, 55 met our inclusion criteria. The mean age was 63.9 ± 13.5 years, 80% had lumbar involvement, and 58.2% had abscesses, primarily paravertebral or psoas in location. Microorganisms were isolated in 65.5% of the cases, with Staphylococcus aureus being the most common (41.7%). The blood culture positivity was 55.5%, while tissue culture positivity was 40.4%. Logistic regression revealed that lower albumin (p = 0.046) and higher ALP levels (p = 0.045) were independent predictors of a positive microbial yield from tissue biopsies. Conclusions: Serum albumin and ALP levels may aid clinical decision-making regarding invasive sampling in SD. When blood cultures are negative and albumin is low while ALP is elevated, clinicians should consider prioritizing tissue biopsy. These findings may help optimize diagnostic strategies and should be validated in larger, prospective studies. Full article

Percutaneous vertebroplasty (PVP) has emerged as a key intervention for painful vertebral compression fractures in osteoporotic and metastatic disease, but its safety profile warrants comprehensive evaluation. We conducted a PRISMA-compliant systematic review of studies published between 2009 and 2024, identifying 15 clinical studies (n ≈ 8500 patients) that reported PVP-related complications in adults with osteoporotic or neoplastic fractures. Data extraction focused on complication incidence, presentation, imaging findings, risk factors, and management strategies. Cement leakage was the most frequently detected event (20–70% of levels, higher in neo-plastic lesions), yet symptomatic neural or vascular sequelae occurred in <1%. Pulmonary cement embolism appeared on imaging in 2–26% of cases but was clinically evident in ≤0.5%, with conservative management or brief anticoagulation sufficing for most patients. New vertebral fractures developed in 8–20% of osteoporotic and up to 30% of metastatic cohorts, paralleling underlying bone fragility rather than PVP itself. Postprocedural infection (0.2–0.5%) and neurologic injury (<0.5%) were uncommon but required prompt surgical and antibiotic interventions. Overall, PVP’s benefits—rapid pain relief and mechanical stabilization—outweigh its risks when performed with meticulous technique, vigilant imaging, and multidisciplinary follow-up, confirming its favorable safety profile in both osteoporosis and spinal malignancy. Full article

Background/Objectives: Veillonella species are Gram-negative, non-motile, non-fermentative, obligate anaerobic cocci. They are typically considered commensals of the oral cavity, respiratory tract, genitourinary tract, and gastrointestinal tract. It may be a rare cause of dental infections and discitis/spondylodiscitis. Methods: We report the case of an 80-year-old patient diagnosed with discitis caused by Veillonella parvula, isolated from blood. In addition, we performed a comprehensive literature review summarizing all reported cases of discitis or spondylodiscitis caused by Veillonella species. Results: In our case, antimicrobial susceptibility testing was performed using the Kirby–Bauer disc diffusion method. Based on the results, the patient was treated with amoxicillin/clavulanate, which led to a favourable clinical outcome. A review of the literature revealed that, to date, only 14 cases of spondylodiscitis or discitis caused by Veillonella spp. have been reported. Potential risk factors for Veillonella spp. bacteremia were identified in only 9 cases. The most commonly affected site was the lumbar or lumbosacral spine. Magnetic resonance imaging was consistently regarded as the diagnostic gold standard. Most patients presented with localized pain. The overall therapeutic approach generally consisted of an initial course of intravenous antibiotics, typically ceftriaxone administered either as monotherapy or in combination with metronidazole, followed by an oral regimen with amoxicillin/clavulanate, given alone or alongside metronidazole. Conclusions: Spondylodiscitis due to V. parvula remains extremely rare. Although antimicrobial susceptibility patterns remain heterogeneous, beta-lactams, particularly amoxicillin/clavulanate, appear effective in most cases, and treatment regimens typically involve an initial intravenous phase followed by oral therapy. Full article

Background: Spondylodiscitis is a growing infectious condition with significant morbidity. The impact of multifocal involvement remains understudied. This study compared 90-day all-cause readmission rates between patients with solitary versus multifocal spondylodiscitis and identified the associated risk factors. Methods: A retrospective analysis of the 2020 Nationwide Readmissions Database was conducted. Adult patients with primary spondylodiscitis were identified using ICD-10 codes and categorized into solitary or multifocal involvement groups. Demographic, clinical, and surgical data were extracted. Descriptive statistics and multivariate logistic regression were performed. Results: Of 6132 patients, 585 (9.6%) had multifocal disease. Multifocal patients were slightly younger (58.9 vs. 60.3 years; p = 0.049); had longer hospital stays (14.7 vs. 11.4 days; p < 0.001), time to readmission (p < 0.001); and surgery was more common (p = 0.003). Ninety-day readmission rates were similar (35.6% vs. 34.9%; p = 0.766). Type 2 diabetes was the only comorbidity significantly associated with multifocal disease (p = 0.020) and independently predicted readmission (aOR 1.236). Surgery and longer length of stay were protective (aOR 0.743; 0.0990). Conclusions: Multifocal spondylodiscitis is relatively common but not an independent risk factor for readmission. Readmission rates of both cohorts were similar. Surgery and prolonged hospitalization may reduce readmission risk. Full article

Objectives: Spinal diseases are commonly encountered health problems with a wide spectrum. In addition to degenerative changes, other common spinal pathologies include metastases and compression fractures. Benign tumors like hemangiomas and infections such as spondylodiscitis are also frequently observed. Although magnetic resonance imaging (MRI) is considered the gold standard in diagnostic imaging, the morphological similarities of lesions can pose significant challenges in differential diagnoses. In recent years, the use of artificial intelligence applications in medical imaging has become increasingly widespread. In this study, we aim to detect and classify vertebral body lesions using the YOLO-v8 (You Only Look Once, version 8) deep learning architecture. Materials and Methods: This study included MRI data from 235 patients with vertebral body lesions. The dataset comprised sagittal T1- and T2-weighted sequences. The diagnostic categories consisted of acute compression fractures, metastases, hemangiomas, atypical hemangiomas, and spondylodiscitis. For automated detection and classification of vertebral lesions, the YOLOv8 deep learning model was employed. Following image standardization and data augmentation, a total of 4179 images were generated. The dataset was randomly split into training (80%) and validation (20%) subsets. Additionally, an independent test set was constructed using MRI images from 54 patients who were not included in the training or validation phases to evaluate the model’s performance. Results: In the test, the YOLOv8 model achieved classification accuracies of 0.84 and 0.85 for T1- and T2-weighted MRI sequences, respectively. Among the diagnostic categories, spondylodiscitis had the highest accuracy in the T1 dataset (0.94), while acute compression fractures were most accurately detected in the T2 dataset (0.93). Hemangiomas exhibited the lowest classification accuracy in both modalities (0.73). The F1 scores were calculated as 0.83 for T1-weighted and 0.82 for T2-weighted sequences at optimal confidence thresholds. The model’s mean average precision (mAP) 0.5 values were 0.82 for T1 and 0.86 for T2 datasets, indicating high precision in lesion detection. Conclusions: The YOLO-v8 deep learning model we used demonstrates effective performance in distinguishing vertebral body metastases from different groups of benign pathologies. Full article

With an incidence of 0.3 per 100,000, spondylodiscitis is a rare condition in children. It is typically bacterial in origin and most commonly caused by Staphylococcus aureus. Bone involvement in cat-scratch disease (CSD) due to Bartonella henselae is exceedingly rare, occurring in only 0.17–0.27% of cases. We present the case of a 3-year-old boy with a two-week history of intermittent back pain and a recent onset fever. Initial laboratory findings were unremarkable, and MRI revealed spondylodiscitis at L3/4 without abscess formation. Empirical antibiotic treatment with ampicillin/sulbactam showed no clinical response. Serologic testing revealed a positive Bartonella henselae IgM (IgG negative), leading to a change in antibiotic treatment to azithromycin and rifampicin for three weeks, resulting in rapid clinical improvement. Follow-up at nine weeks showed marked clinical and radiologic improvement. Although IgM subsequently turned negative without IgG seroconversion—a pattern previously described in Bartonella infections—this does not exclude the diagnosis. Biopsy or tissue PCR was not performed due to the mild clinical course. A review of the literature identified 28 pediatric cases of Bartonella henselae spondylodiscitis, with significant variation in diagnostic and treatment approaches. This case underscores the importance of considering Bartonella in the differential diagnosis of pediatric vertebral osteomyelitis. Full article

Spondylodiscitis is a devastating invasive infection that can lead to debilitating pain, motor weakness, or paralysis, even with appropriate medical and surgical treatment. Over the past two decades, there has been a worldwide increase in the incidence of spondylodiscitis, which can be attributed to a higher prevalence of various risk factors including intravenous drug use, hemodialysis, and spinal surgeries. The lumbar spine is the most likely region to be affected, with Staphylococcus aureus being the predominant pathogen. Management of spondylodiscitis requires a multi-disciplinary approach, with close coordination between the spinal surgeon and the infectious diseases specialist. Clinicians should become familiar with the epidemiology and presentation of patients with suspected spondylodiscitis because timely diagnosis and treatment may lead to improved outcomes. This unique review incorporates the perspectives from infectious disease and spine surgery specialists. Full article

Background/Objectives: Primary spondylodiscitis (SD) cases surging in incidence globally remain a diagnostic and therapeutic challenge for physicians. The effect of lesion location on outcomes remains unclear. This study aims to assess the 90-day all-cause readmission rate in patients suffering from spondylodiscitis in different regions of the spine, with a secondary objective of comparing in-hospital mortality rates. Methods: Utilizing the 2020 Nationwide Readmissions Database (NRD), USA, adult patients (>18 years) were selected by diagnosis with ICD-10 codes for primary spondylodiscitis. Patients were categorized by localization into eight groups, excluding multifocal patients. Comparative analysis and logistic regressions were performed. Results: Among 5547 patients, lumbar SD was most prevalent, followed by thoracic and lumbo-sacral regions. Cervical SD had the lowest readmission rate (31.3%) and lower odds versus lumbar SD (adjusted OR = 0.73; p = 0.007). Other regions showed no significant differences. In-hospital mortality varied by location. The sacral region, renal failure, and advanced age were the strongest mortality predictors. Conclusions: While the incidence of spondylodiscitis varies by location on the spine, we found no significant differences in readmission rates across regions. However, there were substantial differences in in-hospital mortality rates. Comorbidities, particularly renal failure and advanced age, appear to outweigh spinal localization as risk factors for mortality and readmission. Full article

We report a case of spondylodiscitis caused by Aspergillus nidulans (SCAN). A. nidulans is a saprophytic fungus and emerging pathogen responsible for a variety of infections, although it is rarely implicated in osteoarticular infections. The patient was a 59-year-old immunocompromised patient with a history of lymphoma and splenectomy. Following diagnosis, the patient was promptly and effectively treated with voriconazole. A literature review underlines the distinctive features of the few case reports of SCAN, as well as the original features of the present case report. Full article

Background/Objectives: Spondylodiscitis (SD) is a challenging and multifaceted condition with increasing incidences globally. Mental health disorders (MHDs) are well recognized for their negative impacts on outcomes. To our knowledge, the effects of MHDs on SD have not been studied. This study aims to assess the incidence of MHDs in patients hospitalized for SD, and their impact on 90-day all-cause readmission rates using the Nationwide Readmission Database (NRD). Methods: A retrospective analysis using the 2020 NRD was performed. Adult patients were selected by primary ICD-10 codes for SD. MHDs were defined by ICD-10 F-codes. Demographic and clinical data were extracted, and readmissions were identified using VisitLinks. Patients were stratified based on MHD presence, with statistical analyses conducted to identify independent risk factors for readmission. Results: Of a total of 6139 patients, 3771 (61.4%) had an MHD. The overall 90-day readmission rate was 35%, with MHD patients experiencing a significantly higher rate (36.1%). Substance-related disorders, particularly opioid (OR 1.187, p = 0.019) and alcohol use disorders (OR 1.310, p = 0.020), were independently associated with increased readmission risk. Although common, depression, anxiety, schizophrenia, and personality disorders were not significant predictors. Conclusions: MHDs are prevalent among SD patients and are associated with an increased risk of hospital readmission, particularly in those with substance-related disorders. Integrating mental health interventions into SD management may improve patient outcomes. This study is limited by the use of an administrative database, which may lead to potential under-reporting of clinical variables. Future research may explore targeted interventions to optimize care for this high-risk population. Full article

The management of spinal infections, such as spondylodiscitis, remains a complex challenge. With advancements in technology, spinal endoscopy has emerged as a promising minimally invasive approach. This systematic review and case series aims to evaluate the efficacy of endoscopic techniques in treating primary and post-operative spinal infections. A comprehensive literature review was conducted using databases such as PubMed, MEDLINE, and Cochrane Library, focusing on studies from 2000 to 2023. Our case series included patients treated with endoscopy for spinal infections in our institution between 2020 and 2023. The findings suggest that endoscopic techniques are associated with reduced tissue trauma, shorter hospital stays, and faster recovery, while maintaining comparable clinical outcomes to traditional open surgery. Despite the relatively high pathogen identification rates and favorable clinical outcomes, complications such as residual infection and the need for re-operations were noted. These results emphasize the need for further research to optimize endoscopic procedures in spinal infection management, potentially paving the way for this technique to become a standard treatment option. Full article