Methicillin-sensitive Staphylococcus aureus (MSSA) accounts for greater than 36% of the Staphylococcus species isolated, but the incidence of methicillin-resistant S. Staphylococcus species has been isolated as the causative pathogen in 50% to 80% of cases. Spine (Phila Pa 1976) 25:1668, 2000 and Sapico FL, Montgomerie JZ: Pyogenic vertebral osteomyelitis: report of nine cases and review of the literature. Box 25-1 contains a list of risk factors.ĭata from Hadjipavlou AG, Mader JT, Necessary JT, Muffoletto AJ: Hematogenous pyogenic spinal infections and their surgical management. Recent urinary tract infection was the most common concurrent infection (28%), followed by soft tissue infection and respiratory tract infection, respectively. Multiple studies evaluating potential risk factors concluded that a current active infection at any site in the body is the leading risk factor for the development of pyogenic vertebral osteomyelitis. The rising numbers of patients with immunosuppression, whether from human immunodeficiency virus infection, chronic disease, or steroid use, along with intravenous drug abuse and an aging population, are increasing the prevalence of pyogenic infections. Vertebral pyogenic osteomyelitis is two to three times more common in male patients than in female patients. Hematogenous pyogenic vertebral osteomyelitis in the cervical spine represents 6% of all cases of vertebral osteomyelitis. Of these disorders, more than 95% manifest as spondylodiskitis. Hadjipavlou and colleagues described pyogenic spine infection as a spectrum of disease comprising spondylitis, diskitis, spondylodiskitis, pyogenic facet arthropathy, and epidural abscess. Pyogenic Hematogenous Cervical Spine Infection This chapter discusses pyogenic, granulomatous and postoperative infections of the cervical spine. Table 25-1 provides classification methods. The most common types of spinal infections are hematogenous bacterial infection, epidural abscess, and postoperative wound infection. Multiple factors can be used to classify spine infection, including the pathogen, method of inoculation, anatomic location, and duration of infection. The classification of cervical infections includes diskitis and osteomyelitis and is identical to the system used in the thoracic and lumbar spine. Infection of the cervical spine accounts for less than 10% of all spine infections, but it is the source of 27% of all neurologic deficits associated with an infectious process. Video 25-1: Application of Wound Vacuum-Assisted Closure Postoperative infections are uncommon in the cervical spine, and the incidence appears to be higher after posterior cervical spine procedures than after anterior cervical procedures. The goals of treatment include establishing a diagnosis, preserving neurologic function, relieving pain, maintaining or correcting deformity, and eradicating the infection. Obtaining a tissue diagnosis to confirm the presence of cervical osteodiskitis and for directing therapy is vital if possible, the use of antibiotics should be avoided before biopsy, except in patients with sepsis. aureus (MRSA) species are on the rise.ĭelayed diagnosis of cervical infections is common because of the nonspecific nature of the symptoms. Staphylococcus species is the most common cause of pyogenic hematogenous cervical spine infections, and methicillin-sensitive Staphylococcus aureus (MSSA) is the most common species. Infections of the cervical spine are more likely to lead to neurologic complications. Vertebral osteomyelitis and diskitis comprise a spectrum of disease, and one rarely exists without the other. This chapter discusses pyogenic, granulomatous, and postoperative infections of the cervical spine The classification of cervical infections includes diskitis and osteomyelitis. Infections of the cervical spine account for less than 10% of all spine infections, but they are the source of 27% of all neurologic deficits associated with an infectious process.
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