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Nontuberculous Pyogenic Spinal Infection in Adults: A 12-Year Experience From a Tertiary Referral Center

Butler, Joseph S. MB BCh, BAO*; Shelly, Martin J. MRCSI*; Timlin, Marcus MRCSI*; Powderly, William G. MD, FRCPI†; O’Byrne, John M. MCh, FRCSI*

Spine:
doi: 10.1097/01.brs.0000244662.78725.37
Clinical Case Series
Abstract

Study Design. We performed a retrospective review of 48 cases of pyogenic spinal infection presenting over a 12-year period to the National Spinal Injuries Unit (NSIU) of the Republic of Ireland. The NSIU is the tertiary referral center for all adult spinal injuries and diseases of the spine warranting surgical intervention in the Republic of Ireland.

Objectives. The objective of this study was to analyze the presentation, etiology, management, and outcome of nontuberculous pyogenic spinal infection in adults.

Summary of Background Data. Pyogenic spinal infection encompasses a broad range of clinical entities, including spondylodiscitis, septic discitis, vertebral osteomyelitis, and epidural abscess. Management of pyogenic spinal infection can involve conservative methods and surgical intervention.

Methods. The medical records, radiologic imaging, and bacteriology results of 48 patients with pyogenic vertebral osteomyelitis from 1992 through 2004 were reviewed. The Hospital Inpatient Enquiry (HIPE) System and the NSIU Database were used to identify our study cohort.

Results. The average age of presentation was 59 years with an even distribution between males and females. Most patients (21 of 48) were symptomatic for between 2 and 6 weeks before presenting to hospital. The most frequently isolated pathogen was Staphylococcus aureus, in 23 of 48 cases (48%); 35 of 48 cases (73%) were managed by conservative measures alone, including antibiotic therapy and spinal bracing. However, in 13 of 48 cases (27%), surgical intervention was required because of neurologic compromise or mechanical instability.

Conclusions. In the majority of cases, conservative management of pyogenic spinal infection with antibiotic therapy and spinal bracing is very successful. However, in a minority of cases, surgical intervention is warranted and referral to a specialist center is appropriate.

In Brief

We performed a retrospective review of 48 cases of adult pyogenic spinal infection presenting over a 12-year period to the National Spinal Injuries Unit of the Republic of Ireland. We analyzed the presentation, etiology, management, and outcome of nontuberculous pyogenic spinal infection.

Author Information

From the *National Spinal Injuries Unit and the †Medical Professorial Unit, Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland.

Acknowledgment date: December 5, 2005. Acceptance date: January 19, 2006.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Joseph S. Butler, MB BCh, BAO, General Clinical Research Unit, UCD School of Medicine and Medical Science, Mater Misericodiae University Hospital, Eccles St., Dublin 7, Ireland; E-mail: josephsbutler@hotmail.com

© 2006 Lippincott Williams & Wilkins, Inc.