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The Diagnosis and Treatment of Spinal Infections
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The Diagnosis and Treatment of Spinal Infections

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (30 August 2022) | Viewed by 10899

Special Issue Editors

Dr. Sung-kyu Kim

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Guest Editor
Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
Interests: spine
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Chi Heon Kim

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Guest Editor
Department of Neurosurgery, Seoul National University College of Medicine and Hospital, Korea
Interests: spinal tumor; minimally invasive spinal surgery; big data analysis
Prof. Dr. John M. Rhee

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Guest Editor
Orthopaedic and Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
Interests: cervical spine surgery; deformity surgery

Special Issue Information

Dear Colleagues,

At present, spinal infections are a growing problem. The aging of the population, intravenous drug use, immunosuppressive conditions, multiple and complex comorbidities, and increase in the use of invasive spinal and other medical procedures over many decades has contributed to an increase in the number of spinal infections.

Spinal infections are often difficult to diagnose. Back and neck pain are common complaints, and routine radiographs are of little help in the early stages of the disease. We should always consider spinal infections in the differential of new-onset back or neck pain in febrile patients, patients with endocarditis or recent Gram-positive bacteremia, or the previously mentioned high-risk patient groups. Fever is a common but inconsistent feature present in less than half of the patients with pyogenic spine infections, and even less so in fungal, mycobacterial, and brucellar infections. 

In the surgical treatment of spinal infections, the use of instrumentations within the infected area of the spine has been increasingly discussed. Despite concerns regarding the presence of foreign material at the infection site, many surgeons have suggested the use of instrumentation for spinal reconstruction or stability. There is no consensus about which treatment method is superior. Despite such debates, implants placed in active infections have been shown to be safe and efficacious in clinical studies. Changing antibiotic resistance patterns and a decreasing general health status may all play a significant role in this clinical problem.

This Special Issue on spinal infections seeks to find solutions to many unanswered questions that plague clinicians. Therefore, this Special Issue will provide a comprehensive focus on spinal infections, exploring current trends in the identification, epidemiology, diagnosis, treatment, outcomes, and complications of spinal infections.

Dr. Sung-kyu Kim
Prof. Dr. Chi Heon Kim
Prof. Dr. John M. Rhee
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • spinal infection
  • aging
  • immunosuppressive conditions
  • invasive procedures
  • diagnosis
  • treatment
  • instrumentation
  • outcome

Related Special Issue

Published Papers (6 papers)

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Research

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15 pages, 2141 KiB  
Article
Recurrence Rates and Its Associated Factors after Early Spinal Instrumentation for Pyogenic Spondylodiscitis: A Nationwide Cohort Study of 2148 Patients
by Jeong Seop Lim and Tae-Hwan Kim
J. Clin. Med. 2022, 11(12), 3356; https://doi.org/10.3390/jcm11123356 - 11 Jun 2022
Cited by 8 | Viewed by 1197
Abstract
Recent studies have consistently reported the safety and effectiveness of early spinal instrumentation for pyogenic spondylodiscitis. However, none of these studies investigated the recurrence rate or associated factors based on this specific group of patients. Recurrence prediction models that are not based on [...] Read more.
Recent studies have consistently reported the safety and effectiveness of early spinal instrumentation for pyogenic spondylodiscitis. However, none of these studies investigated the recurrence rate or associated factors based on this specific group of patients. Recurrence prediction models that are not based on a homogenous cohort of patients undergoing early spinal instrumentation show theoretical limitations for clinical use. A nationwide, population-based, retrospective cohort study using a claims database was planned to investigate the recurrence rate and its associated factors in patients who underwent early instrumented spinal fusion surgery for pyogenic spondylodiscitis. We used data from the Korean National Health Insurance claims database collected between 2014 and 2018. A total of 2148 patients who underwent early (within 6 weeks after the diagnosis) instrumented spinal fusion surgery for pyogenic spondylodiscitis were included, including 1925 patients (90%) without recurrence and 223 patients (10%) with recurrence. Logistic regression models were used to identify factors associated with recurrence, and sensitivity analysis was performed according to two different definitions for recurrence: shorter (2 weeks or more) and longer (6 weeks or more) periods of antibiotic therapy for recurrence. The recurrence rates in our cohort were 14.1%, 10.4%, and 8.0% at 2, 4, and 6 weeks, respectively, in relation to the duration of antibiotic treatment for recurrence. We identified age 60–69 years (OR = 2.42), age > 70 years (OR = 2.29), posterior thoracic approach (OR = 1.85), multiple surgical approaches (OR = 4.17), use of a cage (OR = 1.66), transfusion (OR = 2.55), antibiotics for resistant organisms (OR = 2.55), and systemic steroid treatment over 2 weeks (OR = 2.27) as the factors associated with recurrence. The recurrence rates and associated factors from our first population-based and the largest clinical study can be practically used as a reasonable reference and provide clinicians with an acceptable tool for the comprehensive risk assessment for recurrence after early spinal instrumentation for pyogenic spondylodiscitis. Full article
(This article belongs to the Special Issue The Diagnosis and Treatment of Spinal Infections)
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9 pages, 244 KiB  
Article
Vertebral Osteomyelitis and Infective Endocarditis Co-Infection
by Tadatsugu Morimoto, Hirohito Hirata, Koji Otani, Eiichiro Nakamura, Naohisa Miyakoshi, Yoshinori Terashima, Kanichiro Wada, Takaomi Kobayashi, Masatoshi Murayama, Masatsugu Tsukamoto and Masaaki Mawatari
J. Clin. Med. 2022, 11(8), 2266; https://doi.org/10.3390/jcm11082266 - 18 Apr 2022
Cited by 5 | Viewed by 1761
Abstract
Many cases of vertebral osteomyelitis (VO) and infective endocarditis (IE) co-infection have been reported, and it has been recognized that attention should be paid to the possibility of both diseases co-existing during diagnosis and treatment. However, the incidence, clinical status, and outcomes of [...] Read more.
Many cases of vertebral osteomyelitis (VO) and infective endocarditis (IE) co-infection have been reported, and it has been recognized that attention should be paid to the possibility of both diseases co-existing during diagnosis and treatment. However, the incidence, clinical status, and outcomes of IE in patients with VO remain unclear. For this study, the eligibility criteria for patient recruitment included all cases of VO at the five medical university hospitals. Patients with a history of spinal surgery were excluded from this study. Echocardiography was routinely performed for all patients with VO. IE was diagnosed according to the modified Duke criteria for definite endocarditis. We analyzed demographic data, underlying conditions, clinical features, laboratory data, echocardiography, radiologic images, treatments, and outcomes. VO was diagnosed in 59 patients and IE was diagnosed in seven patients (12%). There were no significant differences in the clinical features, microorganisms, or radiographic status between the VO-IE co-infection and VO-only groups. In this study, using routine echocardiography for VO, the IE prevalence was 12%. The lack of specific clinical features and laboratory findings may hamper the diagnosis of IE. Therefore, clinicians are always required to suspect IE in patients with VO. Full article
(This article belongs to the Special Issue The Diagnosis and Treatment of Spinal Infections)
10 pages, 734 KiB  
Article
Chronological Analysis of Primary Cervical Spine Infection: A Single-Center Analysis of 59 Patients over Three Decades (1992–2018)
by Myung-Jin Sung, Sung-Kyu Kim and Hyoung-Yeon Seo
J. Clin. Med. 2022, 11(8), 2210; https://doi.org/10.3390/jcm11082210 - 15 Apr 2022
Cited by 1 | Viewed by 1241
Abstract
Primary cervical spine infections progress quickly and cause neurological impairment at an early stage. Despite their clinical significance, few studies have investigated primary cervical spine infections, owing to the rarity of the condition. This study analyzed the characteristics of 59 patients treated for [...] Read more.
Primary cervical spine infections progress quickly and cause neurological impairment at an early stage. Despite their clinical significance, few studies have investigated primary cervical spine infections, owing to the rarity of the condition. This study analyzed the characteristics of 59 patients treated for primary cervical spine infections between 1992 and 2018 at our hospital. Clinical and radiological analyses were conducted. Moreover, a comparative analysis was performed, incorporating each patient’s underlying disease, mortality and complications, and treatment results. Comparison between groups based on the chronological period (1992–2000, 2001–2009, and 2010–2018) revealed that the mean age of onset has increased significantly in recent years. The rate of neurological impairment, duration of antibiotic use, and frequency of underlying disease increased significantly with time. No significant differences among groups were observed in the hematological and microbiological analyses. The incidence rate of epidural abscess and multisegmental infection increased significantly in recent years. There was no statistically significant difference in the complication and mortality rates, according to the time period. We think that prompt diagnosis and appropriate treatment are necessary, considering the current trends in primary cervical spine infection. Full article
(This article belongs to the Special Issue The Diagnosis and Treatment of Spinal Infections)
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14 pages, 2228 KiB  
Article
Risk Factors for Postoperative Deep Infection after Instrumented Spinal Fusion Surgeries for Degenerative Spinal Disease: A Nationwide Cohort Study of 194,036 Patients
by Jihye Kim and Tae-Hwan Kim
J. Clin. Med. 2022, 11(3), 778; https://doi.org/10.3390/jcm11030778 - 31 Jan 2022
Cited by 10 | Viewed by 2015
Abstract
Previous studies to identify risk factors for postoperative deep infection following instrumented spinal fusion surgery for degenerative spinal disease are based on insufficient information and have limited use in clinical practice. This study aims to fill this gap by assessing the risk factors [...] Read more.
Previous studies to identify risk factors for postoperative deep infection following instrumented spinal fusion surgery for degenerative spinal disease are based on insufficient information and have limited use in clinical practice. This study aims to fill this gap by assessing the risk factors and their adjusted relative risks through a comprehensive analysis, including all core information. In this nationwide, population-based, cohort study, data were obtained from the Korean National Health Insurance claims database between 1 January 2014, and 31 December 2018. This study included a cohort of 194,036 patients older than 19 years, who underwent instrumented spinal fusion surgery for degenerative spinal disease. We divided this population into cases (patients with postoperative deep infection) and controls (patients without postoperative deep infection); risk factors for postoperative deep infection were determined by multivariable analysis. The definition of postoperative deep infection varied, and sensitivity analyses were performed according to each definition. The estimates of all the statistical models were internally validated using bootstrap samples. The study included 767 patients (0.39%) with postoperative deep spinal infections and 193,269 controls. The final multivariable model identified the following variables as significant risk factors for postoperative deep infection: age between 60–69 years (OR = 1.6 [1.1–2.3]); age between 70–79 years (OR = 1.7 [1.2–2.5]); age > 80 years (OR = 2.1 [1.3–3.2]); male sex (OR = 1.7 [1.5–2.0]); rural residence (OR = 1.3 [1.1–1.5]); anterior cervical approach (OR = 0.2 [0.1–0.3]); posterior cervical approach (OR = 0.5 [0.2–1.0]); multiple approaches (OR = 1.4 [1.2–1.6]); cerebrovascular disease (OR = 1.5 [1.2–1.8]); peripheral vascular disease (OR = 1.3 [1.1–1.5]); chronic pulmonary disease (OR = 1.2 [1.0–1.4]); rheumatologic disease (OR = 1.6 [1.3–2.1]); liver disease (OR = 1.4 [1.1–1.7]); diabetes (OR = 1.5 [1.3–1.7]); hemiplegia or paraplegia (OR = 2.2 [1.5–3.3]); allogenous transfusion (OR = 1.6 [1.3–1.8]); and use of systemic steroids over 2 weeks (OR = 1.5 [1.1–2.0]). Our results, which are based on homogenous patient groups, provide clinicians with an acceptable tool for comprehensive risk assessment of postoperative deep infection in patients who will undergo instrumented spinal fusion surgery for degenerative spinal disease. Full article
(This article belongs to the Special Issue The Diagnosis and Treatment of Spinal Infections)
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9 pages, 246 KiB  
Article
Risk Factors of Coexisting Septic Spondylitis and Arthritis: A Case-Control Study in a Tertiary Referral Hospital
by Sheng-Fen Wang, Po-Liang Lai, Hsiang-Fu Liu, Tsung-Ting Tsai, Yu-Chih Lin, Yun-Da Li, Ping-Yeh Chiu, Ming-Kai Hsieh and Fu-Cheng Kao
J. Clin. Med. 2021, 10(22), 5345; https://doi.org/10.3390/jcm10225345 - 16 Nov 2021
Cited by 1 | Viewed by 1322
Abstract
Introduction: In patients under immunosuppression or severe sepsis, it is sometimes manifested as coexisting septic arthritis and spondylitis. The aim of this study is to evaluate and investigate the risk factors of infectious spondylitis associated with septic arthritis. Methods: The study retrospectively reviewed [...] Read more.
Introduction: In patients under immunosuppression or severe sepsis, it is sometimes manifested as coexisting septic arthritis and spondylitis. The aim of this study is to evaluate and investigate the risk factors of infectious spondylitis associated with septic arthritis. Methods: The study retrospectively reviewed the patients diagnosed with infectious spondylitis between January 2010 and September 2018 for risk factors of coexisting major joint septic arthritis. Results: A total of 10 patients with infectious spondylitis and coexisting septic arthritis comprised the study group. Fifty matched patients with solely infectious spondylitis were selected as the control group. Major risk factors include preoperative C-reactive protein (p = 0.001), hypoalbuminemia (p = 0.011), history of total joint replacement (p < 0.001), duration of preoperative antibiotics treatment (p = 0.038) and psoas muscle abscess (p < 0.001). Conclusion: Infectious spondylitis and septic arthritis are thought of as medical emergencies due to their high mortality and morbidity. Our study evaluated 5 risk factors as significant major findings: hypoalbuminemia (<3.4 g/dL), higher preoperative CRP (>130 mg/L), psoas muscle abscess, longer preoperative antibiotics treatment (>8 days) and history of total joint replacement. Clinicians should pay attention to the patients with those five factors to detect the coexisting infections as early as possible. Full article
(This article belongs to the Special Issue The Diagnosis and Treatment of Spinal Infections)

Review

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12 pages, 458 KiB  
Review
Wound-Related Complication in Growth-Friendly Spinal Surgeries for Early-Onset Scoliosis—Literature Review
by Michał Latalski, Grzegorz Starobrat, Marek Fatyga, Ireneusz Sowa, Magdalena Wójciak, Joanna Wessely-Szponder, Sławomir Dresler and Anna Danielewicz
J. Clin. Med. 2022, 11(9), 2669; https://doi.org/10.3390/jcm11092669 - 09 May 2022
Cited by 4 | Viewed by 2506
Abstract
Background: The treatment for early-onset scoliosis (EOS) is one of the most challenging for pediatric orthopedics. Surgical treatment is often necessary, and wound problems and surgical site infections (SSIs) are common, with potentially severe complications in these patients. The aim of the study [...] Read more.
Background: The treatment for early-onset scoliosis (EOS) is one of the most challenging for pediatric orthopedics. Surgical treatment is often necessary, and wound problems and surgical site infections (SSIs) are common, with potentially severe complications in these patients. The aim of the study was to review current literature according to this complication. Methods: PubMed, Cochrane Library, and Embase were systematically searched for relevant articles by two independent reviewers in January 2022. Every step of the review was done according to PRISMA guidelines. Results: A total of 3579 articles were found. Twenty four articles were included in this systematic review after applying our inclusion and exclusion criteria. EOS surgery has a varying but high rate of wound-related problems (on average, 15.5%). Conclusion: The literature concerning the definitions, collection, and interpretation of data regarding EOS wound-related complications is often difficult to interpret. This causes problems in the comparison and analysis. Additionally, this observation indicates that data on the incidence of SSI may be underestimated. Awareness of the high rate of SSI of EOS surgery is crucial, and an optimal strategy for prevention should become a priority. Full article
(This article belongs to the Special Issue The Diagnosis and Treatment of Spinal Infections)
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