[Spontaneous infectious spondylodiscitis in an internal medicine department: epidemiological and clinical study in 41 cases].

By London Spine
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[Spontaneous infectious spondylodiscitis in an internal medicine department: epidemiological and clinical study in 41 cases].

Rev Clin Esp. 2008 Jul-Aug;208(7):347-52

Authors: Martínez Hernández PL, Amer López M, Zamora Vargas F, García de Paso P, Navarro San Francisco C, Pérez Fernández E, Montoya Lozano F, Vázquez Muñoz E

Abstract
INTRODUCTION: The clinical-epidemiological characteristics of patients who were diagnosed of spontaneous infectious spondylodiscitis (SIS) in our Internal Medicine Department are analyzed and the related factors associated with the increase of the incidence are evaluated.
PATIENTS AND METHODS: A cross-sectional, retrospective study of patients diagnosed of SIS from 1996 to 2005 was conducted. The study was divided in two periods: A (1996-2000) and B (2001-2005) and two main etiologic groups (pyogenic SIS and mycobacterial SIS) were compared.
RESULTS: A total of 41 patients were diagnosed of SIS: 13 (31.7%) in period A and 28 (68.3%) in period B. Mean age was 58.5 +/- 17.6 years (range: 29-89). There were 73.2% men and all women presented in period B (0 vs 11, p = 0.008). Backgrounds were: 28 (68.3%) predisposing factors for SIS, 22 (53.6%), previous infections and 23 (56.1%) spinal diseases. There were not changes in the backgrounds during the study. The etiology of SIS was: 26 (63.4%) pyogenic, 12 (29.3%) mycobacterial and 3 (7.3%) brucellar. Patients with pyogenic SIS were older (63.6 +/- 3.2 vs 51.2 +/- 5.1 years, p = 0.035) and had less from onset of symptoms to diagnosis (62 +/- 12 vs 291 +/- 66 days, p = 0.0001) than patients with mycobacterial SIS. Total incidence of SIS and incidence of pyogenic SIS increased significantly during the study: (1.7/1000 admissions/year, p = 0.0057) and (1/1000 admissions/year, p = 0.0476). In the multivariate analysis, time from onset of symptoms to diagnosis was the only variable independently associated with the pyogenic etiological group (OR: 0.985, 95% CI: 0.975, 0.996, p = 0.005).
CONCLUSIONS: In our study, the increasing incidence of SIS was related to an increase in pyogenic SIS incidence. Although older age and some backgrounds could be orientative of SIS etiology, these factors did not increase during the study.

PMID: 18625181 [PubMed – indexed for MEDLINE]

Spontaneous intracranial hypotension syndrome treated with a double epidural blood patch.

By London Spine
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Spontaneous intracranial hypotension syndrome treated with a double epidural blood patch.

Acta Anaesthesiol Scand. 2012 Nov;56(10):1332-5

Authors: Beleña JM, Nuñez M, Yuste J, Plaza-Nieto JF, Jiménez-Jiménez FJ, Serrano S

Abstract
Spontaneous intracranial hypotension (SIH) is considered to be a very rare disease. It is characterised by an orthostatic headache in the absence of a past history of a trauma or a dural puncture. SIH is caused by a spontaneous spinal cerebrospinal fluid (CSF) leakage demonstrated by neuroradiological studies in most of the patients. Conservative treatment usually includes bed rest, hydration and administration of caffeine or steroids. However, when the patient is refractory to the conservative treatment, an epidural blood patch (EBP) is performed. We report a 34-year-old woman with SIH and no neuroradiologically demonstrable clear point of CSF leakage, who was treated with a double EBP at two different levels (lumbar and thoracic) in the same procedure. The patient was successfully managed, and she was still asymptomatic at the 18 months follow-up. After review of literature, we observed that execution of a double EBP at the same time is not a common procedure for treatment of SIH. We consider that simultaneous use of two EBP could be useful as a novel treatment in those cases of SIH without demonstration of CSF leakage.

PMID: 22834896 [PubMed – in process]

Spontaneous resolution of scoliosis associated with lumbar spondylolisthesis: a case report.

By London Spine
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Spontaneous resolution of scoliosis associated with lumbar spondylolisthesis: a case report.

Spine J. 2013 Feb 12;

Authors: Zhou Z, Song Y, Cai Q, Kong Q

Abstract
BACKGROUND CONTEXT: Scoliosis in association with spondylolisthesis is a common phenomenon. According to the traditional opinion, scoliosis should be managed depending on its classification and flexibility. Recently, Crostelli and Mazza proposed a new opinion toward this topic. They advocate that spondylolisthesis-associated scoliosis, especially severe scoliosis, should be considered as idiopathic scoliosis and must be treated with the same principles used in the treatment of idiopathic scoliosis. According to their viewpoints, more scoliotic curves in association with spondylolisthesis need to be treated, either surgically or conservatively. PURPOSE: To describe the spontaneous correction of a severe case of scoliosis by internal fixation of the spondylolisthesis. STUDY DESIGN: Case report of a patient with scoliosis developing in association with high-grade lumbar spondylolisthesis. METHODS: A 12-year-old girl presented with a 2-year history of spinal curvature. She did not have low back or leg pain. The scoliotic deformity corrected readily in the supine position. Radiographs revealed 88% slippage of L5 on S1 in addition to a long section curve of the spine with the main 50° curve at the thoracic level. The spondylolisthesis was repaired with segmental instrumentation and circumferential fusion of L5 and S1. RESULTS: The scoliosis showed spontaneous resolution gradually after lumbosacral fusion and reached a complete correction 2 years after surgery. CONCLUSIONS: The relationship between scoliosis and spondylolisthesis is complex. If scoliosis is considered to be caused by spondylolisthesis, surgery for the latter condition might be the only required intervention for the patient. Unnecessary operation for scoliosis should be avoided.

PMID: 23415020 [PubMed – as supplied by publisher]