Research Article
Volume 5 Issue 8 - 2021
Current Concepts in the Management of Pyogenic Spondylodiscitis: A Narrative Review
John Enekele Onuminya1*, Dorcas Salime Onuminya2 and Mutaleeb Ayodele Shobode3
1Department of Orthopaedics and Traumatology, Faculty of Clinical Sciences, College of Medicine, Ambrose Alli University, Ekpoma, Edo State and Josalu Specialist Hospital, Lokoja, Kogi State, Nigeria
2Kogi State Specialist Hospital, Lokoja, Kogi State, Nigeria and Josalu Specialist Hospital, Lokoja, Kogi State, Nigeria
3Department of Clinical services, National Orthopedic Hospital, Dala, Kano, Nigeria
*Corresponding Author: John Enekele Onuminya, Professor, Department of Orthopaedics and Traumatology, Faculty of Clinical Sciences, College of Medicine, Ambrose Alli University, Ekpoma, Edo State, Nigeria.
Received: June 28, 2021; Published: July 19, 2021




Abstract

Background: Pyogenic Spondylodiscitis (PS) represents a spectrum of spine disease ranging from septic discitis, vertebral osteomyelitis and spinal epidural abscess (SEA). Though uncommon, it remains an important spine infection in adults which is associated with major morbidity and serious long term sequalae. It is an Orthopaedic emergency that requires prompt and aggressive management.

Objective: The aim of the present review of the literatures is to highlight the current concepts in the management of PS.

Methods: We carried out a comprehensive review of literatures, using key words such as spinal infections, pyogenic spondylodiscitis, vertebral osteomyelitis, spinal epidural abscess, diagnosis, clinical features, investigations, laboratory, imaging, treatment, nonoperative, operative, complications on the search engines of PUBMED, Google Scholar and Scopus in April, 2021. Eligible articles for the review included full length published articles which we have access to contents.

Results: Thirty five full length articles published between 1970 and 2019 were found eligible for the review. The diagnosis of PS is difficult owing to other close differentials including Tubercular Spondylodiscitis (TS). High index of clinical suspicion, laboratory investigations and imaging with contrast enhanced MRI are necessary for prompt diagnosis of PS. Specimens for microbiological assay are necessary for the identification of the causative pathogens. Staphylococcus aureus is the most common pathogen in majority of cases. The main complications of PS are vertebral body destruction, spinal instability, SEA and neurological deficit. The new clinical-radiological classification of PS is a useful tool in decision making concerning appropriate Orthopaedic treatment. Treatment may be non-operative with long-term targeted antibiotic therapy and bracing or surgical decompression and stabilization. Non-operative treatment is successful in majority of cases.

Conclusion: Early diagnosis and treatment of PS is the panacea for good outcome. The major challenges in the management of PS are late diagnosis and presentation with deteriorating neurological deficit.

Keywords: Pyogenic Spondylodiscitis; Vertebral Osteomyelitis; Spinal Epidural Abscess

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Citation: John Enekele Onuminya., et al. “Current Concepts in the Management of Pyogenic Spondylodiscitis: A Narrative Review”. EC Emergency Medicine and Critical Care 5.8 (2021): 12-21.

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