Spinal infection: state of the art and management algorithm

Spinal infection is a rare pathology although a concerning rising incidence has been observed in recent years. This increase might reflect a progressively more susceptible population but also the availability of increased diagnostic accuracy. Yet, even with improved diagnosis tools and procedures, the delay in diagnosis remains an important issue. This review aims to highlight the importance of a methodological attitude towards accurate and prompt diagnosis using an algorithm to aid on spinal infection management. METHODS: Appropriate literature on spinal infection was selected using databases from the US National Library of Medicine and the National Institutes of Health. RESULTS: Literature reveals that histopathological analysis of infected tissues is a paramount for diagnosis and must be performed routinely. Antibiotic therapy is transversal to both conservative and surgical approaches and must be initiated after etiological diagnosis. Indications for surgical treatment include neurological deficits or sepsis, spine instability and/or deformity, presence of epidural abscess and upon failure of conservative treatment. CONCLUSIONS: A methodological assessment could lead to diagnosis effectiveness of spinal infection. Towards this, we present a management algorithm based on literature findings

Meta-analysis of pre-clinical studies of early decompression in acute spinal cord injury:a battle of time and pressure

The use of early decompression in the management of acute spinal cord injury (SCI) remains contentious despite many pre-clinical studies demonstrating benefits and a small number of supportive clinical studies. Although the pre-clinical literature favours the concept of early decompression, translation is hindered by uncertainties regarding overall treatment efficacy and timing of decompression.We performed meta-analysis to examine the pre-clinical literature on acute decompression of the injured spinal cord. Three databases were utilised; PubMed, ISI Web of Science and Embase. Our inclusion criteria consisted of (i) the reporting of efficacy of decompression at various time intervals (ii) number of animals and (iii) the mean outcome and variance in each group. Random effects meta-analysis was used and the impact of study design characteristics assessed with meta-regression.Overall, decompression improved behavioural outcome by 35.1% (95%CI 27.4-42.8; I(2)=94%, p<0.001). Measures to minimise bias were not routinely reported with blinding associated with a smaller but still significant benefit. Publication bias likely also contributed to an overestimation of efficacy. Meta-regression demonstrated a number of factors affecting outcome, notably compressive pressure and duration (adjusted r(2)=0.204, p<0.002), with increased pressure and longer durations of compression associated with smaller treatment effects. Plotting the compressive pressure against the duration of compression resulting in paraplegia in individual studies revealed a power law relationship; high compressive forces quickly resulted in paraplegia, while low compressive forces accompanying canal narrowing resulted in paresis over many hours.These data suggest early decompression improves neurobehavioural deficits in animal models of SCI. Although much of the literature had limited internal validity, benefit was maintained across high quality studies. The close relationship of compressive pressure to the rate of development of severe neurological injury suggests that pressure local to the site of injury might be a useful parameter determining the urgency of decompression

Estudo prospectivo comparativo entre pseudoartrose e fusão óssea na estenose de canal lombar Prospective-comparative study between pseudarthrosis and bone fusion in lumbar stenosis

OBJETIVO: Estudo prospectivo comparativo entre pseudoartrose e fusão óssea na estenose de canal lombar MÉTODO: 38 pacientes operados de estenose de canal lombar e submetidos à artrodese avaliados por meio de questionários (escala visual analógica - VAS e questionário de incapacidade Rolland Morris). Foram solicitadas radiografias para avaliação da fusão lombar. RESULTADOS: Foi observada uma efetiva melhora entre o momento pré-operatório e após um ano em relação ao VAS, tanto no grupo que obteve fusão óssea como no grupo com pseudartrose. Em relação ao questionário Rolland Morris houve uma tendência de melhora no grupo com fusão óssea e uma significante melhora no grupo com pseudoartrose. CONCLUSÃO: Não houve diferença entre os grupos (fusão óssea e pseudoartrose) em relação à dor e incapacidade. Nível de Evidência: Nível II, estudo prospectivo longitudinal.<br>OBJECTIVE: Prospective-comparative study between pseudarthrosis and bone fusion in lumbar stenosis METHODS: 38 patients operated on for lumbar spinal stenosis and submitted to arthrodesis were evaluated by the Visual Analogue Scale (VAS) and Roland Morris Disability Questionnaire. Radiographs were requested to evaluate spinal fusion. RESULTS: An effective improvement was observed between the preoperative period and one year after the operation, in relation to VAS, both in the group that received a bone fusion and in the group with pseudarthrosis. With regard to the Roland Morris questionnaire, there was a tendency towards an improvement in the bone fusion group and a significant improvement in the pseudarthrosis group. CONCLUSION: There was no difference between the groups (bone fusion and pseudarthrosis) in relation to pain and disability. . Level of Evidence: Level II, longitudinal prospective study