Aim. This study seeks to outline the clinical, laboratory, and imaging features of patients with pyogenic spondylitis. It aims to define a novel imaging sign that could indicate the severity of suppurative spondylitis, aiding in its early diagnosis and treatment. Method. This retrospective study included 137 patients from 2013 to 2023. Through the analysis and summary of imaging characteristics among all patients, we identified a distinct MRI sign known as ‘the Disc Penetration sign’ (DP). This sign is defined as an image finding on sagittal MRI depicting the anterior and posterior penetration of an abscess through the intervertebral disc space, affecting both the anterior margin of the vertebrae and the structures within the spinal canal. Observational parameters included WBC, ESR, CRP, hemoglobin, and albumin levels. Documentation of the study included location and segment of the lesion, presence or absence of spinal cord compression, and paravertebral abscesses. Results. 56 patients presented with the Disc Penetration sign(DP) and 81 did not. In both groups, there were no significant differences in gender ratio or age (P > 0.05). However, significant differences were observed in the presence of comorbid diabetes and chronic kidney disease (p < 0.05). The DP group had a significantly greater ESR level (74.30±33.79 mm/h vs. 51.46±30.46 mm/h, P < 0.001) and CRP level (47.28 mg/L vs. 26.18 mg/L, P = 0.003). Additionally, the DP group had a significantly lower Hb (100.66±19.82 g/L vs. 116.99±19.99g/L,P < 0.001) and the serum albumin level (28.81±6.59 g/L vs. 34.09±6.17 g/L,P < 0.001). Imaging results showed no significant differences in affected spinal segments or parts (p>0.05). Patients in the DP group showed a higher likelihood of developing paravertebral abscesses compared to those in the non-DP group (n = 54 [96.4%] vs. n = 33 [40.7%], P < 0.001), and also exhibited a higher incidence of spinal cord compression(n = 32 [57.1%] vs. n = 17 [21.0%], P < 0.001). Conclusions. The study suggests that the Disc Penetration sign in pyogenic spondylitis patients correlates with more severe inflammation and higher incidence of paraspinal abscess, pointing to worse stability of the spine, longer bone restructuring time, and potentially poorer prognosis. These findings enable clinicians to rapidly assess the severity of the disease and prognosticate outcomes more effectively We emphasize the need for early, pathogen-specific diagnosis and treatment, particularly considering surgical intervention for patients demonstrating substantial paraspinal abscesses or
Previous studies have shown improved outcome following surgery for spinal cord compression due to metastatic disease. Further papers have shown that many patients with metastatic disease are not referred for orthopaedic opinion. The aims of this paper are to study the survival and morbidity of patients with spinal metastatic disease who receive radiotherapy. Do patients develop instability and progressive neurological compromise? Can we predict which patients will benefit from surgery?. Retrospective review of patients receiving radiotherapy for pain relief or cord compression as a result of metastatic disease. Patients were scored with regards to Tomita and Tokuhashi, survival and for deterioration in neurology or
National Institute of Clinical Excellence guidelines on Metastatic Spinal Cord Compression recommend urgent consideration of patients with spinal metastases and imaging evidence of structural spinal failure with
Purpose of study:. The question of prolonged bracing following injury in patients diagnosed with SCIWORA remains controversial. Proponents of the ‘Segmental
Introduction. This is the first study to illustrate spinal fracture distribution and the impact of different injury mechanisms on the spinal column during contemporary warfare. Methods. A retrospective analysis of Computed Tomography (CT) spinal images entered onto the Centre for Defence Imaging (CDI) database, 2005-2009. Isolated spinous and transverse process fractures were excluded to allow focus on cases with implications for immediate management and prospective disability burden. Fractures were classified by anatomical level and stability with validated systems. Clinical data regarding mechanism of injury and associated non-spinal injuries for each patient were recorded. Statistical analysis was performed using Fisher's Exact test. Results. 57 cases (128 fractures) were analysed. Ballistic (79%) and non-ballistic (21%) mechanisms contribute to vertebral fracture and
Study Design. A prospective cohort study was carried out looking at the functional outcome and post-procedure translational segmental instability after multi-level lumbar decompression using a Hinge osteotomy technique. Objective. The Hinge osteotomy technique involves unilateral subperiosteal muscle dissection with osteotomy of the base of the spinous processes thereby preserving the integrity of the posterior elements. The objective of this study was to demonstrate the results of this technique clinically and radiologically. Methods. Between February 2005 and February 2007, 120 patients (51 male and 69 female) diagnosed with degenerative and/or congenital lumbar stenosis with a mean age of 64 years, underwent central and bilateral canal decompression using the hinge osteotomy technique. A mean of 2 segments (range 2-4) was decompressed. All patients were followed up for a minimum of three years. Five outcome measures were used: visual analogue scale for leg pain, Likert scale for functional status, symptom specific well-being score, general well-being score, and ODI score. The outcome measures were recorded pre-operatively and at 6 months and 3 years post-operatively. Successful surgical outcome was defined as an improvement in at least four out of five outcome measures. Results. 108 patients (90%) had a successful surgical outcome. There was a statistically significant improvement in all outcome criteria (p< 0.001) when measured at the 6-month post-operative mark as compared to pre-operatively, with further marginal significant improvement (p< 0.05) at 3 years post-surgery. There was no evidence of progressive lumbar segmental instability at 3 years post-operatively. Conclusion. Decompression of multi-level lumbar spine stenosis using the unilateral approach with the Hinge osteotomy technique is a safe approach for multi-level stenosis, with good outcome and no evidence of significant segmental translational
Neck pain can be caused by pressure on the spinal cord or nerve roots from bone or disc impingement. This can be treated by surgically decompressing the cervical spine, which involves excising the bone or disc that is impinging on the nerves or widening the spinal canal or neural foramen. Conventional practise is to fuse the adjacent intervertebral joint after surgery to prevent intervertebral motion and subsequent recompression of the spinal cord or nerve root. However fusion procedures cause physiological stress transfer to adjacent segments which may cause Adjacent Segment Degeneration (ASD), a rapid degeneration of the adjacent discs due to increased stress. ASD is more likely to occur in fusions of two or more levels than single level fusions and is more common where there is existing degeneration of the adjacent discs, which is not unusual in people over 30 years of age. Partial dynamic stabilisation, which generally involves a semi-rigid spinal fixation, allows a controlled amount of intervertebral motion (less than physiological, but more than fusion) to prevent increased stress on the adjacent segments (potentially preventing ASD) whilst still preventing neural recompression. Partial dynamic stabilisation is suitable for treating