ISSN:1077-2855    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1077-2855    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Abstract:Incidence of tuberculosis (TB) of the spinal column has seen a steady increase in developed countries over the last few years. Patients harboring the human immunodeficiency virus (HIV) and immigration patterns are potential causes of the rise in incidence. Current treatment options, including pharmacological and surgical interventions, are reviewed. Appropriately aggressive surgical approaches can be used to protect neurologic function and reconstruct the unstable spinal column. Circumferential fusion, which is used in pyogenic infection and tumor spinal surgery, may offer the best spinal reconstruction. Using a combination of conservative and surgical interventions, the control of TB-induced neurologic dysfunction and spinal instability can be accomplished.

ISSN:1077-2855    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Abstract:To evaluate the management of postoperative infections after spinal surgery, the authors performed a retrospective review of patients who developed a deep wound infection after a spinal instrumentation procedure. The incidence of wound infections, risk factors, and summary of presenting manifestations are featured in this review. The current, advocated treatment regimen consists of operative debridement of the infected wound, insertion of an antibiotic-containing irrigation-suction system for an average of 5 days, maintenance of the instrumentation system within the infected wound, followed by a course of intravenous and oral antibiotics. All patients were infection free with a minimum of 8 months follow-up.

ISSN:1077-2855    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Abstract:Pyogenic vertebral osteomyelitis is a diagnosis all physicians must be prepared to promptly recognize and treat. The mail predisposing factors include diabetes mellitus, intravenous drug use, and immunosuppression. The majority of infections occur via hematogenous spread to the vertebral body, with the lumbar spine being the most commonly involved region.Staphylococcus aureusremains the most common organism. Patients typically present with a progressive history of back or neck pain. The diagnosis if further suggested by elevations in the erythrocyte sedimentation rate, C-reactive protein, and appropriate findings on magnetic resonance imaging. The diagnosis is confirmed with biopsy and culture. Medical management is the main stay of treatment, but surgery continues to play an active role. Indications for surgical intervention include diagnostic uncertainty, the need for neural decompression, failure of antibiotic treatment, and instability. When pyogenic vertebral osteomyelitis is promptly identified and appropriately managed, the prognosis is generally favorable. The authors review the epidemiology, pathophysiology, clinical presentation, diagnostic tools, and therapeutic management of pyogenic vertebral osteomyelitis.

ISSN:1077-2855    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Abstract:Spinal epidural abscess and subdural empyema are uncommon in a general neurosurgical practice. Despite the availability of improved imaging studies and a greater awareness, the mortality rate remains high. Patients with spinal epidural abscess and subdural empyema commonly present with back pain that may rapidly progress to weakness or paralysis if untreated. The key to successful treatment is prompt diagnosis and implementation of timely and effective treatment. Patients with spinal pain and fever should raise a suspicion for an epidural abscess or subdural empyema. Magnetic resonance imaging (MRI) is the most appropriate imaging study, and if an abscess is present in a patient with a progressive neurologic symptoms, the patient should undergo urgent surgical decompression and debridement. However, a few selected patients with no neurologic deficit and a known pathogenic organism that is sensitive to antibiotics have been successfully treated without surgery. A 4-week to 8-week course of intravenous antibiotic treatment is usually necessary, and with early intervention, the prognosis is often good.

ISSN:1077-2855    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Abstract:Spinal infection is an uncommon but important clinical problem that often requires aggressive medical and surgical management. When spinal infection is recognized early and treated appropriately, a full recovery often can be expected. Treatment and outcome of spontaneous (pyogenic and nonpyogenic) and postoperative spondylodiskitis are discussed. The principles of conservative treatment are establishment of accurate microbiological diagnosis, treatment with specific antibiotics, spinal immobilization, and careful monitoring for spinal instability or neurologic deterioration. The principles of surgical treatment are to obtain multiple intraoperative cultures of bone and soft tissue, perform a thorough debridement of infected tissue and decompression of neural structures, and reconstruct the unstable spinal column with bone graft with or without concomitant instrumentation.

ISSN:1077-2855    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Abstract:Subarachnoid hemorrhage and intramedullary hematoma of the spinal axis are rare entities encountered by the neurosurgeon. Causes of spontaneous hemorrhage vary considerably and often pose a diagnostic dilemma for the treating clinician. Vascular malformations, such as arteriovenous malformations, remain the most common source of hemorrhage, and, depending on their location, can present with symptoms similar to cerebral subarachnoid hemorrhage. Sophisticated imaging modalities are often needed in diagnosis, such as selective spinal arteriography and magnetic resonance imaging (MRI). Other causes of spinal axis hemorrhage include spinal artery aneurysms, tumors, and a host of other less common entities. Modern imaging techniques and interventional neuroradiologic and surgical advancements have improved diagnosis and treatment of these complex disorders.

ISSN:1077-2855    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Abstract:Spinal subdural and epidural hematomas are rare entities, but their relative rarity is overshadowed by their tremendous clinical significance. The authors present a summary of the relevant literature regarding two subsets of these lesions, spontaneous and post-traumatic hematomas. The authors review in some detail the presentation, diagnosis, imaging, and treatment of those complex and frequently challenging clinical entities. Spinal epidural and subdural hematomas must be considered in the differential diagnosis of any patient presenting with back or neck pain. Failure to identify and adequately treat patients with these lesions may result in unnecessary and avoidable morbidity and even mortality.

ISSN:1077-2855    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1077-2855    

出版商:OVID    

年代:1999

数据来源: OVID