Haematogenous Spondylodiscitis in Patients With Liver Cirrhosis: Case Series of 36 Patients. Issue 8 (15th April 2020)

• Record Type: Journal Article
• Authors: Abdelrahman, Hemdan; Shousha, Mootaz; Bahrami, Reza; Boehm, Heinrich
• Is Part Of: Spine. Volume 45:Issue 8(2020)
• Publication Date: 2020-04-15
• Subjects: epidural abscess -- haematogenous -- infection -- liver cirrhosis -- mortality -- neurological deficit -- spondylodiscitis -- surgery; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000003326
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: A retrospective study of 36 liver cirrhosis patients presenting with spondylodiscitis. Objectives: The aim of this study was to analyze the characteristics of spondylodiscitis in the presence of liver cirrhosis and furthermore, to evaluate the outcome of surgery in this specific group of patients. Summary of Background Data: The incidence of haematogenous spondylodiscitis is increasing. The coexistence of liver cirrhosis makes the course of the disease more aggressive. Methods: A total of 36 liver cirrhosis patients presented with haematogenous spondylodiscitis. The onset of infection, clinical course and outcomes of management were reviewed retrospectively. Results: The associated comorbidities were cardiac in 17 patients, diabetes in 19, renal insufficiency in 16, and another focus for infection in nine cases. Neurological deficits were found in 24 patients (67%) and fever in 15 cases. Nine patients had septic manifestations. The lumbar spine was affected in 25 patients (69%). Noncontiguous spinal infection was found in nine patients (25%) and epidural abscess in 24 individuals. The preoperative C-reactive protein was elevated in all cases. The causative organism was most commonly Staphylococcus aureus (17 patients). A combined anteroposterior approach was necessary in 28 patients and a minimallly invasive surgery was performed in 30 cases. In-hospital mortality was 14% (5 patients). The neurological improvement rate was 82%. The postoperative antibiotic therapy was taken for more than 8 weeks in 22 patients. In 15 patients, a combination of antibiotics was necessary. Conclusion: Spinal infection in the presence of liver cirrhosis is challenging. The rate epidural abscess formation is relatively high. Early diagnosis remains the main cornerstone in the management and the indication for surgery should be carefully considered. Minimally invasive techniques should be used when possible to minimize complication rate, and higher amounts of intraoperative blood loss should be expected. Level of Evidence: 4 Abstract : Thirty-six cirrhotic patients presenting with spondylodiscitis were treated surgically. The rate of neurological deficits and epidural abscess formation was relatively high. Mortality rate was high. Magnetic resonance imaging (MRI) of the whole spine is recommended. Minimally invasive techniques should be used when possible, and higher amounts of intraoperative blood loss should be expected.