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Surgical treatment of aspergillus spondylodiscitis
A van Ooij1, J M Beckers, M J Herpers
1Department of Orthopaedic Surgery, University Hospital Maastricht, The Netherlands. avoo@sort.azm.nl
Abstract:
Four cases of aspergillus spondylodiscitis were treated with operative debridement and fusion. In this rarely encountered mycotic infection of the spine in immunocompromised patients rapid destruction of the intervertebral disc and vertebral bodies can occur. In advanced cases antimycotic drug therapy is thought to be ineffective and a forcing indication for surgery exists when the destruction is progressive and spinal cord compression is imminent or manifest. Spinal instrumentation can be of help in maintaining or restoring spinal stability and maintaining spinal alignment. In our four patients the aspergillus spondylodiscitis was successfully eradicated and fusion achieved. In two of three patients with a neurologic deficit, this deficit disappeared. Two patients died within 6 months after the operative treatment, due to complications related to the underlying illness. One patient was left with a subtotal paraplegia.
Insights
Surgical debridement and fusion effectively treated Aspergillus spondylodiscitis, a rare spinal infection. This approach eradicated the infection and improved neurological deficits in most patients, though outcomes varied.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Spinal Surgery
Background:
- Aspergillus spondylodiscitis is a rare, aggressive mycotic infection affecting the spine, particularly in immunocompromised individuals.
- Rapid destruction of intervertebral discs and vertebral bodies can occur, leading to potential spinal cord compression.
- Antimycotic drug therapy is often ineffective in advanced cases, necessitating surgical intervention.
Observation:
- Four cases of Aspergillus spondylodiscitis were treated with operative debridement and spinal fusion.
- Spinal instrumentation was utilized to maintain or restore spinal stability and alignment.
- Patients presented with varying degrees of vertebral and disc destruction, with some experiencing neurological deficits.
Findings:
- Successful eradication of Aspergillus spondylodiscitis was achieved in all four patients.
- Spinal fusion was successfully obtained in all treated cases.
- Neurological deficits resolved in two out of three patients who presented with such deficits.
- Two patients died within six months post-operatively due to underlying illness complications.
- One patient was left with subtotal paraplegia.
Implications:
- Operative debridement and fusion represent a viable and effective treatment strategy for Aspergillus spondylodiscitis.
- Spinal instrumentation plays a crucial role in managing spinal stability and alignment during treatment.
- While surgical intervention can lead to positive outcomes, patient survival is often influenced by the severity of the underlying immunocompromised state.