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Spontaneous infective spondylitis and mycotic aneurysm: incidence, risk factors, outcome and management experience

Shih-Hao Chen1,2, Wei-Che Lin3,2, Chen-Hsiang Lee4,5

  • 1Department of Orthopaedics, Chang-Gung Memorial Hospital, Kasohsiung, Taiwan.

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
|November 30, 2007
PubMed

Insights

Infective spondylitis and mycotic aneurysms rarely occur together. Early detection via imaging signs like psoas abscesses is crucial for timely surgical intervention and improved patient survival rates.

Area of Science:

  • Vascular Surgery
  • Infectious Diseases
  • Spinal Surgery

Background:

  • Mycotic aneurysms are rare but serious vascular infections.
  • Infective spondylitis, a spinal infection, can coexist with mycotic aneurysms.
  • This study investigates the clinical presentation and outcomes of this rare dual pathology.

Observation:

  • A retrospective review identified six cases (10.3%) of concomitant infective spondylitis and mycotic aneurysm.
  • Patients with both conditions were significantly more likely to experience neurological deficits (50% vs. 0%).
  • Key imaging findings included psoas abscess (83.3%) and vertebral endplate destruction (50%).

Findings:

  • Salmonella infection was identified in four patients, all of whom survived after surgical intervention.
  • Two patients with Streptococcus pyogenes and Staphylococcus aureus infections died despite conservative management.
  • Specific imaging findings like paravertebral swelling and unclear planes can suggest coexisting spinal infection in mycotic aneurysm cases.

Implications:

  • Prompt recognition of imaging indicators for spinal infection is vital in patients with mycotic aneurysms.
  • Conversely, prevertebral masses in spinal infection workups warrant consideration of concurrent mycotic aneurysms.
  • Aggressive surgical management appears critical for favorable outcomes in Salmonella-related spondylitis and mycotic aneurysm.

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