Symptomatické neurologické komplikácie sa vyskytujú u 15-30 % pacientov s infekčnou endokarditídou. Zároveň sa u 35-60 % pacientov vyskytujú klinicky nemé mozgové embólie. Staphylococcus aureus je patogén, ktorý najčastejšie spôsobuje postihnutie nervového systému. Uvádzame prípad 67-ročného muža s infekčnou endokarditídou po stomatologickom výkone, ktorý sa prejavil ako spondylodiscitída a mnohopočetná embolizácia do mozgu, vrátane mozgového abscesu, ktorý si vyžiadal neurochirurgickú drenáž. Po 6 týždňoch liečby širokospektrálnymi antibiotikami a komplexnej podpornej terapii sme pacienta prepustili v uspokojivom somatickom a psychickom stave. Pokračuje príprava pacienta na kardiochirurgický výkon.

Symptomatic neurological complications occur in 15-30% of patients with infective endocarditis. At the same time, other clinically silent cerebral embolisms occur in 35-60% of patients. Staphylococcus aureus is the pathogen that causes nervous system involvement most frequently. We report a case of a 67-year-old man with infective endocarditis following a dental procedure that manifested as spondylodiscitis and multiple brain embolization, including a brain abscess that required drainage. After six weeks of treatment with broad-spectrum antibiotics and complex supportive therapy, we discharged the patient in a satisfactory mental and somatic condition. The preparation of the patient for cardiac surgery is ongoing.

• MeSH
• absces mozku diagnostické zobrazování   etiologie   patologie   terapie   MeSH
• discitida diagnostické zobrazování   komplikace   patologie   MeSH
• echokardiografie transezofageální MeSH
• endokarditida * diagnostické zobrazování   farmakoterapie   komplikace   patologie   terapie   MeSH
• extrakce zubů škodlivé účinky   MeSH
• intrakraniální embolie * diagnostické zobrazování   komplikace   patologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mitrální insuficience diagnostické zobrazování   etiologie   farmakoterapie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH

PURPOSE OF THE STUDY The purpose of the retrospective study is to analyse a group of patients surgically treated for cervical spondylodiscitis. The first hypothesis states that the removal of infected intervertebral disc without its anterior column reconstruction in the acute phase of infection results in worse clinical and radiological evaluation of the patient. The second hypothesis defines that the use of titanium implant in anterior column reconstruction in the chronic phase of infection increases the risk of recurrent infection. MATERIAL AND METHODS The evaluated group of patients who underwent surgery includes a total of 21 patients (8 females, 13 males) with the mean age of 57.6 years. 12 patients in the acute phase of infection were treated by anterior debridement without disc space reconstruction, of whom four patients were completed by posterior instrumented fusion in the second stage. In 9 patients in the chronic phase of infection radical anterior debridement was completed by anterior titanium implant reconstruction, of whom in five patients posterior instrumented fusion was performed in the second stage. All patients were clinically evaluated by mJOA, VAS and Frankel score preoperatively, at 6 months and at 1 year postoperatively. The radiologic evaluation assessed the instrumentation failure, spinal fusion and kyphosis progression measured by sagittal Cobb angle. RESULTS The mJOA values improved from the mean preoperative value of 1.6 to 13.15 (6M) and 13.3 (1Y) postoperatively (p = 0.055). The VAS score increased from the mean value of 8.5 preoperatively to 2.15 (6M) and 1.35 (1Y) postoperatively (p < 0.001). No patient reported worse neurological finding postoperatively. The kyphosis progression measured by sagittal Cobb angle from the preoperative +6.7 decreased to +3.2 degrees at 1 year after surgery. The group of 12 patients treated in the acute phase of infection by anterior debridement without anterior column reconstruction showed worsening of kyphosis from +1.1 before surgery to +1.6 degrees at 1 year after surgery. The group of eight patients treated in the chronic phase by anterior debridement and reconstruction of the anterior column by implant changed from +15.9 before surgery to +6.1 degrees at 1 year after surgery. In two out of 12 patients with neurological deficit, the T2-weighted MRI finding of signal hyperintensity showed no improvement of the neurological deficit. DISCUSSION In the group of all operated patients, neither the worsening in the clinical evaluation using the mJOA or VAS score, nor kyphosis progression measured by Cobb angle in the sagittal plane, or failure of instrumentation in the anteroposterior procedure were reported postoperatively. In a total of nine patients operated on during the chronic phase of infection, in whom titanium implant was used to reconstruct the anterior column defect, no recurrent deep infection was observed. CONCLUSIONS In the acute phase we prefer anterior debridement with epidural abscess evacuation without anterior column reconstruction and posterior instrumented fusion in case of kyphosis progression in the second stage. In the chronic phase, radical anterior debridement with titanium implant reconstruction, eventually with posterior instrumented fusion is preferred. Key words: cervical spondylodiscitis, epidural abscess, anterior debridement, bacterial biofilm.

• MeSH
• debridement MeSH
• discitida * diagnostické zobrazování   chirurgie   MeSH
• fúze páteře * MeSH
• hrudní obratle MeSH
• kyfóza * MeSH
• lidé středního věku MeSH
• lidé MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY To describe epidemiological and clinical features of pyogenic spinal infections in patients treated at the Department of Infectious, Parasitic and Tropical Diseases of the Hospital Na Bulovce in 2010-2014, and to analyse a predictive significance of selected variables. MATERIAL AND METHODS A single-centre retrospective cohort study carried out from 1.1.2010 to 31.12.2014 enrolled adult patients with septic spondylitis, discitis and facet joint infections. Recorded parameters included: demographics, chronic comorbidities, time to diagnosis, radiological work-up, anatomical level of spinal infection, source of infection, etiological agent, complications, treatment and outcomes. RESULTS Fifty-four patients were enrolled, 35 men (65%) and 19 women (35%), age range 33-90, mean age 63 years. Forty patients (74.1%) had a chronic comorbidity, 20 patients (37%) were obese. Time to diagnosis ranged between 1-90 days, mean 16.3 days. The diagnosis was assessed with MRI in 41 (75.9%) and CT in 11 patients (20.4%). Lumbosacral spine was affected in 38 (70.4%), thoracic in 14 (25.5%), cervical in 8 patients (14.8%), and 6 patients (11.1%) had a multilevel disease. Epidural abscess developed in 28 (51.9%), paravertebral oedema or abscess in 41 patients (75.9%). Endocarditis was diagnosed in 8 patients (14.8%). Aetiology was identified in 45 patients (83.3%), with Staphylococcus aureus isolated in 29 patients (53.7%). Twenty-two patients (40.7%) were treated surgically in addition to antibiotics. The mean length of hospital stay, parenteral antibiotic treatment and total antibiotic treatment was 48.7, 38.2 and 71.5 days, respectively. Thirty-six patients (66.6%) recovered with no or mild sequelae, 7 (13%) with severe sequelae, and 11 patients (20.4%) died. None of the analysed variables proved to be a statistically significant predictive factor of clinical outcome. DISCUSSION In accordance with previous studies pyogenic spinal infections were diagnosed mainly in elderly with chronic internal comorbidities, mostly with magnetic resonance imaging, they were often localized in lumbar spine, with staphylococci being the leading agents. In spite of unavailable CT-navigated biopsy, the aetiology was discovered in majority of patients. In contrast, this study found a more frequent posterior segments involvement, a shorter time to treatment, no tuberculous cases, a relatively high case fatality ratio, but less sequelae and no relapse. CONCLUSIONS The study confirmed an increasing incidence of pyogenic spinal infections, known predisposing factors, importance of MRI in diagnostics, disease predilection in lumbar spine, staphylococcal predominance in causative pathogens, and a relatively high case fatality ratio. Although time to treatment was not proved to be a negative predictive factor of clinical outcome, it is an imperative to strive for an early diagnosis and treatment. Predictors of clinical outcome have to be evaluated in a more extensive cohort of patients. Key words: spinal infection, discitis, spondylitis, spondylodiscitis, epidural abscess, psoas muscle abscess.

• MeSH
• antibakteriální látky terapeutické užití   MeSH
• čas zasáhnout při rozvinutí nemoci MeSH
• centra terciární péče MeSH
• discitida diagnostické zobrazování   farmakoterapie   mikrobiologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• meziobratlový kloub diagnostické zobrazování   mikrobiologie   MeSH
• ortopedické výkony MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• spondylitida diagnostické zobrazování   farmakoterapie   mikrobiologie   MeSH
• stafylokokové infekce diagnostické zobrazování   farmakoterapie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH