Comparative analysis of spontaneous infectious spondylitis

Pyogenic versus tuberculous

Yangwon Lee, Bum-Joon Kim, Se-Hoon Kim, Seung Hwan Lee, Won Hyung Kim, Sung Won Jin

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: Spondylitis is often chemotherapy resistant and requires long-term treatment. Without adequate chemotherapy, the outcome can be fatal or result in severe neurologic damage. Therefore, differentiating the etiology of spondylitis is very important, particularly in spontaneous cases. As the prevalence of tuberculosis in Korea has decreased in recent years, updated clinical research about spondylitis is warranted. Methods: From April 2010 to March 2016, data from spondylitis patients were collected retrospectively. In total, 69 patients (51 with pyogenic spondylitis and 18 with tuberculous spondylitis) were included. Clinical data, laboratory findings including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, measurements of Cobb angles at the initial and final follow-up, and radiologic features on magnetic resonance imaging (MRI) scans were evaluated. To test differences between the pyogenic and tuberculous groups, numerical data were compared using the student’s t-test and Mann-Whitney U test, and categorical data were compared using the chi-square test and Fisher’s exact test. Results: The patients’ mean age was 60.0 years. Male sex was slightly predominant (56.5%). There was no difference in mean age and sex between the two groups. The pyogenic group had a relatively higher proportion of immunocompromised patients. The peak CRP value was higher in the pyogenic group than in the tuberculous group (14.08 mg/dL and 8.50 mg/dL, respectively, p=0.009), whereas the ESR was not significantly different between the groups (81.5 mm/h and 75.6 mm/h, respectively, p=0.442). Radiologically, the presence of disc space sparing and vertebral body collapse differed between the groups. In the tuberculous group, the disc was more commonly preserved on contrast-enhanced MRI (50% and 23.5%, respectively, p=0.044), and vertebral body collapse was more common (66.6% and 15.7%, respectively, p<0.001). The mean length of hospitalization was longer in the pyogenic group (56.5 days and 41.2 days, respectively, p=0.001). Four mortality cases were observed only in the pyogenic group. The most commonly isolated microorganism in the pyogenic group was Staphylococcus aureus (S. aureus) (methicillin susceptible S. aureus and methicillin resistant S. aureus [MRSA] in 8 and 4 cases, respectively). Conclusion: The clinical and radiological manifestations of spontaneous spondylitis differ based on the causative organism. Pyogenic spondylitis patients tend to have a higher CRP level and a more severe clinical course, whereas tuberculous spondylitis patients present with destruction of the vertebral body with disc sparing more frequently. The presence of MRSA is increasing in community-acquired spondylitis cases.

Original languageEnglish
Pages (from-to)81-88
Number of pages8
JournalJournal of Korean Neurosurgical Society
Volume61
Issue number1
DOIs
Publication statusPublished - 2018 Jan 1

Fingerprint

Spondylitis
C-Reactive Protein
Blood Sedimentation
Methicillin-Resistant Staphylococcus aureus
Staphylococcus aureus
Magnetic Resonance Imaging
Drug Therapy
Methicillin
Immunocompromised Host
Chi-Square Distribution
Korea
Nonparametric Statistics
Nervous System
Tuberculosis
Hospitalization
Students

Keywords

  • Bacterial infection
  • Bone diseases
  • Infectious
  • Osteomyelitis
  • Spondylitis
  • Spondylodiscitis
  • Tuberculosis

ASJC Scopus subject areas

  • Surgery
  • Neuroscience(all)
  • Clinical Neurology

Cite this

Comparative analysis of spontaneous infectious spondylitis : Pyogenic versus tuberculous. / Lee, Yangwon; Kim, Bum-Joon; Kim, Se-Hoon; Lee, Seung Hwan; Kim, Won Hyung; Jin, Sung Won.

In: Journal of Korean Neurosurgical Society, Vol. 61, No. 1, 01.01.2018, p. 81-88.

Research output: Contribution to journalArticle

Lee, Yangwon ; Kim, Bum-Joon ; Kim, Se-Hoon ; Lee, Seung Hwan ; Kim, Won Hyung ; Jin, Sung Won. / Comparative analysis of spontaneous infectious spondylitis : Pyogenic versus tuberculous. In: Journal of Korean Neurosurgical Society. 2018 ; Vol. 61, No. 1. pp. 81-88.
@article{f4f93812d43f46959e662716aaa76221,
title = "Comparative analysis of spontaneous infectious spondylitis: Pyogenic versus tuberculous",
abstract = "Objective: Spondylitis is often chemotherapy resistant and requires long-term treatment. Without adequate chemotherapy, the outcome can be fatal or result in severe neurologic damage. Therefore, differentiating the etiology of spondylitis is very important, particularly in spontaneous cases. As the prevalence of tuberculosis in Korea has decreased in recent years, updated clinical research about spondylitis is warranted. Methods: From April 2010 to March 2016, data from spondylitis patients were collected retrospectively. In total, 69 patients (51 with pyogenic spondylitis and 18 with tuberculous spondylitis) were included. Clinical data, laboratory findings including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, measurements of Cobb angles at the initial and final follow-up, and radiologic features on magnetic resonance imaging (MRI) scans were evaluated. To test differences between the pyogenic and tuberculous groups, numerical data were compared using the student’s t-test and Mann-Whitney U test, and categorical data were compared using the chi-square test and Fisher’s exact test. Results: The patients’ mean age was 60.0 years. Male sex was slightly predominant (56.5{\%}). There was no difference in mean age and sex between the two groups. The pyogenic group had a relatively higher proportion of immunocompromised patients. The peak CRP value was higher in the pyogenic group than in the tuberculous group (14.08 mg/dL and 8.50 mg/dL, respectively, p=0.009), whereas the ESR was not significantly different between the groups (81.5 mm/h and 75.6 mm/h, respectively, p=0.442). Radiologically, the presence of disc space sparing and vertebral body collapse differed between the groups. In the tuberculous group, the disc was more commonly preserved on contrast-enhanced MRI (50{\%} and 23.5{\%}, respectively, p=0.044), and vertebral body collapse was more common (66.6{\%} and 15.7{\%}, respectively, p<0.001). The mean length of hospitalization was longer in the pyogenic group (56.5 days and 41.2 days, respectively, p=0.001). Four mortality cases were observed only in the pyogenic group. The most commonly isolated microorganism in the pyogenic group was Staphylococcus aureus (S. aureus) (methicillin susceptible S. aureus and methicillin resistant S. aureus [MRSA] in 8 and 4 cases, respectively). Conclusion: The clinical and radiological manifestations of spontaneous spondylitis differ based on the causative organism. Pyogenic spondylitis patients tend to have a higher CRP level and a more severe clinical course, whereas tuberculous spondylitis patients present with destruction of the vertebral body with disc sparing more frequently. The presence of MRSA is increasing in community-acquired spondylitis cases.",
keywords = "Bacterial infection, Bone diseases, Infectious, Osteomyelitis, Spondylitis, Spondylodiscitis, Tuberculosis",
author = "Yangwon Lee and Bum-Joon Kim and Se-Hoon Kim and Lee, {Seung Hwan} and Kim, {Won Hyung} and Jin, {Sung Won}",
year = "2018",
month = "1",
day = "1",
doi = "10.3340/jkns.2016.1212.005",
language = "English",
volume = "61",
pages = "81--88",
journal = "Journal of Korean Neurosurgical Society",
issn = "2005-3711",
publisher = "Daehan sin'gyeong oe'gwa haghoe",
number = "1",

}

TY - JOUR

T1 - Comparative analysis of spontaneous infectious spondylitis

T2 - Pyogenic versus tuberculous

AU - Lee, Yangwon

AU - Kim, Bum-Joon

AU - Kim, Se-Hoon

AU - Lee, Seung Hwan

AU - Kim, Won Hyung

AU - Jin, Sung Won

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: Spondylitis is often chemotherapy resistant and requires long-term treatment. Without adequate chemotherapy, the outcome can be fatal or result in severe neurologic damage. Therefore, differentiating the etiology of spondylitis is very important, particularly in spontaneous cases. As the prevalence of tuberculosis in Korea has decreased in recent years, updated clinical research about spondylitis is warranted. Methods: From April 2010 to March 2016, data from spondylitis patients were collected retrospectively. In total, 69 patients (51 with pyogenic spondylitis and 18 with tuberculous spondylitis) were included. Clinical data, laboratory findings including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, measurements of Cobb angles at the initial and final follow-up, and radiologic features on magnetic resonance imaging (MRI) scans were evaluated. To test differences between the pyogenic and tuberculous groups, numerical data were compared using the student’s t-test and Mann-Whitney U test, and categorical data were compared using the chi-square test and Fisher’s exact test. Results: The patients’ mean age was 60.0 years. Male sex was slightly predominant (56.5%). There was no difference in mean age and sex between the two groups. The pyogenic group had a relatively higher proportion of immunocompromised patients. The peak CRP value was higher in the pyogenic group than in the tuberculous group (14.08 mg/dL and 8.50 mg/dL, respectively, p=0.009), whereas the ESR was not significantly different between the groups (81.5 mm/h and 75.6 mm/h, respectively, p=0.442). Radiologically, the presence of disc space sparing and vertebral body collapse differed between the groups. In the tuberculous group, the disc was more commonly preserved on contrast-enhanced MRI (50% and 23.5%, respectively, p=0.044), and vertebral body collapse was more common (66.6% and 15.7%, respectively, p<0.001). The mean length of hospitalization was longer in the pyogenic group (56.5 days and 41.2 days, respectively, p=0.001). Four mortality cases were observed only in the pyogenic group. The most commonly isolated microorganism in the pyogenic group was Staphylococcus aureus (S. aureus) (methicillin susceptible S. aureus and methicillin resistant S. aureus [MRSA] in 8 and 4 cases, respectively). Conclusion: The clinical and radiological manifestations of spontaneous spondylitis differ based on the causative organism. Pyogenic spondylitis patients tend to have a higher CRP level and a more severe clinical course, whereas tuberculous spondylitis patients present with destruction of the vertebral body with disc sparing more frequently. The presence of MRSA is increasing in community-acquired spondylitis cases.

AB - Objective: Spondylitis is often chemotherapy resistant and requires long-term treatment. Without adequate chemotherapy, the outcome can be fatal or result in severe neurologic damage. Therefore, differentiating the etiology of spondylitis is very important, particularly in spontaneous cases. As the prevalence of tuberculosis in Korea has decreased in recent years, updated clinical research about spondylitis is warranted. Methods: From April 2010 to March 2016, data from spondylitis patients were collected retrospectively. In total, 69 patients (51 with pyogenic spondylitis and 18 with tuberculous spondylitis) were included. Clinical data, laboratory findings including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, measurements of Cobb angles at the initial and final follow-up, and radiologic features on magnetic resonance imaging (MRI) scans were evaluated. To test differences between the pyogenic and tuberculous groups, numerical data were compared using the student’s t-test and Mann-Whitney U test, and categorical data were compared using the chi-square test and Fisher’s exact test. Results: The patients’ mean age was 60.0 years. Male sex was slightly predominant (56.5%). There was no difference in mean age and sex between the two groups. The pyogenic group had a relatively higher proportion of immunocompromised patients. The peak CRP value was higher in the pyogenic group than in the tuberculous group (14.08 mg/dL and 8.50 mg/dL, respectively, p=0.009), whereas the ESR was not significantly different between the groups (81.5 mm/h and 75.6 mm/h, respectively, p=0.442). Radiologically, the presence of disc space sparing and vertebral body collapse differed between the groups. In the tuberculous group, the disc was more commonly preserved on contrast-enhanced MRI (50% and 23.5%, respectively, p=0.044), and vertebral body collapse was more common (66.6% and 15.7%, respectively, p<0.001). The mean length of hospitalization was longer in the pyogenic group (56.5 days and 41.2 days, respectively, p=0.001). Four mortality cases were observed only in the pyogenic group. The most commonly isolated microorganism in the pyogenic group was Staphylococcus aureus (S. aureus) (methicillin susceptible S. aureus and methicillin resistant S. aureus [MRSA] in 8 and 4 cases, respectively). Conclusion: The clinical and radiological manifestations of spontaneous spondylitis differ based on the causative organism. Pyogenic spondylitis patients tend to have a higher CRP level and a more severe clinical course, whereas tuberculous spondylitis patients present with destruction of the vertebral body with disc sparing more frequently. The presence of MRSA is increasing in community-acquired spondylitis cases.

KW - Bacterial infection

KW - Bone diseases

KW - Infectious

KW - Osteomyelitis

KW - Spondylitis

KW - Spondylodiscitis

KW - Tuberculosis

UR - http://www.scopus.com/inward/record.url?scp=85041099182&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041099182&partnerID=8YFLogxK

U2 - 10.3340/jkns.2016.1212.005

DO - 10.3340/jkns.2016.1212.005

M3 - Article

VL - 61

SP - 81

EP - 88

JO - Journal of Korean Neurosurgical Society

JF - Journal of Korean Neurosurgical Society

SN - 2005-3711

IS - 1

ER -