Spinal epidural abscess (SEA) is an uncommon infection typically caused by Staphylococcus aureus, predominantly affecting older adults with risk factors such as advanced age, comorbidities, and prior surgical interventions. This report details a case involving a 14-year-old male presenting with acute lumbar pain, lower limb weakness, urinary retention, and skin pustules. The patient had no history of immunologic diseases, diabetes, or drug use. Contrast-enhanced magnetic resonance imaging (MRI) with gadolinium demonstrated a peripheral fluid signal surrounding the thoracic spinal cord, consistent with an epidural abscess from T9-T12 to L1, causing spinal cord compression. Cultures from the abscess and skin pustules identified Staphylococcus epidermidis (S. epidermidis). The patient underwent surgical drainage and remained stable postoperatively. This case highlights an unusual SEA presentation in an adolescent without typical risk factors, emphasizing the importance of considering atypical pathogens and further investigation into infection sources.

In clinical practice, the three most prevalent forms of infectious spondylitis are tuberculous spondylitis (TS), brucellosis spondylitis (BS), and pyogenic spondylitis (PS). It is possible to successfully lessen neurological and spinal damage by detecting them early. In the medical field, radiomics has been applied extensively. It is crucial to find out if MRI imaging can be used to diagnose spinal infections early.

To explore the diagnostic value of establishing models based on MRI radiomics for different spinal infections.

This retrospective study collected clinical and magnetic resonance imaging information on a total of 136 patients diagnosed with spondylitis in April 2019 and August 2023, who were classified into specific spinal infections (TS or BS) and non-specific spinal infections (PS) based on treatment. 3D Slicer software was used to outline the region of interest (ROI) and extracted ROI features. All patients were randomly divided into a training set and a test set (7:3), and after standardized, the t-test and LASSO were sequentially performed in the training set to extract the optimal radiomic features. These features were used to calculate the Radscore and construct the features classifier model and evaluated by test set. Univariate and multivariate logistic regression of Radscore and clinical features to identify predictors contributing to the diagnosis were used to plot nomograms, the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA) to assess the nomogram. The same approach described above was used to diagnose both subgroups of BS and TS in SSI.

321 radiological features were extracted from the three different sequences. The remaining 7 optimal radiomics features were used to calculate the Radscore and establish three feature classifier models, with RF having the best performance (AUC=1 and 0.86). And after univariate and multivariate logistic regression, the final nomogram constructed by Radscore and had good discriminatory performance in the training set and the test set (AUC =0.924 and 0.868), and the calibration curve and DCA showed good clinical efficacy. In the subgroup, the AUC of the training and test sets was 0.929and0.863.

The diagnostic model based on MR radiomics can gradually differentiate tuberculous spondylitis, brucellosis spondylitis, and pyogenic spondylitis.

This article brings to light the importance of MR imaging not only as a tool for the diagnosis of spine and spinal cord infections but also for identifying potential complications that can increase morbidity and mortality. The authors explore the typical imaging characteristics of common and infrequent spine infections and discuss their relevant pathophysiology and clinical features. Infections are categorized by the affected anatomic structure and by the pathogenic microorganisms, such as bacteria, fungi, parasites, and viruses. It also highlights the role of MR imaging in detecting complications such as epidural abscess, and distinguishing these pathologies from other spinal conditions.

Vertebral osteomyelitis (VO) is an infection of the spine with increasing prevalence due to improved diagnostics and aging populations. Multiple pathogens, including Mycobacterium tuberculosis, Brucella spp., and pyogenic bacteria, can cause VO, making differential diagnosis complex, especially in regions with endemic brucellosis and tuberculosis. Early and accurate diagnosis is essential for appropriate treatment.

This was a single-center, retrospective, observational study performed between 2019 and 2022 in Kashi, Xinjiang.

In this study, a total of 319 patients were enrolled, comprising 45.5% with tuberculous vertebral osteomyelitis (TVO; 52.4% females), 37.9% with brucellar vertebral osteomyelitis (BVO; 19.8% females), and 16.6% with pyogenic vertebral osteomyelitis (PVO; 52.8% females). Demographically, TVO had a longer mean time to diagnosis compared to BVO and PVO. BVO was more prevalent in male, and PVO patients had higher rates of spinal surgery history (45.3%) and diabetes (13.2%). Clinically, TVO patients presented with fever (72.4%), sweating (83.4%), weight loss (71.7%), and appetite loss (84.8%) more frequently, while BVO patients reported more lower back pain (86.0%). Laboratory investigations revealed significantly higher leucocyte and neutrophil levels in PVO, whereas TVO patients had elevated monocyte-to-lymphocyte and platelet-to-lymphocyte ratios. Radiologically, TVO patients exhibited a higher incidence of thoracic involvement (56.6%) and skip lesions (20%). Microbiologically, BVO and PVO had high positive culture rates (84.3 and 84.9%, respectively), with M. tuberculosis isolated from only 4.1% of TVO patients.

These findings underscore the distinct clinical, laboratory, and radiological characteristics of TVO, BVO, and PVO.

A retrospective study.

Neurological deficits occur in 1/3 of spinal infection cases. Non-specific symptoms can lead to delays in diagnosis. This study reviews outcomes and the timeliness of diagnosis in patients with spinal infection who sustained subsequent spinal cord impairment.

All 40 patients admitted to The Princess Royal Spinal Injuries Centre, Sheffield, UK, between 2016-2018 for rehabilitation for spinal cord impairment secondary to spinal infection.

The average age was 58.6 years (31-85; SD 13.1) with 24 (60%) being male. 36 (90%) had native infections and 3 (7.5%) were acquired post-operatively (1 (2.5%) unknown). 7 patients had been intravenous drug users (17.5%). 50% (20) had previously sought medical attention for the same symptoms. There were long intervals to suspected diagnosis and to MRI (range 0-30 days). 15 (37.5%) patients deteriorated neurologically following admission to hospital; 8 were taking antibiotics at the time of deterioration. None of the patients had normal C-reactive protein levels at presentation. 7 (17.5%) sustained complete spinal cord impairment. 27 (67.5%) were discharged as wheelchair users.

Whilst the majority of patients responded to rehabilitation interventions, they were left with residual life changing disabilities. Among those requiring rehabilitation, delays in diagnosis appear to frequently occur pre-hospital. This could be attributed to a low index of suspicion in the community. Some deteriorated neurologically despite antibiotics. Close neurological monitoring of those suspected or confirmed to have a diagnosis of spinal infection is appropriate. There should be a low threshold for the use of inflammatory markers when investigating back pain.

Psoas muscle abscess is an insidious disease, with varied clinical manifestations and a challenging diagnosis. This pathology has been more frequently identified due to the increased availability of high-quality radiological imaging, such as computed tomography. In Brazil, Mycobacterium tuberculosis is the most common secondary etiologic agent of psoas abscess. We report the case of a 28-year-old immunocompetent man diagnosed with disseminated tuberculosis, affecting the lungs, lumbar spine, and psoas muscle, leading to permanent locomotion sequelae. This case is very relevant for osteoarticular complaints, as low back pain and limping were the initial symptoms. Diagnosis was confirmed by ultrasound-guided percutaneous drainage of the psoas muscle abscess and detection of the M. tuberculosis complex via Xpert MTB/RIF. A 12-month treatment with antitubercular drugs was effective.

Infective spondylitis is a rare but potentially devastating spinal infection that requires timely diagnosis and appropriate treatment to prevent severe complications, including neurological deficits and spinal deformity. Despite advancements in diagnostic imaging, microbiological techniques, and antimicrobial therapies, clinical challenges persist because of the disease's insidious onset, varied etiologies, and increasing antimicrobial resistance. This review article provides a comprehensive analysis of the current literature on the epidemiology, pathophysiology, diagnostic approaches, and treatment strategies for infective spondylitis.

Vertebral osteomyelitis is a general term for a heterogenous group of spine infections involving the vertebral bone, intervertebral discs, and facet joints. These infections can often spread contiguously to adjacent paraspinal structures, including paravertebral muscles and the epidural space and frequently presents with nonspecific and indolent symptoms, which can delay diagnosis. Treatment can be arduous, requiring prolonged courses of antibiotics often combined with surgical debridement. This review focuses primarily on pyogenic vertebral osteomyelitis in adults, reviewing the pathophysiology, epidemiology, microbiology, diagnosis, and treatment of this infection.

The etiological diagnosis of pyogenic spinal infection is crucial for its precise antibiotic treatment. Traditional methods of detection are often slow and ineffective. In recent times, metagenomic next-generation sequencing (mNGS) has revolutionized pathogen detection, offering a more effective approach to disease management.

Comparing mNGS with microbial culture to comprehensively explore the diagnostic value of mNGS in pyogenic spinal infections.

A multicenter, retrospective observational study.

In a multicenter retrospective observational study, we analyzed the data from 301 patients admitted in four selected hospitals with pyogenic spinal infections from December 2019 to February 2024.

Identification of pathogenic bacteria in patients.

Obtain blood and lesion tissue or pus samples from the enrolled patients for microbial culture, serological and hematological laboratory tests, pathological examination, and mNGS analysis, followed by a comparative analysis of the results.

In our cohort of 301 cases of clinically diagnosed pyogenic spinal infections, 242 yielded etiological evidence. The most common gram-positive bacterium was Staphylococcus aureus, and the most common gram-negative bacterium was Escherichia coli. mNGS showed a significantly higher rate of detection (77.9%) compared with microbial culture (27.2%) with a notable difference (X² = 140.17, P<.001). In culture-negative samples, mNGS could detect pathogens in 73.1% of cases, and in culture-positive samples, it could detect pathogens in 91.5% of cases with 94.7% genus-level concordance. mNGS provided faster results (24-48 h) compared with the culture method (2-7 days).

mNGS serves as a valuable supplement to the culture method and shows potential in identifying the causative pathogen in native pyogenic spinal infections.

A retrospective study.

To evaluate the clinical efficacy of uniportal endoscopic decompression and debridement (UEDD) in treating infectious diseases of the spine (IDS) with neurological deficits.

IDS patients with neurological deficits often require urgent surgical decompression. However, the efficacy of UEDD in this complex patient population is not well-characterized.

This retrospective study analyzed 32 consecutive IDS patients who underwent UEDD surgery. Clinical features, laboratory data (erythrocyte sedimentation rate and C-reactive protein), and treatment outcomes were analyzed.

Definite microorganisms were identified in 27 patients (84.3%), with 24 (88.9%) meeting cure criteria. The cure rate was significantly higher in the detected pathogen group compared to the undetected pathogen group (88.9% vs. 80%; χ²=19.36, p<0.0001). Metagenomic next generation sequencing (mNGS) provided faster diagnosis (41.72±6.81 hours) compared to tissue culture (95.74±35.47 hours, p<0.05). The predominant causative pathogen was Mycobacterium tuberculosis, followed by Staphylococcus aureus. Significant improvements were observed in Visual Analog Scale pain scores, from a mean of 7.9 preoperatively to 1.06 at 1 year postoperatively. The Oswestry Disability Index revealed a similar trend, showing significant improvement (p<0.05).

UEDD is a viable alternative to traditional open surgery for managing IDS in high-risk patients. UEDD offers a dual therapeutic-diagnostic advantage during the initial admission phase, enabling simultaneous debridement, neurological decompression, and targeted biopsy in a single intervention. Compared with traditional tissue culture, mNGS enables rapid microbiological diagnosis and extensive pathogen coverage.

A case study of multiple distinct levels of skipped thoracolumbar spine infection was reported in which 13 successful vacuum sealing drainage (VSD) surgeries were treated.

The patient underwent a total of 13 procedures within our medical facility, including five performed under local anesthesia and eight performed under general anesthesia. The source of the ailment was ultimately identified as Enterobacter cloacae. After the last procedure, the patient's symptoms were alleviated, and the recovery process was satisfactory. Three months post-operation, the Japanese Orthopaedic Association scores had improved to 100%. Imageological examination revealed a satisfactory position of internal fixation, and the abnormal signals in the vertebral body and intervertebral space had been eliminated when compared to the pre-operative results.

The study demonstrates that the extreme lateral approach debridement combined with multiple VSD operations is a secure and successful method of treatment for recurrent spinal infection, providing an alternative to traditional surgery.

Screw loosening is one of the most frequent complications after instrumented spine surgery, which constitutes a heavy burden for patients and the health care system. Low-virulent colonialization with biofilm formation has been identified as a possible cause for screw loosening. The aim of this study was to investigate the rate of low virulent infections in recurrent screw loosening after revision surgery.

Seventy-nine patients from January 2015-July 2018 undergoing revision surgery due to clinically aseptic implant loosening were included in our observational study. Sonication of the loosened implant was performed. All identified patients received clinical and radiographic follow-up. Screw loosening was evaluated in computed tomography scans carried out at least 12 months after revision surgery. Patients were differentiated into the following 3 groups: 1) all patients with low virulent colonialization, who received antibiotic treatment (Co + ABX); 2) all patients with colonialization without postoperative antibiotic treatment (Co-ABX); and 3) reference cohort containing all patients without colonialization (noCo).

Seventy-nine patients (51 females; mean age, 65.12 years) were identified. Forty-two patients (51.2%) received radiologic follow-up with computed tomography scan for implant control. These patients were assigned to 3 groups (Co + ABX: n = 5 [12%]; Co-ABX: n = 8 [19%]; noCo: n = 29 [69%]). In 10 of 13 patients with positive sonication results (Co + ABX and Co-ABX), recurrent screw loosening occurred (76.9%). Antibiotic administration had no influence on screw loosening rates (4 of 5 patients [80%] in Co + ABX and 6 of 8 [75%] patients in Co-ABX; P > 0.05). In the reference group, noCo, in 11 of 29 patients (37.9%), recurrent screw loosening was identified (P = 0.043).

In patients with screw revision surgery, incidence of low-virulent microorganism colonialization is high and may play a role in the incidence of screw loosening. New therapeutic approaches addressing low-virulent infections and biofilm formation may be helpful.

This study is designed to investigate the roles of MMP-2, MMP-9, and MMP-13 in intervertebral disc destruction resulting from different types of spinal infections and their correlations with clinical quantitative data.

Disc tissue samples were collected from 60 patients with spinal infections (20 cases each of STB, BS, and PS in the infection group) and 20 patients with intervertebral disc herniation (control group). The expressions of MMP-2, MMP-9, and MMP-13 were detected by RT-qPCR. Correlation analysis was carried out with clinical quantitative data such as preoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), and related blood routine indicators in the infection group.

In the analysis between the infection group and the control group, MMP-13 was expressed in the diseased intervertebral disc tissue of STB patients, but the result was not statistically significant (P = 0.2172). There was a significant difference in the expression of MMP-13 in the diseased intervertebral discs of BS and PS patients. The expressions of MMP-9 and MMP-2 were markedly increased in the diseased intervertebral disc tissue of STB, BS, and PS patients (all P < 0.05). In the inter-group analysis of the infection group, the expression of MMP-13 in the diseased intervertebral disc tissue of PS patients was significantly different from that of STB and BS (P < 0.0001), while there was no significant difference between the STB and BS groups (P = 0.2393). The expression of MMP-9 in the diseased intervertebral disc tissue of STB patients was significantly different from that of BS and PS (P < 0.0001), but there was no statistically significant difference between the BS and PS groups (P = 0.9643). There was no statistically significant difference in the expression of MMP-2 among the STB, BS, and PS groups. In the correlation analysis with clinical quantitative data, MMP-13 was positively correlated with CRP, ESR, IL-6, WBC, and NEUT levels (r values were 0.7346, 0.3465, 0.3326, 0.6347, and 0.5152 respectively), and negatively correlated with LYM level (r = -0.5152, P < 0.05), and had no correlation with PCT and MXD levels. MMP-9 was positively correlated with ESR level (r = 0.3412, P < 0.05) and had no correlation with CRP, IL-6, PCT, WBC, NEUT, and LYM levels. MMP-2 was positively correlated with NEUT and LYM levels (r values were 0.3021 and 0.3306 respectively, P < 0.05) and had no correlation with ESR, CRP, IL-6, PCT, and WBC levels.

MMP-2, MMP-9, and MMP-13 play crucial roles in intervertebral disc destruction due to spinal infections. The differential expression of MMPs may be one of the reasons for the varying degrees of intervertebral disc destruction in different types of spinal infections. Moreover, when clinical indicators such as CRP, ESR, IL-6, WBC, and NEUT increase, it suggests that the expression of MMP-13 in the intervertebral disc at the lesion site significantly rises, and it may become a new target for the treatment of spinal infections in the future.

Primary lumbar spondylodiscitis is a serious condition with an increasing incidence rate.

From January 2021 to June 2023, we adopted a single-stage oblique lateral approach for the debridement of lumbar infection foci, intervertebral bone grafting fusion, tube irrigation drainage, combined with posterior percutaneous pedicle screw fixation for the treatment of primary lumbar spondylodiscitis.

We found that this surgical technique significantly improved the patients' lower back pain symptoms. During postoperative follow-ups at 1, 3, 6, and 12 months, patients showed remarkable improvements in their JOA and VAS scores, as well as in ESR and CRP levels, compared to the preoperative period.

We believe that the single-stage oblique lateral approach for debridement of lumbar infection foci, intervertebral bone grafting fusion, tube irrigation drainage, and combined posterior percutaneous pedicle screw fixation is an ideal treatment method for primary lumbar spondylodiscitis. This technique offers thorough debridement of the infection focus, sufficient bone grafting, safe operation, and reliable fixation.

Post-surgical spinal infection occurs in up to 20 % of patients, despite aggressive peri-operative antibiotic treatments. To improve prophylaxis, we have designed and evaluated an ultrasound-activated prophylactic antibiotic release system to combat post-surgical bacterial survival. Polylactic acid (PLA) clips (1 cm3) were 3D-printed with an interior reservoir (0.8 cm3) for carrying drug payload, specifically vancomycin (VAN). Under IACUC approval, clips were surgically implanted into the spines of sheep (n = 9) and swine (n = 2) by removing the spinous process at several levels of the lumbar spine. In the sheep, clips were insonated and the interstitial wound fluid was collected to quantify the ultrasound-triggered VAN release. Uninsonated control sheep exhibited an average VAN concentration of 6.32 ± 5.99 µg/mL after 72 h, while ultrasound-triggered clips released significantly higher VAN concentrations at 72 h (22.98 ± 11.22 µg/mL, p = 0.033). In the swine, device efficacy against Staphylococcus aureus was evaluated. Insonated sites saw significant reduction in colony forming units (CFU) to 4.3 ± 3.2 CFU in the activated clips, compared to uninsonated controls where bacterial colonization was higher (2898 ± 1214 CFU, p = 0.017). Overall, these results demonstrate the ability to non-invasively release VAN from an implanted reservoir in vivo, and that this VAN release is effective in mitigating invading microbes in the wound site.

Spinal infections (SI) typically manifest with and pose a growing medical challenge. However, current evidence for treating SI is limited and inconclusive. Our aim was to assess the effectiveness and safety of percutaneous endoscopic disc decompression (PEDD) for SI.

On 20 October 2023, we searched the EMBASE, PubMed, Cochrane Library, China Biology Medicine Disc, China National Knowledge Infrastructure, and Wanfang databases for eligible studies. Cohort studies on SI treated with PEDD, reporting relevant effectiveness or safety outcomes. We assessed study quality using a modified Newcastle-Ottawa Scale and conducted a random-effects meta-analysis to calculate pooled results.

Overall, 36 studies involving 925 patients were included. Erythrocyte sedimentation rate levels decreased significantly at 1-week postoperatively compared with preoperative levels (mean difference [MD] = - 13.48 [95% CI - 15.65 to - 11.31]) and continued to decrease over 3 months. Similarly, the c-reactive protein (CRP), visual analogue scale, and oswestry disability index scores significantly reduced postoperatively. The rates of excellent or good MacNab classification were 92.6% (95% CI 84.1-98.1%). Microbiological diagnostics revealed a 71.7% (95% CI 65.5-77.6%) positive rate in tissue cultures, surpassing blood cultures (odds ratio [OR] 2.72 [95% CI 1.01-7.30]). The rates of complication, reoperation, and mortality were 4.1% (95% CI 1.5-8.0%), 8.6% (95% CI 4.3-14.3%), and 1.7% (95% CI 0.4-4.1%), respectively. Subgroup analyses demonstrated a significantly lower reoperation rate in the group that discontinued antibiotics based on a normal CRP than in the fixed-duration group (2.7% [95% CI 0.3-7.7%] vs 20.1% [95% CI 14.5-26.3%], p = 0.0002). Conversely, ambulation 1 day postoperatively was associated with a higher reoperation rate than ambulation within 5-14 days (16.2% [95% CI 9.3-24.6%] vs 1.1% [95% CI 0.0-6.0%], p = 0.0060).

Our meta-analysis suggests that PEDD is a potentially effective and safe intervention for SI. Optimizing antibiotic discontinuation and postoperative care strategies may contribute to reducing reoperation rate. However, these findings require further validation from controlled studies.

Spinal epidural abscess is a rare infectious lesion of the central nervous system. Here, we report a rare case of a thoracic suppurative epidural abscess in a female patient who developed incomplete paralysis of both lower limbs after chemotherapy for breast cancer. She underwent surgery and recovered well after surgery.

A 49-year-old female patient developed an epidural abscess after chemotherapy for breast cancer; she suffered sudden pain and paralysis in both lower limbs. Thoracic T9-T11 laminectomy, abscess removal, bone grafting, fusion, and internal fixation were performed. After the operation, the muscle strength in both lower limbs gradually recovered.

This is the first reported case of an epidural abscess after chemotherapy for breast cancer. The disease progresses rapidly. During the literature review process, we found that timely removal of the epidural abscess, combined with the administration of appropriate antibiotics at the same time, is crucial for improved healing and successful treatment.

This study aimed to evaluate the efficacy of metagenomic next-generation sequencing (mNGS) technology for identifying pathogens associated with spinal infection (SI).

A retrospective analysis was conducted on clinical data from 193 patients with suspected SI between August 2020 and September 2024. Based on histopathological results, the patients were divided into the SI group (n=162) and the non-SI group (n=31). The diagnostic performance of mNGS technology was compared with that of laboratory examination, imaging examination, and microbial culture.

Among SI group, mNGS detected 135 pathogens in 77.78% (126/162) of the cases, including nine cases of multiple infections. One or more pathogens were detected using mNGS in 86 patients with SI and negative microbial cultures. Staphylococcus aureus (22.22%, n=30) and Mycobacterium tuberculosis (22.22%, n=30) were the major pathogens, while various rare pathogens such as anaerobes, Brucella, and Coxiella burnetii were also detected. For the 40 cases with positive results for both culture- and mNGS-based identification, high consistency (77.50%) was observed. Antibiotic use did not significantly affect the mNGS detection rate (P = 0.45). There was no significant difference in the positivity rate of mNGS between CT-guided needle biopsy (80.00%) and surgical sampling (77.17%) (P = 0.72). The sensitivity of mNGS (77.78%) was significantly higher than that of traditional microbial culture (27.16%), and the specificity was similar (90.32% vs. 96.77%). Although the sensitivities of erythrocyte sedimentation rate-based assay (91.36%), magnetic resonance imaging (88.27%), and C-reactive protein-based assay (87.65%) were better than those of mNGS, their specificities were generally low (20%-40%).

The pathogens responsible for SI are complex and diverse. As a novel diagnostic method, mNGS exhibits a high sensitivity and extensive pathogen coverage for SI diagnosis. When combined with imaging and laboratory indicators, mNGS can significantly improve the accuracy of SI diagnosis and provide strong support for clinical treatment.

This study tested whether combined ceftriaxone and adipose-derived mesenchymal stem cells (ADMSCs) would defend the spinal cord against acute spinal infection (ASI) in rodent. Adult-Male-SD rats were grouped into groups 1 (SC)/2 (ASI)/3 (ASI + ceftriaxone from days 2 to 28 after ASI induction)/4 (ASI + allogenic ADMSCs from day 2 for a total of 3 doses/3 consecutive intervals by intravenous injection)/5 (ASI + combined ceftriaxone and ADMSC) and spinal cord tissues were harvested by day 28. Circulatory levels of TNF-α/IL-6 at days 7 and 28, and these two parameters in spinal fluid at day 28 were lowest in group 1, highest in group 2, significantly lower in group 5 than in groups 3/4, and significantly lower in group 3 than in group 4 (all p < 0.0001). The day-28 bacterial colony formation unit (CFU) in vertebral bone and circulatory WBC counts at the time points of days 7/14/28, and the protein expressions of upstream (TRL-2/TLR-4/MYD88/TRAF6/IKKα/IKKβ /IKBβ/p-NF-κB) and downstream (IL-1β/IL-6/TNF-α/IFN-γ/iNOS) inflammatory signalings displayed a similar pattern of inflammatory biomarkers in spinal fluid among the groups (all p < 0.0001). By day 28, the bone injury score/bone marrow density/ratio of bone volume (BV) to the bone tissue volume (TV)/ratio of bone surface (BS) to BV/ratio of BS to bone TV/trabecular number exhibited an opposite, whereas the trabecular space exhibited an alike pattern of inflammatory biomarkers among the groups (all p < 0.0001). Combined ceftriaxone and ADMSCs therapy offered an additional benefit on protecting the vertebral bone/spinal cord against ASI damage.

Paraspinal muscle abscesses are rare, and generally occur due to injections or hematogenous dissemination. Here, we describe a rare case of a paraspinal muscle and the ipsilateral psoas major abscess in the lumbar region that communicated via the interspaces of the costal processes.

An 83-year-old man with poorly controlled diabetes mellitus and no history of puncture complained of right low back pain for the past 2 months. He was diagnosed with pyelonephritis and referred to our department for close examination of the low back pain. Magnetic resonance imaging revealed a paraspinal muscle and an ipsilateral psoas major abscess in the lumbar region, which communicated through the interspaces of the costal processes. A definitive diagnosis was made using percutaneous aspiration and the patient was successfully treated conservatively.

This case is very rare and impressive because the paraspinal muscle abscess directly communicated with the ipsilateral psoas major muscle abscess. Spinal infections should always be considered in the differential diagnosis of low back pain, particularly in the absence of long-term improvement. Local physical examinations are essential when examining patients with low back pain. Conservative treatment is effective, even if the abscess is extensive.

Primary spondylodiscitis occurs through the hematogenous spread of a pathogen entering the body via a point of entry. The infection's origin often remains unclear. During dental procedures or through minor traumas, oral bacteria can enter the bloodstream and disseminate throughout the body.

This study's objective was to further investigate the role of odontogenic (i.e., teeth-related) causes of spondylodiscitis, especially in cases where another infective focus could not be identified initially.

Retrospective analysis.

In a cohort of 340 consecutive patients with primary spondylodiscitis treated at a Level I Spine Center from 01/01/2018 to 12/31/2022, those with oral bacteria in blood cultures or disc tissue samples and available orthopantomograms (OPG, i.e. panoramic X-ray of the teeth) (please define this-general readership will not know what this is) were retrospectively reevaluated for odontogenic origins. Patients with secondary spondylodiscitis from a previous operation (< 3 months) in the same segment were excluded.

Radiological features indicating an infectious dental focus included apical (in the mandible/maxilla?) radiolucency of the tooth, impacted teeth, residual roots, and vertical or cup-shaped bone loss.

Patients' medical records, imaging data, laboratory, microbiological and histopathological findings, and surgical reports were analyzed. The term oral bacteria refers to the whole microbiome of the oral cavity. Periodontal bacteria are bacterial species implicated in periodontal diseases. For further classification, periodontal bacteria were assigned to one of five complexes previously described.

The most frequent infective source was (what joints?) an infection of the major joints of the extremeties (14.1%), followed by ulcers of the extremities (10.3%) and urosepsis (10.0%). An odontogenic origin was initially identified in 8.9%. In 33.1% of cases, the source of infection was not found. Oral bacteria were found in 38 cases (13.3%) of 286 (i.e. all cases with a positive pathogen detection) of the 33.1% of cases?. Six of these had an identified focus of the throat, and six had an initially clear dental focus. Of the remaining 26 cases, OPG was available for 14. Re-evaluation of OPG revealed an odontogenic focus in 9 out of 14 cases (64.3%). Two of these cases had a concomitant infective focus, while in 7 cases, initially, no infectious focus was found.

An odontogenic origin for spondylodiscitis was more prevalent than initially presumed, particularly in patients where no source was identified at first sight. We therefore recommend a thorough diagnostic dental work-up as a standard procedure for patients with primary spondylodiscitis.

A standard 6-12-week course of antibiotics is recommended for pyogenic spondylitis. Recent evidence supports early minimally invasive posterior fixation surgery; however, its effect on antibiotic treatment duration is unclear. This study aims to identify factors associated with prolonged antibiotic treatment in thoracolumbar pyogenic spondylitis patients resistant to conservative treatment and assess whether early surgery can reduce treatment duration.

We retrospectively reviewed 74 patients with thoracolumbar pyogenic spondylitis undergoing minimally invasive posterior fixation at nine facilities. Patients were grouped based on antibiotic duration (≥ 6 or < 6 weeks) and timing of surgery (≤ 3 weeks or > 3 weeks of starting antibiotics). Univariable and multivariable logistic regression analyses were used to identify factors associated with prolonged antibiotic treatment and study the outcomes of patients undergoing early surgery.

Forty-nine patients (66%) required prolonged antibiotic treatment. The presence of an iliopsoas abscess (p = 0.0006) and elevated C-reactive protein (CRP) levels (≥ 10 mg/dL, p = 0.015) were independently associated with prolonged antibiotic treatment. Early surgery significantly reduced total antibiotic duration (5.3 weeks vs. 9.9 weeks, p < 0.0001) without increasing the incidence of postoperative infection recurrences and unplanned additional surgeries. Despite factors associated with prolonged antibiotic treatment, early surgery consistently shortened the treatment duration compared to late surgery.

Early surgery (within three weeks) with minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis is associated with reduced antibiotic duration and overall treatment duration regardless of the presence of prolonging factors like iliopsoas abscess and elevated CRP levels.

Spondylodiscitis is an infection of the intervertebral disc, the adjacent vertebral body, and/or contiguous structures due to the introduction of infectious agent, usually by the hematogenous route. Imaging is crucial in assessing bacterial and tubercular spondylodiscitis, as well as their associated complications. Magnetic resonance imaging in particular can clearly depict osteo-structural changes in the vertebral body and the associated disc, as well as any soft-tissue complications, such as paravertebral abscess and/or epidural abscess, improving disease characterization and helping to recognize the agent involved. Nevertheless, other non-infectious diseases may mimic imaging appearances of spondylodiscitis and one should be aware of these conditions when interpreting MR images, which include Modic type I degenerative changes, ankylosing spondylitis, acute Schmorl's node, porotic fractures, and spinal neuropathy arthropathy. This pictorial review aims at describing imaging findings of bacterial and non-bacterial spondylodiscitis, complications, and those pathologies that mimic these infections.

Streptococcus oralis, belonging to the viridans group streptococci (VGS), has been considered a member of normal flora mainly inhabiting the oral cavity. However, more recently, there has been growing recognition of its role as a causative agent in various life-threatening infectious diseases such as infective endocarditis (IE) and meningitis. Additionally, the differences in the prevalence, clinical features, and prognosis of opportunistic infections between S. oralis and other VGS species have been addressed. Particularly the predominance of S. oralis in IE has drawn critical attention. In potentially fatal infections, clinical neglect of S. oralis as an instigating agent might significantly impede early diagnosis and treatment. Nevertheless, to date, the infectious diseases associated with S. oralis have not yet been comprehensively described. Therefore, this review will give an overview of infectious diseases caused by S. oralis to uncover its hidden role as an opportunistic pathogen.

Epidural abscess is a rare but serious infection. Although more commonly seen in men over 50, our case is notable for its occurrence in a pediatric patient, highlighting the unusual nature of this abscess at such a young age, particularly in conjunction with septic arthritis of the hip.

A 10-year-old child was admitted to pediatrics for investigation of a prolonged fever. The child presented with back pain associated with left hip lameness. An MRI of the spine showed an epidural collection extending from the 4th to the 10th dorsal vertebrae. This collection compressed the spinal cord. An MRI of the left hip showed an appearance consistent with septic arthritis. A left hip arthrotomy was performed, with laminectomy and drainage of the epidural abscess at D7. The patient was treated with antibiotics. The clinical and biological evolution was favorable.

Epidural abscess is a rare but serious infection, now more easily diagnosed by MRI. It is most often caused by hematogenous spread, mainly by Staphylococcus aureus. Symptoms include back pain, neurological signs and fever. Diagnosis is confirmed by MRI. Early diagnosis is essential to prevent neurological complications and death, as the disease can progress to paralysis. Treatment consists of intravenous antibiotics and surgical intervention as indicated.

Early diagnosis of spinal epidural abscess is important to prevent neurological complications, sepsis and even death. It should be noted that there are no official recommendations or guidelines for the management of epidural spinal abscesses in the pediatric population.

Tuberculosis spondylitis (TS), commonly known as Pott's disease, is a severe type of skeletal tuberculosis that typically requires surgical treatment. However, this treatment option has led to an increase in healthcare costs due to prolonged hospital stays (PLOS). Therefore, identifying risk factors associated with extended PLOS is necessary. In this research, we intended to develop an interpretable machine learning model that could predict extended PLOS, which can provide valuable insights for treatments and a web-based application was implemented.

We obtained patient data from the spine surgery department at our hospital. Extended postoperative length of stay (PLOS) refers to a hospitalization duration equal to or exceeding the 75th percentile following spine surgery. To identify relevant variables, we employed several approaches, such as the least absolute shrinkage and selection operator (LASSO), recursive feature elimination (RFE) based on support vector machine classification (SVC), correlation analysis, and permutation importance value. Several models using implemented and some of them are ensembled using soft voting techniques. Models were constructed using grid search with nested cross-validation. The performance of each algorithm was assessed through various metrics, including the AUC value (area under the curve of receiver operating characteristics) and the Brier Score. Model interpretation involved utilizing methods such as Shapley additive explanations (SHAP), the Gini Impurity Index, permutation importance, and local interpretable model-agnostic explanations (LIME). Furthermore, to facilitate the practical application of the model, a web-based interface was developed and deployed.

The study included a cohort of 580 patients and 11 features include (CRP, transfusions, infusion volume, blood loss, X-ray bone bridge, X-ray osteophyte, CT-vertebral destruction, CT-paravertebral abscess, MRI-paravertebral abscess, MRI-epidural abscess, postoperative drainage) were selected. Most of the classifiers showed better performance, where the XGBoost model has a higher AUC value (0.86) and lower Brier Score (0.126). The XGBoost model was chosen as the optimal model. The results obtained from the calibration and decision curve analysis (DCA) plots demonstrate that XGBoost has achieved promising performance. After conducting tenfold cross-validation, the XGBoost model demonstrated a mean AUC of 0.85 ± 0.09. SHAP and LIME were used to display the variables' contributions to the predicted value. The stacked bar plots indicated that infusion volume was the primary contributor, as determined by Gini, permutation importance (PFI), and the LIME algorithm.

Our methods not only effectively predicted extended PLOS but also identified risk factors that can be utilized for future treatments. The XGBoost model developed in this study is easily accessible through the deployed web application and can aid in clinical research.

This study evaluates the efficacy of metagenomic next-generation sequencing (mNGS) in diagnosing spinal infections and developing therapeutic regimens that combine mNGS, microbiological cultures, and pathological investigations.

Data were collected from 108 patients with suspected spinal infections between January 2022 and December 2023. Lesion tissues were obtained via C-arm assisted puncture or open surgery for mNGS, conventional microbiological culture, and pathological analysis. Personalized antimicrobial therapies were tailored based on these findings, with follow-up evaluations 7 days postoperatively. The sensitivity and specificity of mNGS were assessed, along with its impact on treatment and prognosis.

mNGS showed a significantly higher positive detection rate (61.20%) compared to conventional microbiological culture (30.80%) and PCT (28%). mNGS demonstrated greater sensitivity (79.41%) and negative predictive value (63.16%) than cultures (25% and 22.58%, respectively), with no significant difference in specificity and positive predictive value. Seven days post-surgery, a significant reduction in neutrophil percentage (NEUT%) was observed, though decreases in white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were not statistically significant. At the last follow-up, significant improved in Visual Analogue Scale (VAS) scores, Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores were noted.

mNGS outperforms traditional microbiological culture in pathogen detection, especially for rare and critical pathogens. Treatment protocols combining mNGS, microbiological cultures, and pathological examinations are effective and provide valuable clinical insights for treating spinal infections.

This study aimed to determine the sensitivity and specificity of metagenomic next-generation sequencing (mNGS) for detecting pathogens in spinal infections and to identify the differences in the diagnostic performance between mNGS and targeted next-generation sequencing (tNGS).

A total of 76 consecutive patients with suspected spinal infections who underwent mNGS, culture, and histopathological examinations were retrospectively studied. The final diagnosis of the patient was determined by combining the clinical treatment results, pathological examinations, imaging changes and laboratory indicators. The sensitivity and specificity of mNGS and culture were determined.

The difference between the two detection rates was statistically significant (p < 0.001), with mNGS exhibiting a significantly higher detection rate (77.6% versus 18.4%). The average diagnosis time of mNGS was significantly shorter than that of bacterial culture (p < 0.001, 1.65 versus 3.07 days). The sensitivity and accuracy of mNGS were significantly higher than that of the culture group (p < 0.001, 82.3% versus 17.5%; 75% versus 27.6%), whereas the specificity of mNGS (42.9%) was lower than that of the culture group (p > 0.05, 42.9% versus 76.9%). The sensitivity, specificity, accuracy, and positive predictive value (PPV) of pus were higher than those of tissue samples for mNGS, whereas for culture, the sensitivity, specificity, accuracy, and PPV of tissue samples were higher than those of pus. tNGS demonstrated higher sensitivity and accuracy in diagnosing tuberculosis (TB) than mNGS (80% versus 50%; 87.5% versus 68.8%).

mNGS for spinal infection demonstrated better diagnostic value in developing an antibiotic regimen earlier, and it is recommended to prioritize pus samples for testing through mNGS. Moreover, tNGS outperformed other methods for diagnosing spinal TB and identifying antibiotic-resistance genes in drug-resistant TB.

Retrospective review.

Spinal intradural extramedullary abscess (SIEA) is a rare disease with an unknown incidence. In this study, we systematically described the clinical course of SIEA in a large cohort with acute onset of neurological illness, assessed the morbidity and mortality rates, and determined the potential risk factors for mortality.

Electronic medical records of patients diagnosed with SIEA at a single institution for the period between September 2005 and December 2020 were retrieved.

Over a period of 15 years, 881 patients with spinal infections were treated either conservatively or surgically at our center, of whom 45 patients (45/881, 5.1%) had SIEA. The overall mean age was 69.6 ± 5.6 years of patients diagnosed with SIEA and all of them underwent posterior decompression via laminectomy. The mean Charlson Comorbidity Index (CCI) was 6.9 ± 2.5, indicating a poor baseline reserve. Progressive neurological decline was observed in all patients (mean motor score, 88.6 ± 9.7). The in-hospital rate and 90-day mortality were 4.4% and 10%, respectively. Mortality was not surgery related. Most importantly, the patients' motor deficits and blood infection parameters significantly improved after surgery. Risk factors for mortality were increased age, comorbidities as measured by CCI, and preoperative motor weakness (MS).

Immediate surgical decompression via laminectomy, with antiseptic irrigation and drainage of the subdural space, followed by antibiotic therapy, appears to be the key to ensuring beneficial clinical outcomes to treatment of rare diseases such as SIEA.

Vertebral osteomyelitis and discitis (VOD), an infection of intervertebral discs, often requires spine surgical intervention and timely management to prevent adverse outcomes. Our study aims to develop a machine learning (ML) model to predict the indication for surgical intervention (during the same hospital stay) versus nonsurgical management in patients with VOD.

This retrospective study included adult patients (≥18 years) with VOD (ICD-10 diagnosis codes M46.2,3,4,5) treated at a single institution between 01/01/2015 and 12/31/2019. The primary outcome studied was surgery. Candidate predictors were age, sex, race, Elixhauser comorbidity index, first-recorded lab values, first-recorded vital signs, and admit diagnosis. After splitting the dataset, XGBoost, logistic regression, and K-neighbor classifier algorithms were trained and tested for model development.

A total of 1,111 patients were included in this study, among which 30% (n=339) of patients underwent surgical intervention. Age and sex did not significantly differ between the two groups; however, race did significantly differ (P<0.0001), with the surgical group having a higher percentage of white patients. The top ten model features for the best-performing model (XGBoost) were as follows (in descending order of importance): admit diagnosis of fever, negative culture, Staphylococcus aureus culture, partial pressure of arterial oxygen to fractional inspired oxygen ratio (PaO2:FiO2), admit diagnosis of intraspinal abscess and granuloma, admit diagnosis of sepsis, race, troponin I, acid-fast bacillus culture, and alveolar-arterial gradient (A-a gradient). XGBoost model metrics were as follows: accuracy =0.7534, sensitivity =0.7436, specificity =0.7586, and area under the curve (AUC) =0.8210.

The XGBoost model reliably predicts the indication for surgical intervention based on several readily available patient demographic information and clinical features. The interpretability of a supervised ML model provides robust insight into patient outcomes. Furthermore, it paves the way for the development of an efficient hospital resource allocation instrument, designed to guide clinical suggestions.

Cervical spondylodiscitis is a rare pathology, with an incidence of 0.5-2.5 per 100,000 population, posing significant potential risks. This type of infection can lead to neurological impairment in up to 29% of patients. Radical surgical debridement of the infected segment, fusion, and an intravenous antibiotic regimen remains the gold standard in most spine centers. This study aimed to analyze the surgical outcome in a tertiary spine center based on disease severity.

In this study, we retrospectively included all patients diagnosed with cervical spondylodiscitis and treated at the University Hospital Augsburg between January 2017 and May 2022. We collected and analyzed baseline parameters on clinical presentation with symptoms, laboratory parameters, radiological appearance, and surgical parameters such as type of approach and implant, as well as neurological and radiological outcomes. Descriptive statistics were performed using SPSS, and relevant correlations were examined using the t-test for independent samples and the chi-square test.

Twenty-four patients (9%) with cervical spondylodiscitis were identified. Twenty-two (92%) surgically treated patients were subdivided into the complicated discitis group (n = 14, 64%) and the uncomplicated discitis group (n = 8, 36%). Seventeen patients (71%) presented with sepsis on admission, 17 patients (71%) were diagnosed with epidural abscess on primary imaging, and 5 patients (21%) had more than one discitis lesion at a distant spinal segment. The presence of epidural abscess was significantly associated with systemic sepsis (OR = 6.2; p = 0.03) and myelopathy symptoms (OR = 14.4; p = 0.00). The most frequently detected specimen was a multisensitive Staphylococcus aureus (10 patients, 42%). Six patients (25%) died after a median of 20 days despite antibiogram-accurate therapy, five of whom were diagnosed with a complicated type of discitis. The follow-up data of 15 patients (63%) revealed permanent neurological damage in 9 patients (38%). Notably, the surgical approach was a significant factor for revision surgery (p = 0.008), as three out of five (60%) ventrodorsal cases with complicated discitis were revised.

Cervical spondylodiscitis represents a severe infectious disease that is often associated with permanent neurological damage or a fatal outcome, despite adequate surgical and antibiotic treatments. Complicated types of discitis may require a more challenging surgical and clinical course.

Thoracic spinal epidural abscess (SEA) is a rare but dangerous condition, and traditional surgical methods are accompanied by extensive trauma and approach-related complications. Here we introduce the technique of full-endoscopic transforaminal debridement and decompression and evaluate its feasibility for treating brucellar thoracic SEA.

We performed thoracic full-endoscopic transforaminal decompression and debridement on two patients with neurological deficits caused by brucellar SEA, which is mainly composed of granulation tissue rather than pus. Postoperative MRI was conducted to confirm the presence of any residual abscess compressing the nerves. Frankel grading was employed to assess the recovery of neurological function, and complications were documented.

There were no occurrences of dural tear, postoperative hematoma, or pulmonary complications. Their neurological function had significantly improved after surgery, and postoperative MRI confirmed no residual abscess compressing the spinal cord. During the 2-year follow-up, one patient achieved complete recovery (from Frankel-C to Frankel-E), while another patient improved from Frankel-A to Frankel-D. Neither patient experienced infection recurrence, instability, nor kyphotic deformity.

We described the novel application of transforaminal endoscopic surgery in brucellar thoracic granulomatous SEA and preliminarily indicated the feasibility of this technique as a minimally invasive alternative to open surgery.

The incidence of spontaneous or primary spondylodiscitis has been increasing over the years, affecting the aging population with multiple comorbidities. Several conditions influencing treatment outcomes stand out, such as diabetes mellitus, renal insufficiency, cardiovascular and respiratory dysfunction, and malnutrition. Due to these, the question arises regarding properly managing their current conditions and pre-existing disease states. Treatment plans must consider all concomitant comorbidities rather than just the infectious process. This can be done with the help of multidisciplinary teams to provide comprehensive care for patients with pyogenic spondylodiscitis. To date, there is no article regarding comprehensive medicine for spontaneous pyogenic spondylodiscitis; hence, this paper reviews the evidence available in current literature, recognizes knowledge gaps, and suggests comprehensive care for treating patients with spinal infections. Pre-requisites for implementing multidisciplinary teams include leadership, administrative support, and team dynamics. This group comprises an appointed leader, coordinator, and different subspecialists, such as orthopedic surgeons, infectious disease specialists, internists, rehabilitation doctors, psychiatrists, microbiologists, radiologists, nutritionists, pharmacologists, nurses, and orthotists working together with mutual trust and respect. Employing collaborative teams allows faster time for diagnosis and improves clinical outcomes, better quality of life, and patient satisfaction. Forefront communication is clear and open between all team members to provide holistic patient care. With these in mind, the need for employing multidisciplinary teams and the feasibility of its implementation emerges, showing a promising and logical path toward providing comprehensive care in managing multimorbid patients with pyogenic spondylodiscitis.

A 57-year-old man presented with odynophagia for 1 week was referred for FDG PET/CT scan to rule out recurrent hypopharyngeal cancer. The FDG PET/CT showed hypermetabolic lesions in hypopharyngeal area and adjacent cervical spine with pneumorrhachis, the presence of intraspinal air, on attenuation CT images, which might indicate a life-threatening infection. An emergency MRI confirmed the presence of cervical spondylodiscitis with an epidural abscess. The patient rapidly progressed to quadriplegia and difficulty voiding on the same day as the PET/CT scan, leading to emergent operation. The patient received antibiotics treatment and discharged 4 months later without evidence of cancer recurrence.

This study aimed to explore the clinical efficacy of metagenomic next-generation sequencing (mNGS) in diagnosing and treating suspected spinal infectious diseases.

Between October 2022 to December 2023, a retrospective analysis was performed on patient records within the Department of Spinal Surgery at Guilin People's Hospital. The analysis included comprehensive data on patients with presumed spinal infectious diseases, incorporating results from mNGS tests conducted externally, conventional pathogen detection results, laboratory examination results, and imaging findings. The study aimed to assess the applicability of mNGS in the context of suspected spinal infectious lesions.

Twenty-seven patients were included in the final analysis. Pathogenic microorganisms were identified in 23 cases. The included cases encompassed 1 case of tuberculous spondylitis, 1 case of fungal infection, 3 cases of Brucella spondylitis, 3 cases of viral infection, 9 cases of bacterial infection, and 6 cases of mixed infections. Pathogenic microorganisms remained elusive in 4 cases. The application of the mNGS method demonstrated a significantly elevated positive detection rate compared to conventional methods (85.19% vs. 48.15%, P < 0.05). Moreover, the mNGS method detected a greater variety of pathogen species than traditional methods (Z = 10.69, P < 0.05). Additionally, the mNGS method exhibited a shorter detection time.

mNGS demonstrated significantly higher detection rates for bacterial, fungal, viral, and mixed infections in cases of suspected spinal infectious diseases. The clinical implementation of mNGS could further enhance the efficiency of diagnosing and treating suspected spinal infectious diseases.

The clinical incidence of spinal infection is gradually increasing, and its onset is insidious, easily leading to missed diagnosis and misdiagnosis, which may lead to serious complications such as nervous system dysfunction, spinal instability and/or deformity, and cause a huge burden on society and families. Early identification of the causative agent and precision medicine will greatly reduce the suffering of patients. At present, the main pathogenic bacteria that cause spinal infection are Staphylococcus aureus, Streptococcus, Pneumococcus, Escherichia coli, and Klebsiella. There are no reports of spinal infection caused by Pseudomonas fluorescens.

We report a 32-year-old female patient with spinal infection. She presented with flank pain, initially thought to be bone metastases or bone tuberculosis, and had a family background of tumors. Her clinical features and changes in imaging and laboratory tests led to the suspicion of thoracic spine infection. Histopathology of the lesion showed inflammation, tissue culture of the lesion was negative several times, and the possible pathogen - Pseudomonas fluorescens was found after gene sequencing of the lesion. The patient recovered completely after a full course of antibiotic treatment.

This report increases the range of pathogens involved in spinal infections, highlights the unique advantages of gene sequencing technology in difficult-to-diagnose diseases, and validates conservative treatment with a full course of antibiotics for spinal infections without complications.

Spontaneous sternoclavicular joint infection (SSCJI) is a rare and poorly understood disease process. This study aims to identify factors guiding effective management strategies for SSCJI by using data mining.

An Institutional Review Board-approved retrospective review of patients from 2 large hospitals (2010-2022) was conducted. SSCJI is defined as a joint infection without direct trauma or radiation, direct instrumentation or contiguous spread. An interdisciplinary team consisting of thoracic surgeons, radiologists, infectious disease specialists, orthopaedic surgeons, hospital information experts and systems engineers selected relevant variables. Small set data mining algorithms, utilizing systems engineering, were employed to assess the impact of variables on patient outcomes.

A total of 73 variables were chosen and 54 analysed against 11 different outcomes. Forty-seven patients [mean age 51 (22-82); 77% male] met criteria. Among them, 34 underwent early joint surgical resection (<14 days), 5 patients received delayed surgical intervention (>14 days) and 8 had antibiotic-only management. The antibiotic-only group had comparable outcomes. Indicators of poor outcomes were soft tissue fluid >4.5 cm, previous SSCJI, moderate/significant bony fragments, HgbA1c >13.9% and moderate/significant bony sclerosis.

This study suggests that targeted antibiotic-only therapy should be considered initially for SSCJI cases while concurrently managing comorbidities. Patients displaying indicators of poor outcomes or no symptomatic improvement after antibiotic-only therapy should be considered for surgical joint resection.

Discitis linked to Pott's spine is an infrequent yet severe issue, especially difficult to manage among elderly individuals due to age-related bodily changes and concurrent health issues. This report details the successful physiotherapy-based recovery of a senior patient afflicted with discitis related to Pott's spine. The individual, a 61-year-old man, presented symptoms including intense back pain, restricted movement, and neurological issues. The diagnosis was confirmed via imaging scans, indicating spinal tuberculosis and vertebral disc involvement. Treatment embraced a comprehensive approach involving medication alongside physiotherapy. The physiotherapeutic regimen aimed at pain alleviation, enhancing spinal flexibility, strengthening weakened muscles, and promoting functional autonomy. Techniques such as manual therapy, targeted exercises, and patient education were employed. Despite the challenges posed by the patient's age and existing conditions, significant enhancements in pain management, mobility, and everyday functioning were noted during the rehabilitation journey. This case underscores the significance of prompt diagnosis, collaborative care, and personalized physiotherapeutic interventions in attaining positive outcomes for elderly patients grappling with discitis associated with Pott's spine. Further investigation is needed to delineate optimal rehabilitation approaches for this intricate condition among the elderly.