Dr. SAMEER A. KITAB
This study examines 288 patients with hematogenous spine infections, focusing on instability. The research includes demographics, definitions of spondylodiscitis, TB vs. non-TB involvement, and infection types by pathogens, revealing insights into the condition's presentation and distribution among genders and spine locations.
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Dr. SAMEER A. KITAB Professor And Consultant Orthopedic Spine Surgeon. Adiwaniyah Medical College-Adiwaniyah Iraqi Board For Medical Specialists-spine Fellowship Program. Baghdad Medical College-graduated 1988. Iraqi Board For Medical Specialists -1996
Clinical Characteristics of 288 Patients Presenting With Clinical Characteristics of 288 Patients Presenting With Hematogenous Spine Infections Hematogenous Spine Infections With Special Emphasis on Instability. With Special Emphasis on Instability. Prospective Observational Study Prospective Observational Study KARAM. M.B.Ch.B; Spine Fellow SAMEER KITAB, M.D
Study design and demographics A retrospective analysis of prospectively collected 288 cases of spontaneous (non- postsurgical) from a single center (Alqadissiyah-middle Euphrates). study from 1997-2022. Patients with previous interventions at the same level were excluded. 3 ADD A FOOTER
Definition: Definition: Spondylodiscitis was defined by a combination of characteristic radiological changes of the intervertebral disc in magnetic resonance imaging (MRI) and/or computed tomography (CT) scans, plain radiographs and clinical findings including elevated CRP levels, elevated WBC, back and/or neck pain as well as fever. 89 cases with cervicodorsal spine infections. 189 cases of lumbosacral spine infections. 4 ADD A FOOTER
TB vs Non-TB Multilevel involvement ( more than two vertebral bodies involved) Multicentric involvement . Relative sparing of the intervertebral disk. Large paravertebral abscess ( more than twice the vertebral body) Bone fragments. Subligamentous spread. Heterogenous signal intensity on MRI. Rim enhancement pattern on MRI. 5 ADD A FOOTER
Demographics: Cervicodorsal: 89 cases MALES: 48.3% FEMALES: 51.7% Mean Age at presentation: 46.7 year age (6-75 years old) Lumbosacral: 189 cases MALES: 49.2% Females: 50.8% Mean age at presentation : 45.7 years age (4-84 years old) Almost equal gender and age distribution in cervicodorsal and lumbosacral spine locations. 6 ADD A FOOTER
Infections types according to pathogens: Cervicodorsal: 89 cases TB spondylodiscitis: 59.6% Pyogenic spondylodiscitis: 30.7% Hydatid disease: 9.1% Lumbosacral: 189 cases TB spondylodiscitis: 29.6% Pyogenic spondylodiscitis: 62.3% Hydatid disease: 3.5% Brucella spondylodiscitis: 4.5% The frequency of TB spondylitis is more in the cervicodorsal region, while pyogenic spinal infections are more frequent in the lumbosacral. 7 ADD A FOOTER
Co-morbidities: Cervicodorsal: 89 cases D.M: 15.7% Renal Impairment: 2.2% Auto immune or Rh. A: 1.1% Deformity de novo: 1.1% Hematologic diseases: 1.1% Lumbosacral: 189 cases D.M: 11.7% Renal Impairment: 3.6% Stroke: 5% 8 ADD A FOOTER
Time lag from presentation to definite diagnosis: Cervicodorsal cases (89 case): TB spondylodiscitis: 262 days Pyogenic cases: 31 days Lumbosacral cases (189): TB spondylodiscitis: 98 days. Pyogenic cases: 51.7 days. Time lag behind definitive diagnosis of spine infections is more with TB spondylodiscitis. 9 ADD A FOOTER
Remote surgery predisposing to pyogenic spine infections Lumbosacral: 189 cases No history of remote surgery: 72.5% Gall bladder surgery: 9.2% Renal Surgery or intervention: 10.0% Uterine surgery: 6.7% Bariatric surgery: 1.7% Cervicodorsal: 89 cases No history of remote surgery: 18.5% Gall bladder surgery: 29.6% Thyroid surgery: 18.5% Renal Surgery or instrumentation: 14.8% Uterine surgery: 14.8% Hernia Repair: 3.7% 10 ADD A FOOTER
Georg Schmorl prize of the German spine society (DWG) 2021: Spinal Instability Spondylodiscitis Score (SISS) a novel classification system for spinal instability in spontaneous spondylodiscitis 11 ADD A FOOTER
Parameters of the Spinal Instability Spondylodiscitis Parameters of the Spinal Instability Spondylodiscitis Score (SISS) Score (SISS) Spinal alignment Subluxation/Translation 4 De novo deformity (kyphosis/scoliosis) 2 Normal alignment 0 Mechanical pain Yes 3 Occasional pain but not mechanical 1 Pain-free lesion 0 Location Junctional (occiput-C2, C7-T2, T11-L1, L5-S1) 3 Mobile Spine (C3-6, L2-4) 2 Semirigid (T3-10) 1 Rigid (S2-5) 0 Bone lesion > 50% vertebral body involvement 4 < 50% vertebral body involvement 2 Endplate involvement 1 Intact endplates 0 12 ADD A FOOTER
Spinal Instability Spondylodiscitis Score (SISS) Based on SINS score of spinal Mets Disease A total score of 0 4 was defined as stable, 5 9 as potentially unstable, and 10 14 as unstable spondylodiscitis. Instability in infection is different from instability caused by traumatic injuries as it develops over a period of time rather than acutely 13 ADD A FOOTER
Parameters of the Spinal Instability Spondylodiscitis Score (SISS) The proposed classification system is the first to aid spine surgeons in deciding whether surgical treatment is indicated in spinal infections based on biomechanics. 14 ADD A FOOTER
Tuberculosis Spine Instability Score (TSIS) Development of Tuberculosis Spine Instability Score (TSIS) An Evidence-Based and Expert Consensus-Based Content Validation Study Among Spine Surgeons Kaustubh Ahuja, MS,a Pankaj Kandwal, MS, et al. SPINE Volume 47, Number 3, pp 242 2, 2021. 15 ADD A FOOTER
Tuberculosis Spine Instability Score (TSIS) Necessitating a different and specific scoring system to diagnose instability. TB Differs: 1-The pattern of spinal involvement, 2-presence of simultaneous destruction and healing processes, 3- unique pattern of neurological involvement 4-deformity 16 ADD A FOOTER
Tuberculosis Spine Instability Score (TSIS) Pain Age Pain even at rest, pain on loading and movement or instability catch with no relief on recumbency 3 Pain on loading and movement or instability catch with relief on recumbency 2 Occasional pain or not mechanical 1 Pain-free lesion 0 <5 years 3 5 10 years 2 10 15 years 1 >15 years 0 Location Junctional (occiput C2, C7 T2, T10 L2, L5 S1) 2 Mobile spine (C3 C6, L2 L5) 1 Rigid (rest of the spine) 0 17 ADD A FOOTER
Tuberculosis Spine Instability Score (TSIS) Adjusted kyphotic deformity >60 Degrees 3 30 60 Degrees 2 10 30 Degrees 1 <10 Degrees 0 Vertebral body loss >1.5 3 0.75 1.5 2 <0.75 0 Additional involvement of posterior spinal elements Bilateral facet joint involvement and destruction OR radiographically scoliosis, AP or lateral translation 3 Unilateral facet joint involvement 2 None 0 18 ADD A FOOTER
Tuberculosis Spine Instability Score (TSIS) Multifocal contiguous disease 3 or more disc space/spinal segments 3 2 disc spaces/spinal segments 2 1 disc space/spinal segments 1 No disc space (central disease) 0 Intervertebral/Paravertebral abscess Presence 1 Absence 0 Total score: <7: stable. 7 10: impending instability. >10: unstable. The current scoring system is a dynamic guide for spinal stability and a higher score represents instability at a particular stage of the disease which may change with time.(min. 0 &max. 21) 19 ADD A FOOTER
