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Spinal infection: state of the art and management algorithm

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Abstract

Introduction

Spinal infection is a rare pathology although a concerning rising incidence has been observed in recent years. This increase might reflect a progressively more susceptible population but also the availability of increased diagnostic accuracy. Yet, even with improved diagnosis tools and procedures, the delay in diagnosis remains an important issue. This review aims to highlight the importance of a methodological attitude towards accurate and prompt diagnosis using an algorithm to aid on spinal infection management.

Methods

Appropriate literature on spinal infection was selected using databases from the US National Library of Medicine and the National Institutes of Health.

Results

Literature reveals that histopathological analysis of infected tissues is a paramount for diagnosis and must be performed routinely. Antibiotic therapy is transversal to both conservative and surgical approaches and must be initiated after etiological diagnosis. Indications for surgical treatment include neurological deficits or sepsis, spine instability and/or deformity, presence of epidural abscess and upon failure of conservative treatment.

Conclusions

A methodological assessment could lead to diagnosis effectiveness of spinal infection. Towards this, we present a management algorithm based on literature findings.

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Acknowledgments

Special acknowledgments to Professor António Oliveira and Dr. Jorge Seabra (Hospital Geral de Santo António, Porto) and Dr. Pedro Varanda (Hospital de Braga, Braga) for their contributions to the manuscript.

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Authors and Affiliations

  1. Orthopedic Surgery Department, Hospital de Braga, Sete Fontes-São Victor, 4710-243, Braga, Portugal

    Rui M. Duarte

  2. Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4709-057, Braga, Portugal

    Rui M. Duarte

  3. Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA

    Alexander R. Vaccaro

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Duarte, R.M., Vaccaro, A.R. Spinal infection: state of the art and management algorithm. Eur Spine J 22, 2787–2799 (2013). https://doi.org/10.1007/s00586-013-2850-1

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