Professor And Consultant Orthopedic - PowerPoint Presentation

1. 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 -1996Dr. SAMEER A. KITAB

2. Clinical Characteristics of 288 Patients Presenting With Hematogenous Spine InfectionsWith Special Emphasis on Instability.Prospective Observational StudyKARAM. M.B.Ch.B; Spine FellowSAMEER KITAB, M.D

3. 3ADD A FOOTERA 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.Study design and demographics

4. 4ADD A FOOTERSpondylodiscitis was defined by a combination of characteristicradiological changes of the intervertebral disc inmagnetic resonance imaging (MRI) and/or computed tomography(CT) scans, plain radiographs and clinical findings including elevatedCRP levels, elevated WBC, back and/or neck pain as well asfever. 89 cases with cervicodorsal spine infections.189 cases of lumbosacral spine infections.Definition:

5. 5ADD A FOOTERMultilevel 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.TB vs Non-TB

6. 6ADD A FOOTERCervicodorsal: 89 casesMALES: 48.3%FEMALES: 51.7%Mean Age at presentation: 46.7 year age (6-75 years old)Lumbosacral: 189 casesMALES: 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.Demographics:

7. 7ADD A FOOTERCervicodorsal: 89 casesTB spondylodiscitis: 59.6%Pyogenic spondylodiscitis: 30.7%Hydatid disease: 9.1%Lumbosacral: 189 casesTB 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.Infections types according to pathogens:

8. 8ADD A FOOTERCervicodorsal: 89 casesD.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 casesD.M: 11.7%Renal Impairment: 3.6%Stroke: 5%Co-morbidities:

9. 9ADD A FOOTERCervicodorsal cases (89 case): TB spondylodiscitis: 262 days Pyogenic cases: 31 daysLumbosacral cases (189): TB spondylodiscitis: 98 days. Pyogenic cases: 51.7 days.Time lag behind definitive diagnosis of spine infections is more with TB spondylodiscitis. Time lag from presentation to definite diagnosis:

10. 10ADD A FOOTERRemote surgery predisposing to pyogenic spine infectionsCervicodorsal: 89 casesNo 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%Lumbosacral: 189 casesNo 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%

11. 11ADD A FOOTERSpinal Instability Spondylodiscitis Score (SISS)—a novel classification systemfor spinal instability in spontaneous spondylodiscitisFriederike Schomig · Zhao Li · Lena Perka · et al.European Spine Journal (2022) 31:1099–1106Georg Schmorl prize of the German spine society (DWG) 2021:

12. 12ADD A FOOTER Parameters of the Spinal Instability Spondylodiscitis Score (SISS) LocationJunctional (occiput-C2, C7-T2, T11-L1, L5-S1) 3Mobile Spine (C3-6, L2-4) 2Semirigid (T3-10) 1Rigid (S2-5) 0 Bone lesion> 50% vertebral body involvement 4< 50% vertebral body involvement 2Endplate involvement 1Intact endplates 0 Spinal alignmentSubluxation/Translation 4De novo deformity (kyphosis/scoliosis) 2Normal alignment 0 Mechanical painYes 3Occasional pain but not mechanical 1Pain-free lesion 0

13. 13ADD A FOOTERBased on SINS score of spinal Mets DiseaseA 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 frominstability caused by traumatic injuries as it develops overa period of time rather than acutelySpinal Instability Spondylodiscitis Score (SISS)

14. 14ADD A FOOTERThe proposed classificationsystem is the first to aid spine surgeonsin deciding whether surgical treatment is indicated in spinalinfections based on biomechanics. Parameters of the Spinal Instability Spondylodiscitis Score (SISS)

15. 15ADD A FOOTER Development of Tuberculosis Spine Instability Score (TSIS) An Evidence-Based and Expert Consensus-Based Content Validation Study Among Spine SurgeonsKaustubh Ahuja, MS,a Pankaj Kandwal, MS, et al.SPINE Volume 47, Number 3, pp 242–2, 2021.Tuberculosis Spine InstabilityScore (TSIS)

16. 16ADD A FOOTER Necessitating a different and specific scoring system to diagnose instability.TB Differs:1-The pattern of spinal involvement, 2-presence of simultaneousdestruction and healing processes, 3- unique patternof neurological involvement4-deformityTuberculosis Spine InstabilityScore (TSIS)

17. 17ADD A FOOTERTuberculosis Spine InstabilityScore (TSIS) Age <5 years 35–10 years 210–15 years 1>15 years 0 LocationJunctional (occiput–C2, C7–T2, T10–L2, L5–S1) 2Mobile spine (C3–C6, L2–L5) 1Rigid (rest of the spine) 0 PainPain even at rest, pain on loading and movement or ‘‘instability catch’’ with no relief on recumbency 3Pain on loading and movement or ‘‘instability catch’’ with relief on recumbency 2Occasional pain or not mechanical 1Pain-free lesion 0

18. 18ADD A FOOTERTuberculosis Spine InstabilityScore (TSIS) Adjusted kyphotic deformity>60 Degrees 330–60 Degrees 210–30 Degrees 1<10 Degrees 0 Vertebral body loss>1.5 30.75–1.5 2<0.75 0 Additional involvement of posterior spinal elementsBilateral facet joint involvement and destruction OR radiographically scoliosis, AP or lateral translation 3Unilateral facet joint involvement 2None 0

19. 19ADD A FOOTERTuberculosis Spine InstabilityScore (TSIS) Multifocal contiguous disease3 or more disc space/spinal segments 32 disc spaces/spinal segments 21 disc space/spinal segments 1No disc space (central disease) 0 Intervertebral/Paravertebral abscessPresence 1Absence 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)