Spondylitis – Spondylodiszitis – ein aktuelles Update

Zusammenfassung

Die Spondylodiszitis ist eine Infektion der Bandscheiben mit einer nachfolgenden Infektion der benachbarten Wirbelkörper. Hauptursache sind 3 Erregergruppen: Bakterien (pyogene Infektion), Tuberkuloseerreger und Pilze (granulomatöse Infektion) und Parasiten. Bei der pyogenen Spondylodiszitis dominieren meist Monoinfektionen mit Staphylococcus aureus bei einer Häufigkeit bis zu 80%. Die Letalität liegt bei der Spondylodiszitis bei 2 – 3%. Tuberkulöse Infektionen sind häufig mit Psoas- und paravertebralen Abszessen assoziiert. In bis zu 50% der Patienten werden neurologische Ausfälle registriert. Zur mikrobiologischen Diagnostik werden Blutkulturen für aerobe und anaerobe Keime eingesetzt. Die histologische Untersuchung führt jedoch signifikant häufiger zu einem positiven Erregernachweis. Hinsichtlich Genauigkeit ergibt sich eine deutliche Überlegenheit der 16S-rRNA-PCR im Vergleich zur mikrobiologischen Untersuchung von Gewebeproben. Das MRT zeigt eine hohe Sensitivität und Spezifität und ist daher den anderen radiologischen Methoden überlegen. Die Beseitigung der Infektion, die Verminderung der schmerzhaften Beschwerden sowie die Wiederherstellung und Bewahrung von Struktur bzw. Funktion der Wirbelsäule gelten als Hauptziele jeder Behandlungsmaßnahme. Eine standardisierte Antibiotikatherapie der Spondylodiszitis ist bisher nicht eindeutig definiert. Entscheidend sind der Erregernachweis und eine entsprechende gezielte Antibiotikatherapie. Die antibiotische Therapie sollte zunächst 2 – 4 Wochen intravenös verabreicht werden. Anschließend ist eine Umstellung auf eine orale Gabe für 6 – 12 Wochen vorzusehen. Beim Nachweis antibiotikaresistenter Infektionen mit neurologischen Ausfällen wird empfohlen, ein chirurgisches Vorgehen mit sorgfältigem Débridement und Instrumentation vorzunehmen sowie eine Nachbehandlung mit intravenös verabreichten Antibiotika über 3 Wochen mit anschließend 3-monatiger oraler Antibiotikabehandlung zu verordnen. Chirurgische Eingriffe sind indiziert bei neurologischen Defiziten, progressiver Zunahme spinaler Deformierungen, Versagen der konservativen Therapie mit unzureichender Schmerzlinderung und unsicherer Keimidentifizierung. Die Auswahl des Operationsverfahrens sollte hauptsächlich nach dem Ausmaß der Knochendestruktion, der Lokalisation und den individuellen Gegebenheiten bei den Patienten richten. Eine gute Prognose kann gestellt werden, wenn CRP und BSG in den ersten Wochen deutlich abfallen.

Schlüsselwörter

Spondylodiszitis - Spondylitis - Osteomyelitis - Infektion

• References/Literatur

• 1 Tayles N, Buckley HR. Leprosy and tuberculosis in Iron Age Southeast Asia?. Am J Phys Anthropol 2004; 125: 239-256
• 2 Schultz M. Microscopic investigation in fossil hominoidea: a clue to taxonomy, functional anatomy, and the history of diseases. Anat Rec 1999; 25: 225-232
• 3 Witas HW, Donoghue HD, Kubiak D. et al. Molecular studies on ancient M. tuberculosis and M. leprae: methods of pathogen and host DNA analysis. Eur J Clin Microbiol Inf Dis 2015; 34: 1733-1749
• 4 Wimmer C, Stöckl B. Die konservative Behandlung. In: Hendrich C, Frommelt L, Eulert J. Hrsg. Septische Knochen- und Gelenkchirurgie. Berlin, Heidelberg, New York: Springer; 2004: 171-183
• 5 Döhler R, Konstantinou L. Die Skelett-Tuberkulose – eine der ältesten Erkrankungen der Menschheit. Chirurgische Allgemeine 2015; 16: 556-558
• 6 Pott P. Remarks on that kind of palsy of the lower limbs which is frequently found to accompany a curvature of the spine, and is supposed to be caused by it. Medical Classics 1936; Vol 1. Baltimore: William & Wilkins; 1936
• 7 Wilensky AO. Osteomyelitis of the vertebrae. Ann Surg 1929; 89: 561-570
• 8 Compere EL, Garrison M. Correlation of pathologic and roentgenologic findings in tuberculosis and pyogenic infections of the vertebrae. Ann Surg 1936; 104: 1038-1067
• 9 Rauschmann MA, Thomann KD, Schwetlick G. et al. Vom „feuchten Beinfraß“ zur beherrschbaren Komplikation. Orthopäde 2004; 33: 389-396
• 10 Walter G, Kemmerer M, Kappler C. et al. Treatment Algorithms for Chronic Osteomyelitis. Dtsch Arztebl Int 2012; 109: 257-264
• 11 Lee KY. Comparison of Pyogenic Spondylitis and Tuberculous Spondylitis. Asian Spine J 2014; 8: 216-223
• 12 Shousha M, Heyde C, Boehm H. Cervical spondylodiscitis: change in clinical picture and operative management during the last two decades. Eur Spine J 2015; 24: 571-576
• 13 Zimmerli W. Clinical practice Vertebral Osteomyelitis. N Engl J Med 2010; 362: 1022-1029
• 14 Eysel P, Peters KM. Spondylodiszitis. In: Peters KM, Klosterhalfen B. Hrsg. Bakterielle Infektionen der Knochen und Gelenke. Stuttgart: Enke; 1997: 52-93
• 15 Cramer J, Haase N, Behre I. et al. Spondylitis und Spondylodiszitis. Trauma und Berufskrankheit 2003; 5: 336-341
• 16 Lee CY, Wu MH, Cheng CC. et al. Comparison of gram-negative and gram-positive haematogenous pyogenic spondylodiscitis: clinical characteristics and outcomes of treatment. BMC Infectous Dis 2016; 16: 735
• 17 Zarghooni K, Röllinghhoff M, Sobottke R. et al. Treatment of spondylodiscitis. Int Orth 2012; 36: 405-411
• 18 Sobottke R, Seifert H, Fätkenheuer G. et al. Current diagnosis and treatment of spondylodiscitis. Dtsch Arztebl Int 2008; 105: 181-187
• 19 Kehrer M, Pedersen C, Jensen TG. et al. Increased short- and long-term mortality among patients with infectious spondylodiscitis compared with a reference population. Spine J 2015; 15: 1233-1240
• 20 Pigrau C, Almirante B, Flores X. et al. Spontaneous pyogenic vertebral osteomyelitis and endocartditis: incidence, risk factors, and outcome. Am J Med 2005; 118: 1287
• 21 Mylona E, Samarkos M, Kakalou E. et al. Pyogenic vertebral osteomyelitis. A systematic review of clinical characteristics. Semin Arthritis Rheum 2009; 39: 10-17
• 22 Fantoni M, Trecarichi EM, Rossi B. et al. Epidemiological and clinical features of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci 2012; 16: 2-7
• 23 Nasto LA, Colangelo D, Rossi B. et al. Post-operative Spondylodiscitis. Eur Rev Med Pharmacol Sci 2012; 16: 50-57
• 24 Urrutia J, Zamora T, Campos M. Cervical pyogenic spinal infections: are they more severe diseases than infections in other vertebral locations?. Eur Spine J 2013; 22: 2815-2820
• 25 Aagaard T, Roed C, Dragsted C. et al. Microbiological and therapeutic challenges in infectious spondylodiscitis: a cohort study of 100 cases, 2006–2011. Scand J Infect Dis 2013; 45: 417-424
• 26 Merino P, Candel FJ, Gestoso I. et al. Microbiological diagnosis of spinal tuberculosis. Int Orthop 2012; 36: 233-238
• 27 Duarte RM, Vaccaro AR. Spinal infection: state of the art and management algorithm. Eur Spine J 2013; 22: 2787-2799
• 28 Kwon JW, Hyun SJ, Han SH. et al. Pyogenic Vertebral Osteomyelitis: Clinical Features, Diagnosis, and Treatment. Korean J Spine 2017; 14: 27-34
• 29 Butler JS, Shelly MJ, Timlin M. et al. Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center. Spine (Phila Pa 1976) 2006; 31: 2695-2700
• 30 Müller EJ, Russe OJ, Muhr G. Osteomyelitis der Wirbelsäule. Orthopäde 2004; 33: 305-315
• 31 Govender S. Spinal infections. J Bone Joint Surg Br 2005; 87: 1454-1458
• 32 Sendi P, Bregenzer T, Semmerli W. Spinal epidural abscess in clinical practice. QJM 2008; 1001: 1-12
• 33 Cottle L, Riordan T. Infectious spondylodiscitis. J Infect 2008; 56: 401-412
• 34 Priest DH, Peacock JE. Haematogenous vertebral osteomyelitis due to Staphylococcus aureus in the adult: clinical features and therapeutic outcomes. South Med J 2005; 98: 854-862
• 35 Kim CJ, Kim EJ, Song KH. et al. Characteristics of culture-negative pyogenic spondylitis and tuberculous spondylitis: a retrospective study. BMC Infect Dis 2016; 16: 560
• 36 Park JH, Shin HS, Park JT. et al. Differentiation between Tuberculous Spondylitis and Pyogenic Spondylitis on MR Imaging. Korean J Spine 2011; 8: 283-287
• 37 Lam KS, Webb JK. Discitis. Hosp Med 2004; 65: 280-286
• 38 Jung N, Seifert H, Siewe J. et al. Spondylitis. Internist (Berl) 2013; 54: 945-953
• 39 Schimmer RC, Jeanneret C, Nunley P. et al. Osteomyelitis of the cervical spine: a potentially dramatic disease. J Spinal Disord Tech 2002; 15: 110-117
• 40 Brown R, Hussain M, McHugh K. et al. Discitis in young children. J Bone Joint Surg Br 2001; 83: 106-111
• 41 Kang BU, Lee SH, Ahn Y. et al. Surgical site infection in spinal surgery: detection and management based on serial C-reactive protein measurements. J Neurosurg Spine 2010; 13: 158-164
• 42 Fleege C, Wichelhaus TA, Rauschmann M. Systemic and local antibiotic therapy of conservative and operative treatment of spondylodiscitis. Orthopäde 2012; 41: 727-735
• 43 Gasbarrini A, Boriani L, Salvadori C. et al. Biopsy for suspected spondylodiscitis. Eur Rev Med Parmacol Sci 2012; 16: 26-34
• 44 Nam KH, Song GS, Han IH. et al. Diagnostic Value of Biopsy Techniques in Lumbar Spondylodiscitis: Percutaneous Needle Biopsy and Open Biopsy. Korean J Spine 2011; 8: 267-271
• 45 Kumar R, Das RK, Mahapatra AK. Role of interferon gamma release assay in the diagnosis of Pott disease. J Neurosurg Spine 2010; 12: 462-466
• 46 Delogu G, Zumbo A, Fadda G. Microbiological and immunological diagnosis of tuberculous spondylodiscitis. Eur Rev Med Pharmacol Sci 2012; 1 (Suppl. 02) 73-78
• 47 Fenollar F, Roux V, Stein A. et al. Analysis of 525 samples to determine the usefulness of PCR amplification and sequencing of the 16S rRNA gene for diagnosis of bone and joint infections. J Clin Microbiol 2006; 44: 1018-1028
• 48 Mörk S, Kothe R, Ulrich C. Infektionen der Wirbelsäule. Orthopädie & Unfallchir 2011; 6: 514-518
• 49 Frangen TM, Kälicke T, Gottwald M. et al. Die operative Therapie der Spondylodiszitis. Eine Analyse von 78 Patienten. Unfallchirurg 2006; 109: 743-753
• 50 Nolla JM, Ariza J, Gomez-Vaquero C. et al. Spontaneous pyogenic vertebral osteomyelitis in nondrug users. Semin Arthritis Rheum 2012; 31: 271-278
• 51 Woertgen C, Rothoerl RD, Englert C. et al. Pyogenic spinal infections and according to the 36-item Short Form Health Survey. J Neurosurg Spine 2006; 4: 441-446
• 52 Loibl M, Stoyanov L, Doenitz C. et al. Outcome-related co-factors of clinically-suspected spinal infection. J Infect 2009; 58: 259-265
• 53 Lim MR, Lee JY, Vaccaro AR. Surgical infections in the traumatized spine. Clin Orthop Relat Res 2006; 444: 114-119
• 54 An HS, Seldomridge JA. Spinal infections: diagnostic tests and imaging studies. Clin Orthop Relat Res 2006; 444: 27-33
• 55 Uckay I, Dinh A, Vauthey L. et al. Spondylodiscitis due to Propionibacterium acnes: report of twenty-nine cases and a review of the literature. Clin Microbiol Infect 2010; 16: 353-358
• 56 Yu SH, Kim DH, Kim HS. et al. Infectious Spondylodiscitis by uncommon Pathogens: A Pitfall of Empirical Antibiotics. Korean J Spine 2016; 13: 97-101
• 57 Angani G, Amanullah K, Rauniyar RK. Potts Spine, Diagnostic, Imaging, Modalities, and Technology Advancement. N Am J Med Sci 2013; 5: 404-411
• 58 Trecarichi EM, Di Meco E, Mazotta V. et al. Tuberculosis spondylodiscitis: epidemiology, clinical features, treatment, and outcome. Eur Rev Med Pharmacol Sci 2012; 16: 58-72
• 59 Moo MS. Tuberculosis of the spine: Controversies and new challenge. Spine (Phila Pa 1976) 1997; 22: 1791-1797
• 60 Tuli SM. General principles of osteoarticular tuberculosis. Clin Orthop 2002; 398: 11-19
• 61 Turunc T, Demiroglu YZ, Uncu H. et al. A comparative analysis of tuberculous, brucellar and pyogenic spontaneous spondylodiscitis patients. J Infect 2007; 55: 158-163
• 62 Li T, Liu T, Jiang Z. et al. Diagnosing pyogenic, brucella and tuberculous spondylitis using histopathology and MRI: A retrospective study. Exp Ther Med 2016; 12: 2069-2077
• 63 Yu LD, Feng ZY, Wang XW. et al. Fungal spondylodiscitis in a patient recovered from H7N9 virus infection. J Zheijang Univ Sci 2016; 17: 874-881
• 64 Skaf GS, Kanafani ZA, Araj GF. et al. Non-pyogenic infections of the spine. Int J Antimicrob Agents 2010; 36: 99-105
• 65 Sheik AF, Khosvari AD, Goodarzi H. et al. Pathogen identification in Suspected Cases of Pyogenic Spondylodyscitis. Front Cell Infect Microbiol 2017; 7: 60-69
• 66 Vahrenkamp B, Wenker W. Diagnosis of Spondylodiscitis. Audiopraxis 2013; 6: 161-174
• 67 Harada Y, Tokuda O, Matsunaga N. Magnetic resonance imaging characteristics of tuberculous spondylitis vs. pyogenic spondylitis. Clin Imaging 2008; 32: 303-309
• 68 Chang MC, Wu HAT, Lee CH. et al. Tuberculous spondylitis and pyogenic spondylitis: comparative magnetic resonance imaging features. Spine (Phila Pa 1976) 2006; 31: 782-788
• 69 Yilmaz U. Spondylodiszitis. Radiologe 2011; 51: 772-778
• 70 Ramadani N, Dedushi K, Kabashi S. et al. Radiologic Diagnosis of Spondylodiscitis, Role of Magnetic Resonance. Acta Inform Med 2017; 25: 54-57
• 71 Cheung WY, Luk KD. Pyogenic spondylitis. Int Orthop 2012; 36: 397-404
• 72 Frei M, Bialecki J, Wieczorek J. et al. Magnetic Resonance Imaging in Differential Diagnosis of Pyogenic Spondylodiscitis and Tuberculous Spondylodiscitis. Pol J Radiol 2017; 82: 71-87
• 73 Leone A, DellʼAtti C, Magarelli N. et al. Imaging of spondylodiscitis. Eur Rev Med Pharmacol Sci 2012; 16 (Suppl. 02) 8-19
• 74 Jung NY, Jee WH, Ha KY. et al. Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. AJR Am J Roentgenol 2004; 182: 1405-1410
• 75 Diehn FE. Imaging of spine infection. Radiol Clin North Am 2012; 50: 777-798
• 76 Galhotra RD, Jain T, Sandhu P. et al. Utility of magnetic resonance imaging in the differential diagnosis of tubercular and pyogenic spondylodiscitis. J Nat Sci Biol Med 2015; 6: 388-393
• 77 Gemmel F, Rijk PC, Collins JMP. et al. Expanding role of 18F-fluoro-d-deoxyglucose PET and PET/CT in spinal infections. Eur Spine J 2010; 19: 540-557
• 78 Dauchy FA, Dutertre A, Lawson-Ayayi S. et al. Interest of [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography for the diagnosis of relapse in patients with spinal infection: a prospective study. Clin Microbiol Infect 2016; 22: 438-443
• 79 Stumpe K, Zanetti M, Weishaupt D. et al. FDG Positron Emission Tomography for differentiation of degenerative and infectious endplate abnormalities in the lumbar spine detected on MR-imaging. AJR Am J Roentgenol 2002; 179: 1151-1157
• 80 Homagk L, Homagk N, Klauss JR. et al. Spondylodiscitis severity code: scoring system for the classification and treatment of non-specific spondylodiscitis. Eur Spine J 2016; 25: 1012-1020
• 81 Homagk N, Jarmuzek T, Meisel HJ. et al. Advantages of IT-based clinical pathways in surgical treatment of non-specific spondylodiscitis. J Hospital Administ 2016; 5: 19-27
• 82 Pola E, Autore G, Formica VM. et al. New Classification for the treatment of pyogenic spondylodiscitis: validation study on a population of 250 patients with follow-up od 2 years. Eur Spine J 2017;
• 83 Berbari EF, Kanj SS, Kowalski TJ. et al. Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clin Infect Dis 2015; 61: e26
• 84 Bernard L, Dinh A, Ghout I. et al. Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial. Lancet 2015; 385: 875-882
• 85 Roblot F, Besnier JM, Juhel L. et al. Optimal duration of antibiotic therapy in vertebral osteomyelitis. Semin Arthritis Rheum 2007; 36: 269-277
• 86 Park KH, Cho OH, Lee JH. et al. Optimal Duration of Antibiotic Therapy in Patients with Haematogenous Vertebral Osteomyelitis at low Risk and High Risk of Recurrence. Clin Infect Dis 2016; 62: 1262-1269
• 87 Rutges JP, Kempen DH, van Dijk M. et al. Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review. Eur Spine J 2016; 25: 983-999
• 88 Bettini N, Girardo M, Dema E. et al. Evaluation of conservative treatment of non-specific spondylodiscitis. Eur Spine J 2009; 18 (Suppl. 01) 143-150
• 89 Gouliouris T, Aliyu SH, Brown NM. et al. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother 2010; 65: 11-24
• 90 Caldera G, Cahueque M, Cobar A. et al. Fungal Spondylodiscitis: Review. J Spine 2016; 5: 2-6
• 91 Koehler P, Cornely OA. Contemporary Strategies in the Prevention and Management of Fungal Infections. Infect Dis Clin North Am 2016; 30: 265-275
• 92 Pettit NN, Carver PL. Isavuconazole: A New Option for the Management of Invasive Fungal Infections. Ann Pharmacother 2015; 49: 825-842
• 93 Alp E, Doganay M. Current therapeutic strategy in spinal brucellosis. Int J Infect Dis 2008; 12: 573-577
• 94 Alavi SM, Alavi L. Treatment of brucellosis: a systematic review of studies in recent twenty years. Caspian J Intern Med 2013; 4: 636-641
• 95 Zarghooni K, Beyer F, Siewe J. Orthesenbehandlung bei akuten und chronischen Erkrankungen der Hals- und Lendenwirbelsäule. Dtsch Ärztebl Int 2013; 110: 737-742
• 96 Dölken M. Physiotherapie in der Orthopädie. Stuttgart: Thieme; 2015: 737-749
• 97 Guerado E, Cervan AM. Surgical treatment of spondylodiscitis. An update. Int Orthop 2012; 36: 413-420
• 98 Nasto LA, Colangelo D, Mazzotta V. et al. Is posterior percutaneous screw-rod instrumentation a safe and effective alternative approach to TLSO rigid bracing for single-level pyogenic spondylodiscitis? Results of a retrospective cohort analysis. Spine J 2014; 14: 1139-1146
• 99 Shetty AP, Aiyer SN, Kanna R. et al. Pyogenic lumbar spondylodiscitis treated with transforaminal lumbar interbody fusion: safety and outcomes. Int Orthop 2016; 40: 1163-1170
• 100 Chen WH, Jiang LS, Dai LY. Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation. Eur Spine J 2007; 16: 1307-1316
• 101 Tschugg A, Hartmann S, Lener S. et al. Minimally invasive spine surgery in lumbar spondylodiscitis: a retrospective single-center analysis of 67 cases. Eur Spine J 2017;
• 102 Valancius K, Hansen ES, Hoy K. et al. Failure modes in conservative and surgical management of infectious spondylodiscitis. Eur Spine J 2013; 22: 1837-1844
• 103 Shihan E, Janssen I, Wostrak M. et al. Spondylodiscitis by drug-multiresistant bacteria: a single-center experience of 25 cases. Spine J 2014; 14: 2826-2834
• 104 Madert J, Liem M, Frosch KH. et al. Dorsolateraler Zugang und interkorporelle Spondylodese bei Spondylodiszitis der Brust- und Lendenwirbelsäule (TLIF-Technik). Oper Orthop und Traumatol 2013; 25: 262-272
• 105 Lin TY, Tsai TT, Lu ML. et al. Comparison of two-stage open versus percutaneous pedicle screw fixation in treating pyogenic spondylodiscitis. BMC Musculoskelet Disord 2014; 15: 443 doi:10.1186/1471-2474-15-443
• 106 Turel MK, Kerolus M, Deutsch H. The role of minimally invasive spine surgery in the management of pyogenic spinal discitis. J Craniovertebr Junction Spine 2017; 8: 39-43
• 107 Koptan W, El-Miligui Y, El-Sharkawi M. Single stage anterior reconstruction using titanium mesh cages in neglected kyphotic tuberculous spondylodiscitis of the cervical spine. Eur Spine J 2011; 20: 308-313
• 108 Tschöke SK, Fuchs H, Schmidt O. et al. Single-stage debridement and spinal fusion using PEEK cages through a posterior approach for eradication of lumbar pyogenic spondylodiscitis; a safe treatment strategy for a detrimental condition. Pat Saf Surg 2015; 9: 35 doi:10.1186/s13037-015-0083-4
• 109 Linhardt O, Matussek J, Refior HJ. et al. Long-term results of ventro-dorsal versus ventral instrumentation fusion in the treatment of Spondylitis. Int Orthop 2007; 31: 113-119
• 110 Korovessis P, Repantis T, Hadjipavlou AG. Haematogenous pyogenic infection: current perceptions. Orthopedics 2012; 35: 885-892
• 111 Lin CP, Ma HL, Wang ST. et al. Single results of long posterior fixation with short fusion in the treatment of pyogenic spondylodiscitis of the thoracic and lumbar spine: a retrospective study. Spine (Phila Pa 1976) 2012; 37: E1572-E1579
• 112 Lin Y, Li F, Chen W. et al. Single-level lumbar pyogenic spondylodiscitis treated with mini-open anterior debridement and fusion in combination with posterior percutaneous fixation via a modified anterior lumbar interbody fusion approach. J Neurosurg Spine 2015; 23: 747-753
• 113 Bostelmann R, Steiger HJ, Scholz AO. First Report on treating spontaneous infectious spondylodiscitis of lumbar spine with posterior debridement, posterior instrumentation and an injectable calcium sulfate/hydroxyapatite composite eluting gentamicin; a case report. J Med Case Rep 2016; 10: 349
• 114 Mobbs RJ, Maharai M, Rao PJ. Clinical outcome and fusion rates following anterior lumbar interbody fusion with bone graft substitute i-Factor, an anorganic bone matrix/P-15 composite. J Neurosurg Spine 2014; 21: 867-876
• 115 Blizzard DJ, Hills CP, Isaacs RE. et al. Extreme lateral interbody fusion with posterior instrumentation for spondylodiscitis. J Clin Neurosci 2015; 22: 58-61
• 116 Rieger B, Jiang H, Ruess D. et al. First clinical results of minimally invasive vector lumbar interbody fusion (MIS-VLIF) in spondylodiscitis and concomitant osteoporosis: a technical note. Euro Spine J 2016;
• 117 Matsukawa K, Yato Y, Imabayashi H. et al. Biomechanical evaluation of lumbar pedicle screws in spondiolytic vertebrae: comparison of fixation strength between the traditional trajectory and a cortical bone trajectory. J Neurosurg Spine 2016; 24: 910-915
• 118 Matsumoto T, Mine T, Hayashi T. et al. CT Fluoroscopy-Guides Transsacral Intervertebral Drainage for Pyogenic Spondylodiscitis at the Lumbosacral Junction. Cardiovasc Intervent Radiol 2016; 40: 125-129
• 119 Kang DG, Holekamp TF, Wagner SC. et al. Intrasite vancomycin powder for the prevention of surgical site infection in spine surgery: a systematic literature review. Spine J 2015; 15: 702-770
• 120 Bakhsheshian J, Dahdaleh NS, Lam SK. et al. The use of vancomycin powder in modern spine surgery: systematic review and meta-analysis of the clinical evidence. World Neurosurg 2015; 83: 816-823
• 121 Dai LY, Jiang LS, Wang W. et al. Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis. Spine (Phila Pa 1976) 2005; 30: 2342-2349
• 122 Tosun B, Erdemir C, Yonga O. et al. Surgical treatment of thoracolumbar tuberculosis: a retrospective analysis of autogenous grafting versus expandable cages. Eur Spine J 2014; 23: 2299-2306
• 123 Pola E, Rossi B, Nasto LA. et al. Surgical treatment of tuberculous spondylodiscitis. Eur Rev Med Pharmacol Sci 2012; 16 (Suppl. 02) 79-85
• 124 Mummaneni PV, Dhali SS, Eck JC. et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 11: Interbody techniques for lumbar fusion. J Neurosurg Spine 2014; 21: 67-74
• 125 McHenry MC, Easley KA, Locker GA. Vertebral osteomyelitis: long term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis 2002; 34: 1342-1350
• 126 Bornemann R, Müller-Broich JD, Deml M. et al. Diagnose und Behandlung der Spondylitis/Spondylodiszitis in der Klinikroutine. Z Orthop Unfall 2015; 153: 540-545
• 127 Kremers H, Nwojo ME, Ransom JR. et al. Trends in the Epidemiology of Osteomyelitis – A Population-Based Study, 1969 to 2009. J Bone Joint Surg Am 2015; 9: 837-845
• 128 Lehner B, Akbar M, Rehnitz C. et al. Standards der mikrobiologische Diagnostik der Spondylodiszitis. Orthopäde 2012; 41: 702-710