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Oseodiscita Mandell
Oseodiscita Mandell
has a limited role and may give the impression of clinical progression
even though there is otherwise clinical improvement.60 We
advocate the use of follow-up MRI in patients with persistent elevation
of inflammation markers, in patients with persistent pain, or in
patients who develop new neurologic signs or symptoms.60
Early postoperative hardware-associated spine infection is treated
initially with surgical dbridement and retention of the hardware.
Removal of spinal hardware in this situation would compromise the
stability of the spine and the spinal cord. In this setting, surgical
dbridement is followed by a course of parenteral antimicrobial
therapy (see Table 103-3).61 Although not recommended by all
experts,
parenteral antimicrobial therapy at our institution is typically followed
by the use of long-term oral antimicrobial suppression in this situation.
61 Long-term antimicrobial suppression should be continued until
there is radiologic evidence of bone vertebral fusion. This modality is
highly successful in our institution. Complete bone remodeling and
fusion typically are complete after 2 years. At that time, long-term oral
suppression may be discontinued, with a low risk of recurrence. If
there is recurrence, the spinal hardware can be removed without
compromising
the stability of the spine.61 Successful therapy of late postoperative
hardware-associated spine infection often involves removal
of the hardware followed by a course of antimicrobial therapy (