{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T14:24:52Z","timestamp":1768400692415,"version":"3.49.0"},"reference-count":99,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Discitis and osteomyelitis are seen in end-stage renal disease (ESRD) patients due to repeated vascular access for hemodialysis and urinary tract infections leading to recurrent bacteremia. Discitis and osteomyelitis are underdiagnosed due to the nonspecific initial presentation of back pain. In this article, we review the literature for better understanding of the problem and the importance of early diagnosis by primary care physicians and nephrologists. In addition, we discuss the decision-making, follow-up, management, and neurological outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>A detailed PubMed search was performed using the following terms: \u201cend stage renal disease (ESRD)\u201d and \u201cchronic renal failure (CRF),\u201d combined with \u201cspine infections,\u201d \u201cspondylodiscitis,\u201d \u201cdiscitis,\u201d and \u201costeomyelitis.\u201d Search results were limited to articles written in English, case reports, and case series from 1973 to 2012. Editorials, reviews, and commentaries were excluded. Only studies involving human patients were included. The authors also included 4 patients from their own patient population.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>A total of 30 articles met the inclusion criteria. Including the 4 patients from the authors\u2019 patient population, 212 patients with spine infections and maintenance dialysis were identified. The patients\u2019 ages ranged from 38 to 78 years. The duration of dialysis ranged from a few days to 16 years. The time from onset of back pain to diagnosis ranged from 3 days to 6 months. The most common causative organism was <jats:italic>Staphylococcus aureus<\/jats:italic>, followed by <jats:italic>Staphylococcus epidermidis<\/jats:italic> and gram-negative bacteria. Most of the patients were treated with antibiotics alone (76.8%), although surgery was indicated when patients presented with neurological deficits (p &lt; 0.011). Approximately one-quarter of the patients developed neurological deficits, with devastating consequences. Fever and neurological deficits at presentation, culture positive for methicillin-resistant <jats:italic>S. aureus<\/jats:italic>, and age &gt; 65 years were highly correlated with mortality in our analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Several risk factors lead to failure of antibiotics and progression of disease in patients with ESRD. Challenges to diagnosis include vague presenting symptoms, co-existing destructive spondyloarthropathy, poor immune response, chronic elevations of inflammatory markers, and recurrent bacteremia. Infectious processes are more likely to cause permanent neurological deficits than transient deficits. The authors recommend close observation and serial imaging of these patients for early signs of neurological deficits. Any signs of disease progression will require aggressive surgical debridement.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.9.spine18824","type":"journal-article","created":{"date-parts":[[2019,2,27]],"date-time":"2019-02-27T01:12:26Z","timestamp":1551229946000},"page":"674-682","source":"Crossref","is-referenced-by-count":21,"title":["Spondylodiscitis in end-stage renal disease: a systematic review"],"prefix":"10.3171","volume":"30","author":[{"given":"Karthik","family":"Madhavan","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Miami, Miami, Florida; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lee Onn","family":"Chieng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beaumont Health System, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie L.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami, Miami, Florida; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami, Miami, Florida; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Hemodial Int","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1111\/j.1542-4758.2008.00310.x","article-title":"Infective spondylodiscitis in patients on high-flux hemodialysis and on-line hemodiafiltration","volume":"12","author":"Abid S","year":"2008","unstructured":"Abid S, DE Silva S, Warwicker P, Farrington K: Infective spondylodiscitis in patients on high-flux hemodialysis and on-line hemodiafiltration. 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