{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:35:27Z","timestamp":1753893327753,"version":"3.41.2"},"reference-count":64,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T00:00:00Z","timestamp":1684368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The incidence of spondylodiscitis (SD) and isolated spinal epidural empyema (ISEE) has been increasing in the last decades, but the distinct differences between both entities are poorly understood. We aimed to evaluate the clinical phenotypes and long-term outcomes of SD and ISEE in depth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a chart review and analyzed data from our cohorts of consecutive SD and ISEE patients who were treated and assessed in detail for demographic, clinical, imaging, laboratory, and microbiologic characteristics at a university neurosurgical center in Germany from 2002 to 2021. Between-group comparisons were performed to identify meaningful differences in both entities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 208 patients (72 females: age 75 [75 32\u201390] y vs. 136 males: 65 [23\u201387] y, median [interquartile range], <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), of which 142 (68.3%) had SD and 66 (31.7%) had ISEE. Patients with SD were older than ISEE (ISEE: 62\u2005y vs. SD: 70\u2005y, <jats:italic>p<\/jats:italic>\u2009=\u20090.001). While SD was more common in males than females (males: <jats:italic>n<\/jats:italic>\u2009=\u2009101, 71.1% vs. females: <jats:italic>n<\/jats:italic>\u2009=\u200941, 28.9%, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), there was no sex-related difference in ISEE (males: <jats:italic>n<\/jats:italic>\u2009=\u200935, 53.0% vs. females: <jats:italic>n<\/jats:italic>\u2009=\u200931, 47.0%, <jats:italic>p<\/jats:italic>\u2009=\u20090.71). Obesity was more frequent in ISEE than in SD (ISEE: <jats:italic>n<\/jats:italic>\u2009=\u200929, 43.9% vs. SD: <jats:italic>n<\/jats:italic>\u2009=\u200937, 26.1%, <jats:italic>p<\/jats:italic>\u2009=\u20090.016). However, there were no between-group differences in rates of diabetes and immunodeficiency. In the entire study population, a causative pathogen was identified in 192 (92.3%) patients, with methicillin-susceptible staphylococcus aureus being most frequent (<jats:italic>n<\/jats:italic>\u2009=\u2009100, 52.1%) and being more frequent in ISEE than SD (ISEE: <jats:italic>n<\/jats:italic>\u2009=\u200943, 65.2% vs. SD: <jats:italic>n<\/jats:italic>\u2009=\u200957, 40.1%, <jats:italic>p<\/jats:italic>\u2009=\u20090.003). SD and ISEE occurred most frequently in the lumbar spine, with no between-group differences (ISEE: <jats:italic>n<\/jats:italic>\u2009=\u200925, 37.9% vs. SD: <jats:italic>n<\/jats:italic>\u2009=\u200965, 45.8%, <jats:italic>p<\/jats:italic>\u2009=\u20090.297). Primary infectious sources were identified in 145 patients (69.7%) and among this skin infection was most common in both entities (ISEE: <jats:italic>n<\/jats:italic>\u2009=\u200914, 31.8% vs. SD: <jats:italic>n<\/jats:italic>\u2009=\u200925, 24.8%, <jats:italic>p<\/jats:italic>\u2009=\u20090.418). Furthermore, epidural administration was more frequent the primary cause of infection in ISEE than SD (ISEE: <jats:italic>n<\/jats:italic>\u2009=\u200912, 27.3% vs. SD: <jats:italic>n<\/jats:italic>\u2009=\u20095, 4.9%, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). The most common surgical procedure in SD was instrumentation (<jats:italic>n<\/jats:italic>\u2009=\u200987, 61%) and in ISEE abscess evacuation (<jats:italic>n<\/jats:italic>\u2009=\u200963, 95%). Patients with ISEE displayed lower in-hospital complication rates compared to SD for sepsis (ISEE: <jats:italic>n<\/jats:italic>\u2009=\u200912, 18.2% vs. SD: <jats:italic>n<\/jats:italic>\u2009=\u200994, 66.2%, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), septic embolism (ISEE: <jats:italic>n<\/jats:italic>\u2009=\u20094\/48 cases, 8.3% vs. SD: <jats:italic>n<\/jats:italic>\u2009=\u200952\/117 cases, 44.4%, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), endocarditis (ISEE: <jats:italic>n<\/jats:italic>\u2009=\u20091\/52 cases, 1.9% vs. SD: <jats:italic>n<\/jats:italic>\u2009=\u200923\/125 cases, 18.4%, <jats:italic>p<\/jats:italic>\u2009=\u20090.003), relapse rate (ISEE: <jats:italic>n<\/jats:italic>\u2009=\u20094\/46, 8.7% vs. SD: <jats:italic>n<\/jats:italic>\u2009=\u200927\/92, 29.3%, <jats:italic>p<\/jats:italic>\u2009=\u20090.004), and disease-related mortality (ISEE: <jats:italic>n<\/jats:italic>\u2009=\u20091, 1.5% vs. SD: <jats:italic>n<\/jats:italic>\u2009=\u200911, 7.7%, <jats:italic>p<\/jats:italic>\u2009=\u20090.108). Patients with SD showed prolonged length of hospital stay (ISEE: 22 [15, 30] d vs. SD: 38 [29, 53] d, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001) and extended intensive care unit stay (ISEE: 0 [0, 4] d vs. SD: 3 [0, 12] d, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.002).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our 20-year experience and cohort analysis on the clinical management of SD and ISEE unveiled distinct clinical phenotypes and outcomes in both entities, with ISEE displaying a more favorable disease course with respect to complications and relapse rates as well as disease-related mortality.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2023.1200432","type":"journal-article","created":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T07:27:20Z","timestamp":1684394840000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical phenotyping of spondylodiscitis and isolated spinal epidural empyema: a 20-year experience and cohort study"],"prefix":"10.3389","volume":"10","author":[{"given":"Mido Max","family":"Hijazi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timo","family":"Siepmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim","family":"El-Battrawy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Glatte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilker","family":"Ey\u00fcpoglu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriele","family":"Schackert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tareq A.","family":"Juratli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dino","family":"Podlesek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,5,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1016\/j.idc.2005.07.009","article-title":"Adult osteomyelitis","volume":"19","author":"Calhoun","year":"2005","journal-title":"Infect Dis Clin North Am"},{"key":"B2","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1007\/s00701-018-3467-2","article-title":"Management of spinal infection: a review of the literature","volume":"160","author":"Lener","year":"2018","journal-title":"Acta Neurochir (Wien)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1093\/bmb\/ldw003","article-title":"Vertebral osteomyelitis in adults: an update","volume":"117","author":"Nickerson","year":"2016","journal-title":"Br Med Bull"},{"key":"B4","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1177\/197140091302600411","article-title":"Spinal epidural abscess: common symptoms of an emergency condition. A case report","volume":"26","author":"Rosc-Bereza","year":"2013","journal-title":"Neuroradiol J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1668","DOI":"10.1097\/00007632-200007010-00010","article-title":"Hematogenous pyogenic spinal infections and their surgical management","volume":"25","author":"Hadjipavlou","year":"2000","journal-title":"Spine (Phila Pa 1976)"},{"key":"B6","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1093\/qjmed\/hcq178","article-title":"Bacteraemia and subsequent vertebral osteomyelitis: a retrospective review of 125 patients","volume":"104","author":"Corrah","year":"2011","journal-title":"QJM"},{"key":"B7","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1055\/s-0032-1320022","article-title":"A staged treatment algorithm for spinal infections","volume":"74","author":"Stuer","year":"2013","journal-title":"J Neurol Surg A Cent Eur Neurosurg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"201","DOI":"10.3109\/23744235.2015.1103897","article-title":"Long-term prognosis and causes of death after spondylodiscitis: a Danish nationwide cohort study","volume":"48","author":"Aagaard","year":"2016","journal-title":"Infect Dis (Lond)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"ofw191","DOI":"10.1093\/ofid\/ofw191","article-title":"Spinal epidural abscess in adults: a 10-year clinical experience at a tertiary care academic medical center","volume":"3","author":"Artenstein","year":"2016","journal-title":"Open Forum Infect Dis"},{"key":"B10","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1016\/j.jinf.2013.11.011","article-title":"Increasing incidence of pyogenic spondylodiscitis: a 14-year population-based study","volume":"68","author":"Kehrer","year":"2014","journal-title":"J Infect"},{"key":"B11","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/j.spinee.2014.09.003","article-title":"Mortality, complication risk, and total charges after the treatment of epidural abscess","volume":"15","author":"Schoenfeld","year":"2015","journal-title":"Spine J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"875","DOI":"10.3238\/arztebl.2017.0875","article-title":"Spondylodiscitis: diagnosis and treatment options","volume":"114","author":"Herren","year":"2017","journal-title":"Dtsch Arztebl Int"},{"key":"B13","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1007\/s10067-008-1051-5","article-title":"CT-guided fine-needle aspiration in vertebral osteomyelitis: true usefulness of a common practice","volume":"28","author":"de Lucas","year":"2009","journal-title":"Clin Rheumatol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"E4","DOI":"10.3171\/2014.6.FOCUS14127","article-title":"Medical and surgical management of spinal epidural abscess: a systematic review","volume":"37","author":"Arko","year":"2014","journal-title":"Neurosurg Focus"},{"key":"B15","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.spinee.2014.06.008","article-title":"Predicting patients with concurrent noncontiguous spinal epidural abscess lesions","volume":"15","author":"Ju","year":"2015","journal-title":"Spine J"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e929","DOI":"10.5435\/JAAOS-D-19-00685","article-title":"Spinal epidural abscess: diagnosis, management, and outcomes","volume":"28","author":"Schwab","year":"2020","journal-title":"J Am Acad Orthop Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1030","DOI":"10.2106\/JBJS.17.00630","article-title":"Development of predictive algorithms for pre-treatment motor deficit and 90-day mortality in spinal epidural abscess","volume":"100","author":"Shah","year":"2018","journal-title":"J Bone Joint Surg Am"},{"key":"B18","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1007\/s10143-017-0829-9","article-title":"Primary acquired spondylodiscitis shows a more severe course than spondylodiscitis following spine surgery: a single-center retrospective study of 159 cases","volume":"41","author":"Tschugg","year":"2018","journal-title":"Neurosurg Rev"},{"key":"B19","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1089\/sur.2019.038","article-title":"Continuous epidural irrigation and drainage combined with posterior debridement and posterior lumbar inter-body fusion for the management of single-segment lumbar pyogenic spondylodiscitis","volume":"21","author":"Zhou","year":"2020","journal-title":"Surg Infect (Larchmt)"},{"key":"B20","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1093\/cid\/civ633","article-title":"Executive summary: 2015 infectious diseases society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults","volume":"61","author":"Berbari","year":"2015","journal-title":"Clin Infect Dis"},{"key":"B21","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1086\/313753","article-title":"Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis","volume":"30","author":"Li","year":"2000","journal-title":"Clin Infect Dis"},{"key":"B22","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1017\/S0950268807008850","article-title":"Epidemiology of vertebral osteomyelitis (VO) in France: analysis of hospital-discharge data 2002\u20132003","volume":"136","author":"Grammatico","year":"2008","journal-title":"Epidemiol Infect"},{"key":"B23","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.semarthrit.2008.03.002","article-title":"Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics","volume":"39","author":"Mylona","year":"2009","journal-title":"Semin Arthritis Rheum"},{"key":"B24","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1007\/PL00011954","article-title":"Spinal epidural abscess: a meta-analysis of 915 patients","volume":"23","author":"Reihsaus","year":"2000","journal-title":"Neurosurg Rev"},{"key":"B25","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1007\/s00264-011-1425-1","article-title":"Treatment of spondylodiscitis","volume":"36","author":"Zarghooni","year":"2012","journal-title":"Int Orthop"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.1086\/340102","article-title":"Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals","volume":"34","author":"McHenry","year":"2002","journal-title":"Clin Infect Dis"},{"key":"B27","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1053\/sarh.2002.29492","article-title":"Spontaneous pyogenic vertebral osteomyelitis in nondrug users","volume":"31","author":"Nolla","year":"2002","journal-title":"Semin Arthritis Rheum"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1007\/s15010-021-01642-5","article-title":"Influence of microbiological diagnosis on the clinical course of spondylodiscitis","volume":"49","author":"Stangenberg","year":"2021","journal-title":"Infection"},{"key":"B29","doi-asserted-by":"publisher","first-page":"344","DOI":"10.3171\/2013.11.SPINE13527","article-title":"Spontaneous spinal epidural abscess in patients 50 years of age and older: a 15-year institutional perspective and review of the literature: clinical article","volume":"20","author":"Adogwa","year":"2014","journal-title":"J Neurosurg Spine"},{"key":"B30","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1056\/NEJM197509042931001","article-title":"Spinal epidural abscess","volume":"293","author":"Baker","year":"1975","journal-title":"N Engl J Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1016\/S0140-6736(14)61233-2","article-title":"Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial","volume":"385","author":"Bernard","year":"2015","journal-title":"Lancet"},{"key":"B32","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1136\/ard.56.12.709","article-title":"Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases","volume":"56","author":"Colmenero","year":"1997","journal-title":"Ann Rheum Dis"},{"key":"B33","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1227\/00006123-199008000-00001","article-title":"Spinal epidural abscess: a ten-year perspective","volume":"27","author":"Hlavin","year":"1990","journal-title":"Neurosurgery"},{"key":"B34","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1016\/0090-3019(90)90047-S","article-title":"Diagnosis and management of pyogenic vertebral osteomyelitis in adults","volume":"33","author":"Osenbach","year":"1990","journal-title":"Surg Neurol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1016\/j.amjmed.2005.02.027","article-title":"Spontaneous pyogenic vertebral osteomyelitis and endocarditis: incidence, risk factors, and outcome","volume":"118","author":"Pigrau","year":"2005","journal-title":"Am J Med"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci11081019","article-title":"Neurosurgical management and outcome parameters in 237 patients with spondylodiscitis","volume":"11","author":"Pojskic","year":"2021","journal-title":"Brain Sci"},{"key":"B37","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/S0090-3019(99)00055-5","article-title":"Spinal epidural abscess: contemporary trends in etiology, evaluation, and management","volume":"52","author":"Rigamonti","year":"1999","journal-title":"Surg Neurol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1007\/s00132-020-03945-1","article-title":"[Pyogenic spondylodiscitis: symptoms, diagnostics and therapeutic strategies]","volume":"49","author":"Ryang","year":"2020","journal-title":"Orthopade"},{"key":"B39","doi-asserted-by":"publisher","first-page":"2012","DOI":"10.1056\/NEJMra055111","article-title":"Spinal epidural abscess","volume":"355","author":"Darouiche","year":"2006","journal-title":"N Engl J Med"},{"key":"B40","doi-asserted-by":"publisher","first-page":"iii11","DOI":"10.1093\/jac\/dkq303","article-title":"Spondylodiscitis: update on diagnosis and management","volume":"65","author":"Gouliouris","year":"2010","journal-title":"J Antimicrob Chemother"},{"key":"B41","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1007\/s15010-013-0582-0","article-title":"Outcome-related co-factors in 105 cases of vertebral osteomyelitis in a tertiary care hospital","volume":"42","author":"Loibl","year":"2014","journal-title":"Infection"},{"key":"B42","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1016\/j.spinee.2013.10.046","article-title":"Spinal epidural abscesses: risk factors, medical versus surgical management, a retrospective review of 128 cases","volume":"14","author":"Patel","year":"2014","journal-title":"Spine J"},{"key":"B43","doi-asserted-by":"publisher","first-page":"S18","DOI":"10.1016\/j.ijantimicag.2008.06.006","article-title":"Staphylococcus aureus bacteraemia with known sources","volume":"32","author":"Rubinstein","year":"2008","journal-title":"Int J Antimicrob Agents"},{"key":"B44","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1007\/s11908-014-0436-7","article-title":"Spinal epidural abscess","volume":"16","author":"Krishnamohan","year":"2014","journal-title":"Curr Infect Dis Rep"},{"key":"B45","doi-asserted-by":"publisher","first-page":"88","DOI":"10.3340\/jkns.2020.0278","article-title":"Clinical characteristics of spinal epidural abscess accompanied by bacteremia","volume":"64","author":"Chae","year":"2021","journal-title":"J Korean Neurosurg Soc"},{"key":"B46","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1016\/j.surneu.2004.08.081","article-title":"Spinal epidural abscess: clinical presentation, management, and outcome","volume":"63","author":"Curry","year":"2005","journal-title":"Surg Neurol"},{"key":"B47","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1080\/02688690310001627731","article-title":"Spinal epidural abscesses: conservative treatment for selected subgroups of patients","volume":"17","author":"Sorensen","year":"2003","journal-title":"Br J Neurosurg"},{"key":"B48","doi-asserted-by":"publisher","first-page":"3141","DOI":"10.1007\/s00586-017-5180-x","article-title":"Minimally invasive spine surgery in lumbar spondylodiscitis: a retrospective single-center analysis of 67 cases","volume":"26","author":"Tschugg","year":"2017","journal-title":"Eur Spine J"},{"key":"B49","doi-asserted-by":"publisher","first-page":"3000605211060197","DOI":"10.1177\/03000605211060197","article-title":"A disease that is difficult to diagnose and treat: evaluation of 343 spondylodiscitis cases","volume":"49","author":"Kaya","year":"2021","journal-title":"J Int Med Res"},{"key":"B50","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1093\/rheumatology\/kel228","article-title":"Imaging does not predict the clinical outcome of bacterial vertebral osteomyelitis","volume":"46","author":"Zarrouk","year":"2007","journal-title":"Rheumatology (Oxford)"},{"key":"B51","doi-asserted-by":"publisher","first-page":"E3","DOI":"10.3171\/foc.2004.17.6.3","article-title":"Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients","volume":"17","author":"Mann","year":"2004","journal-title":"Neurosurg Focus"},{"key":"B52","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1016\/j.ijid.2021.05.078","article-title":"Clinical characteristics of pyogenic vertebral osteomyelitis, and factors associated with inadequate treatment response","volume":"108","author":"Geisler Crone","year":"2021","journal-title":"Int J Infect Dis"},{"key":"B53","first-page":"178","article-title":"Analysis of 61 cases of vertebral osteomyelitis","author":"Patzakis","year":"1991","journal-title":"Clin Orthop Relat Res"},{"key":"B54","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1080\/003655498750003537","article-title":"Vertebral osteomyelitis at a Norwegian university hospital 1987\u201397: clinical features, laboratory findings and outcome","volume":"30","author":"Chelsom","year":"1998","journal-title":"Scand J Infect Dis"},{"key":"B55","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1148\/radiol.2282020752","article-title":"MR Imaging findings in spinal infections: rules or myths?","volume":"228","author":"Ledermann","year":"2003","journal-title":"Radiology"},{"key":"B56","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.jmii.2017.08.002","article-title":"Clinical characteristics, treatments, and outcomes of hematogenous pyogenic vertebral osteomyelitis, 12-year experience from a tertiary hospital in central Taiwan","volume":"51","author":"Chang","year":"2018","journal-title":"J Microbiol Immunol Infect"},{"key":"B57","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.diagmicrobio.2018.11.024","article-title":"Factors associated with sequelae after treatment of hematogenous pyogenic vertebral osteomyelitis","volume":"94","author":"Lee","year":"2019","journal-title":"Diagn Microbiol Infect Dis"},{"key":"B58","doi-asserted-by":"publisher","first-page":"1262","DOI":"10.1093\/cid\/ciw098","article-title":"Optimal duration of antibiotic therapy in patients with hematogenous vertebral osteomyelitis at low risk and high risk of recurrence","volume":"62","author":"Park","year":"2016","journal-title":"Clin Infect Dis"},{"key":"B59","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1007\/s00586-018-5598-9","article-title":"Multidisciplinary management of pyogenic spondylodiscitis: epidemiological and clinical features, prognostic factors and long-term outcomes in 207 patients","volume":"27","author":"Pola","year":"2018","journal-title":"Eur Spine J"},{"key":"B60","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1093\/clinids\/20.2.320","article-title":"Pyogenic vertebral osteomyelitis: analysis of 20 cases and review","volume":"20","author":"Torda","year":"1995","journal-title":"Clin Infect Dis"},{"key":"B61","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1007\/s00113-020-00781-y","article-title":"[Which factors influence the inpatient course for patients with spondylodiscitis?]","volume":"123","author":"Spiegl","year":"2020","journal-title":"Unfallchirurg"},{"key":"B62","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1007\/s00264-011-1384-6","article-title":"Pyogenic spondylitis","volume":"36","author":"Cheung","year":"2012","journal-title":"Int Orthop"},{"key":"B63","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/qjmed\/hcm100","article-title":"Spinal epidural abscess in clinical practice","volume":"101","author":"Sendi","year":"2008","journal-title":"QJM"},{"key":"B64","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1056\/NEJM194812022392301","article-title":"Nontuberculous spinal epidural infections","volume":"239","author":"Heusner","year":"1948","journal-title":"N Engl J Med"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2023.1200432\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T07:27:25Z","timestamp":1684394845000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2023.1200432\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,18]]},"references-count":64,"alternative-id":["10.3389\/fsurg.2023.1200432"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2023.1200432","relation":{},"ISSN":["2296-875X"],"issn-type":[{"type":"electronic","value":"2296-875X"}],"subject":[],"published":{"date-parts":[[2023,5,18]]},"article-number":"1200432"}}