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Auflistung Dissertationen/Habilitationen nach Autor:in "Abdelrahman, Hamdan"

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    Spinal infections: analysis of 600 patients over eleven years
    (2018) Abdelrahman, Hamdan
    The aim of this study was to analyse the demographic, clinical, radiological and laboratory parameters in patients with haematogenous spinal infection and to study the effects of various causative organisms on these parameters. Therefore, in this work we identified 600 patients over a period of eleven years who had attracted haematogenous spinal infection and evaluated their records retrospectively.We found an increase in the mean age of the patients with spinal infection over the elven years mostly due to increased life expectancy in the German population. Most of the patients in this study had medical comorbidities which may render the patients immunocompromised and more susceptible to infections.The diagnosis of spinal infection in elderly patients is frequently delayed due to the predominance of degenerative spine disease. Spinal infection should be suspected especially in patients with increased back pain, fever and development of neurological deficit. The incidence of neurological affection increases with age even if in absence of compressing intraspinal pathologies.Unifocal infection is the most common form, but the multifocal affection of the spine is not uncommon: (11.3%). It should be excluded by routine use of the whole spine MRI. The latter is also the gold standard imaging modality in cases of epidural and psoas abscesses. Though the inflammatory parameters are non-specific for infection they are important in the workup in cases of spinal infections. C-reactive protein is the most valuable parameter in predicting the ability to isolate a causative organism in most of cases.Spinal infection is mostly caused by one organism, but in diabetic patients and those with bed sores polymicrobial affection should be considered. In the past, tuberculosis represented the major cause of spinal infection but nowadays it changes roles with pyogenic origin. Fungal spinal infection is very rare and represented 1.6% of all cases in this study.The ability to identify a causative organism increased over the years of the study to 79.5%. The reason may be mostly due to the introduction of new media to isolate specific organisms and increased orientation to the microbiological aspects of spinal infections. Staph. aureus remains the main causative organism of spondylodiscitis over the years of the study and also in all age groups. With growing numbers of multimorbid immunocompromised elderly patients, the spondylodiscitis caused by gram negative bacteria has increased, however in patients younger than 50 years still is rare.The key stone in the diagnosis and treatment of cases of spinal infections is the identification of the causative organism from the site of infection. Bacterial cultures and histopathological tissue examination are complementary in distinguishing pyogenic from granulomatous diseases and are mandatory when tumorous lesions are suspected.