Cervical Osteomyelitis Research Articles

Atlantoaxial Subluxation and Cervical Osteomyelitis: Two Unusual Complications of Adenoidectomy

Grisel's syndrome (atlanto-axial subluxation) and cervical osteomyelitis are two unusual complications of adenoidectomy. We present two patients; one with atlanto-axial subluxation following uncomplicated tonsillectomy and adenoidectomy, and one with cervical osteomyelitis following uncomplicated adenoidectomy. Both patients presented with persistent postoperative neck pain. Surgical intervention, as well as long-term intravenous antibiotics, was required. A high index of suspicion, as well as cervical spinal series with flexion-extension views, is necessary for diagnosis. Flexible nasopharyngoscopy and computed tomography of the cervical spine also aided in diagnosis and treatment planning. With early diagnosis and proper treatment, the prognosis is good. Neurologic sequelae were prevented in both of our patients.

Clivus and cervical spinal osteomyelitis with epidural abscess presenting with multiple cranial neuropathies

A 65-year-old diabetic man with a history of otitis was admitted with headache, neck and shoulder pain and cranial nerve abnormalities including sixth, seventh and twelfth nerve palsies, hearing loss and ptosis. Lumbar puncture revealed an elevated CSF protein and pleocytosis. Imaging procedures demonstrated osteomyelitis of the clivus that involved the epidural space and extended within the prevertebral space to the cervical spine. The patient improved after treatment with antibiotics and immobilization of the neck. This case illustrates the importance of recognizing infections of the clivus in patients with cranial nerve abnormalities.

手術治療を行なった頚椎化膿性脊椎炎の検討

手術治療を行なった頚椎化膿性脊椎炎の検討

Cervical Osteomyelitis and Magnetic Resonance Imaging

Cervical Osteomyelitis and Magnetic Resonance Imaging

Oesophageal trauma in patients with spinal cord injury.

Oesophageal perforations associated with cervical fractures occur from a variety of injuries. Fractures of the cervical spine, blunt trauma and penetrating injuries such as gunshot wounds, knives and missiles, perforate the cervical oesophagus. This retrospective study consists of 24 patients with an oesophageal perforation and cervical fracture. Motor vehicle accidents were responsible for 54% of the oesophageal perforations. The other oesophageal injuries were related to anterior spine surgery, gunshot wounds and sports-related activities. The clinical features related to these injuries included the obvious signs of an oesophageal perforation as well as fever of unknown origin, leukocytosis and unexplained persistent tachycardia. A variety of techniques was used to establish the diagnosis. All the patients had treatment for the cervical fracture and 20 patients required surgical repair of the oesophagus. The most common oesophageal complications were stricture of the oesophagus (54%) and oesophageal diverticulum (10%). The other complications were atelectasis, pneumonia, tracheobronchitis, pulmonary embolism, cervical osteomyelitis, cervical abscess, mediastinitis, septicemia and cervical fistulae. These patients have a serious life-threatening illness that may be difficult to diagnose and treat.

Haemophilus parainfluenzae as a Rare Cause of Epidural Abscess: Case Report and Review

We report a case of epidural abscess due to Haemophilus parainfluenzae. This microorganism is a normal inhabitant of the upper respiratory tract that causes endocarditis and, rarely, other invasive infections. To the best of our knowledge, epidural abscess due to H. parainfluenzae has not been reported previously. A 74-year-old man presented with neck pain and subsequently developed incomplete quadriparesis. A cervical epidural abscess and vertebral osteomyelitis were detected by radiologic studies. Surgical drainage and antibiotic therapy resulted in resolution of the abscess and osteomyelitis, and the neurologic sequelae were minimal. Cultures of the purulent material from the abscess yielded H. parainfluenzae. Descriptions in the literature of infections caused by H. parainfluenzae and the antimicrobial agents used for treatment of these infections are reviewed.

Pyogenic cervical vertebral osteomyelitis

Pyogenic cervical vertebral osteomyelitis

Cervical osteomyelitis due to i.v. heroin use: radiologic findings in 14 patients.

We reviewed the radiographs of 14 patients who had cervical osteomyelitis and were IV heroin users. Eleven were men and three were women. Their age range was 33-48 years (mean, 39 years). Eleven regularly used the jugular vein access, and three alternated between the jugular and femoral veins. Initial radiographs of the cervical spine in 13 patients showed destruction of two or more vertebral bodies and the adjacent intervertebral disk, as well as a prevertebral soft-tissue mass. In one patient, findings on initial radiographs were normal, but marked destruction at two contiguous intervertebral levels and a large prevertebral abscess were identified 2 weeks later. All the patients had positive results on cultures of joint aspirates or bone biopsy materials (10 patients) or blood (four patients). Ten grew Staphylococcus aureus; two, Staphylococcus epidermidis; one, Streptococcus viridans; and one, Pseudomonas aeruginosa. CT in nine patients showed inflammatory reaction adjacent to the carotid sheath resulting from the repeated jugular injections and delineated the extent of prevertebral abscess and bone destruction. Scintigrams were of minimal value in establishing the diagnosis. Advanced vertebral body destruction, disk space infection, prevertebral abscess, and anterior cervical inflammatory reaction appear to be typical findings on radiographs in heroin abusers with cervical osteomyelitis.

Cervical Osteomyelitis with Prevertebral Abscess Formation

Cervical Osteomyelitis with Prevertebral Abscess Formation

Amyloidosis of the spine in a patient on long-term hemodialysis

A 54-year-old man with a history of renal failure treated with hemodialysis for over 10 years presented with clinical signs and symptoms and plain radiographic, computed tomographic and magnetic resonance imaging features of cervical vertebral osteomyelitis with spinal cord compression. Decompressive surgery revealed amyloid deposition. In the setting of chronic hemodialysis, differentiation between amyloid deposition and osteomyelitis may not be possible on an imaging basis necessitating biopsy for diagnosis.

Anterior cervical debridement and strut-grafting for osteomyelitis of the cervical spine.

A retrospective review of the surgical experience in treating 18 patients with osteomyelitis of the cervical spine is reported. The patients ranged in age from 20 to 60 years and all complained of neck pain upon admission. Ten patients had a prior history of intravenous drug abuse, three had previously suffered penetrating injuries of the neck, and one had an extraspinal site of osteomyelitis. Bacteria were isolated in 13 cases and tuberculosis in three. Neurological abnormalities were present in over one-half of the patients, consisting of myelopathy (nine cases) or radiculopathy (four cases). Plain cervical spine films and polytomography demonstrated vertebral and end-plate destruction, spinal instability, and increased paravertebral soft-tissue shadow in all cases. Computerized tomography and, more recently, magnetic resonance imaging have proven helpful in detecting bone involvement and the presence of epidural extension associated with cervical osteomyelitis. The risk of vertebral body collapse, kyphosis, and myelopathy in the osteomyelitic cervical spine has standardized the management of this problem in this institution to consist of skeletal traction, needle aspiration or blood culture for organism identification, anterior cervical debridement, autogenous iliac graft fusion, and intravenous administration of antibiotics. Spinal stability and neurological improvement were achieved in all 18 patients.

Cervical spine injury masquerading as a medical emergency

Two cases of cervical spine fractures presenting as cardiac arrest in one case and as a coma with pneumonia and cervical osteomyelitis in the other are discussed. They demonstrate the need for careful history taking as well as a cautious approach to the cervical spine when accurate historical data are not avallable.

Clostridium difficile colitis secondary to intravenous vancomycin

Nearly every known antibiotic has been implicated as a cause of Clostridium difficile colitis. We report the first case resulting from monotherapy with intravenous vancomycin. The patient was on chronic hemodialysis and was treated with intravenous vancomycin for presumed cervical osteomyelitis. After 29 days of therapy he developed abdominal pain and diarrhea and his stool was found to contain both C. difficile and cytotoxin. The patient responded with symptomatic and microbiological recovery to withdrawal of the drug and treatment with oral metronidazole. The prolonged elevation of serum vancomycin levels in patients with renal failure may predispose them to the development of C. difficile colitis.

Pseudomonas aeruginosa as a Causative Agent of Cervical Osteomyelitis

Pseudomonas aeruginosa osteomyelitis and epidural abscess of the cervical spine developed in a previously healthy, 73-year-old man who was not an intravenous drug abuser. In the recent literature, Pseudomonas cervical osteomyelitis has been reported only in intravenous drug abusers or in otherwise healthy individuals after a tooth extraction. In the literature of the past 30 years, isolated cases of cervical osteomyelitis were associated with urinary tract infections. The majority of these cases involved urinary tract instrumentation. The pathogenesis remains controversial. It appears that spontaneous cervical osteomyelitis in a non-intravenous drug abuser has not been previously reported.

Pyogenic cervical osteomyelitis presenting as a massive prevertebral abscess in a patient with rheumatoid arthritis

Pre-existing rheumatoid arthritis appeared to have masked the diagnosis and contributed to a succession of hazardous events in a 58-yearold man with pyogenic cervical osteomyelitis. A massive prevertebral abscess and near asphyxiation finally led to the diagnosis of an indolent Staphylococcus aureus infection in a course marked by antecedent staphylococcal sepsis, a series of dangerous cervical spine chiropractic manipulations in the presence of advanced bony destruction, and, ultimately, cervical spine bony collapse and gibbus formation. The absence of myelopathy despite long-standing progressive advanced destruction is noteworthy. The roentgenologic documentation of this progression was unique. This appears to be the first fully documented case of cervical spine osteomyelitis presenting as a prevertebral abscess in a patient with rheumatoid arthritis.

Evaluation of Blom-Singer voice prosthesis.

Tracheoesophageal puncture and use of a silicone prosthesis is becoming a common and highly effective procedure for voice rehabilitation in the alaryngeal patient. Radiologic evaluations were reviewed of 31 patients scheduled for tracheoesophageal puncture at this institution over the past 3 years. Barium swallow examinations were performed preoperatively to assess anatomy and muscular activity of the pharyngoesophagus. Examinations were performed postoperatively when complications were suspected, phonation was unsatisfactory, or as routine oncologic follow-up. Postoperative complications included neck abscess, cervical osteomyelitis, and feeding tube dissection into the anterior wall of the thoracic esophagus. This method of pre- and postoperative radiologic evaluation of these patients is presented, along with the radiologic manifestations of the complications.

Cervical osteomyelitis

Cervical osteomyelitis

False-Positive Cryptococcal Antigen Test and Cervical Prevertebral Abscess

A false-positive latex agglutination test for cryptococcal antigen occurred in a patient with a cervical prevertebral abscess and vertebral osteomyelitis caused by Klebsiella pneumoniae. Using a commercial latex agglutination test kit, a cryptococcal antigen titer of 1:32 was found in the CSF, but no cryptococcal antigen was found when the CSF was retested at a reference laboratory. The false-positive test resulted in unnecessary therapy with amphotericin B and delay in appropriate diagnostic studies and therapy.

Spinal Cord Compression due to pseudomonas in a heroin addict

Involvement of the spinal cord has not been reported in osteomyelitis of the spinal column caused by Pseudomonas aeruginosa. Cerebrospinal fluid findings have been reported only once in osteomyelitis of the spine by this agent. Our patient had persistently increased cerebrospinal fluid protein during an acute episode of cervical spine osteomyelitis, characterized by fever and neck pain. Roentgenograms of the cervical spine and neurologic examination did not show any definite abnormality. He became paraplegic 18 months later, after having symptoms of numbness of the feet and progressive weakness of the legs for 1 month. A surgical procedure and antibiotic treatment resulted in remarkable recovery. A bone specimen grew P. aeruginosa.

Roentgenographic Aspects of Narcotic Addiction

To the Editor.— Though hematogenous osteomyelitis in narcotic addicts certainly does have a predilection for the spine, I doubt that Pseudomonas aeruginosa is most frequently the offending organism. While it is true that Kido and colleagues 1 found Pseudomonas in the overwhelming majority of their addicts with vertebral infections, Staphylococcus aureus was the offending organism in half the cases reported by Holzman and Bishko. 2 In our recently reported series of patients with cervical osteomyelitis, of the five patients who were addicted to heroin, four were found to be infected with S aureus and no organism was recovered from the other one. Since the treatment of S aureus and P aeruginosa is so entirely different, positive identification of the offending organism is essential, whether it be one of these two or any of many others that have sometimes been reported.