Paraspinal Abscess Research Articles

Percutaneous Disc Biopsy versus Bone Biopsy for the Identification of Infectious Agents in Osteomyelitis/Discitis

PurposeTo determine whether sampling of the disc or bone is more likely to yield positive tissue culture results in patients with vertebral discitis and osteomyelitis (VDO). Materials and MethodsRetrospective review was performed of consecutive patients who underwent vertebral disc or vertebral body biopsy at a single institution between February 2019 and May 2023. Inclusion criteria were age ≥18 years, presumed VDO on spinal magnetic resonance (MR) imaging, absence of paraspinal abscess, and technically successful percutaneous biopsy with fluoroscopic guidance. The primary outcome was a positive biopsy culture result, and secondary outcomes included complications such as nerve injury and segmental artery injury. ResultsSixty-six patients met the inclusion criteria; 36 patients (55%) underwent disc biopsy, and 30 patients (45%) underwent bone biopsy. Six patients required a repeat biopsy for an initially negative culture result. No significant demographic, laboratory, antibiotic administration, or pain medication use differences were observed between the 2 groups. Patients who underwent bone biopsy were more likely to have a history of intravenous drug use (26.7%) compared with patients who underwent disc biopsy (5.5%; P = .017). Positive tissue culture results were observed in 41% of patients who underwent disc biopsy and 15% of patients who underwent bone biopsy (P = .016). No vessel or nerve injuries were detected after procedure in either group. ConclusionsPercutaneous disc biopsy is more likely to yield a positive tissue culture result than vertebral body biopsy in patients with VDO.

<i>Parvimonas micra</i>-Induced Paraspinal Abscess and Pyogenic Spondylitis Following Dental Extraction: A Case Report with a Brief Literature Review

The increasing prevalence of pyogenic spondylitis in older adults is primarily driven by Staphylococcus aureus. Cases caused by anaerobic bacteria are rare. This report focuses on a 71-year-old man diagnosed with spondylitis due to an anaerobic bacterial infection. The causative pathogen—Parvimonas micra—is typically found in the oral cavity. Interestingly, the patient had undergone a tooth extraction before the diagnosis. He was successfully treated with antibiotics; therefore, surgery was not necessary. This case is notable for the uncommon infective organism and, along with a concise literature review, this report provides valuable insights for the medical community.

A comparative perspective on brucellar, pyogenic, and tuberculous spondylodiscitis.

Non-specific features of spondylodiscitis lead to a delay and challenge in the diagnosis/differential diagnosis/treatment processes, and thus, serious complications may arise. This study aims to compare brucellar, pyogenic, and tuberculous types of spondylodiscitis, considering their demographic, clinical, and laboratory differences. This may provide more rapid management and good outcomes. A total of 131 patients with infectious spondylodiscitis were included in the study. The patients were divided into brucellar (n=63), pyogenic (n=53), and tuberculous (n=15) types of spondylodiscitis and compared for demographic, clinical, laboratory, and imaging features. Tuberculous spondylodiscitis had higher scores for weight loss, painless palpation, thoracic spine involvement, and psoas abscess formation than other spondylodiscitis. Also, tuberculous spondylodiscitis had higher rates of neurologic deficit and lower rates of lumbar involvement than brucellar spondylodiscitis. Pyogenic spondylodiscitis is more likely to occur in patients who have a history of spine surgery compared to other forms of spondylodiscitis. Also, pyogenic spondylodiscitis had higher rates of fever, erythema, paraspinal abscess, white blood cell (WBC), and erythrocyte sedimentation rate (ESR) than brucellar spondylodiscitis. On the other hand, brucellar spondylodiscitis had higher rates of rural living and sweating than pyogenic spondylodiscitis. Weight loss, painless palpation, involved thoracic spine, psoas abscess, and neurologic deficit are symptoms favoring tuberculous spondylodiscitis. History of spine surgery, high fever, skin erythema, and paraspinal abscess are findings in favor of pyogenic spondylodiscitis. Rural living, sweating, and involved lumbar spine are symptoms that indicate brucellar spondylodiscitis. These symptoms can be used to distinguish the types of spondylodiscitis.

Treatment of a multimorphic form of vertebral infection (clinical case)

A clinical case of surgical treatment of a patient with a multimorphic form of vertebral infection is presented (spinal epidural abscess, paraspinal abscess, subdural epiema, iliopsoitis, purulent meningitis, complicated by sepsis and bilateral pneumonia). The patient underwent three surgical interventions and underwent targeted antibacterial therapy.

Septic Arthritis of the Spinal Facet Joint: Review of 117 Cases.

Septic arthritis of the spinal facet joints is increasingly recognized in the era of magnetic resonance imaging, but its epidemiology, clinical features, management, and prognosis are ill-defined. We review 101 previously published cases and report 16 cases occurring at our institutions between 2006 and 2018. Most patients presented with fever (60%) and back or neck pain (86%). Radiation into the hip, buttock, or limb was present in 34%. The lumbosacral vertebral segments were involved in 78% of cases. Most cases (64%) were due to Staphylococcus aureus. Bacteremia was present in 66% and paraspinal muscle abscesses in 54%. While epidural abscesses were present in 56%, neurologic complications were seen in only 9%, likely because most abscesses arose below the conus medullaris. Neurologic complications were more common with cervical or thoracic involvement than lumbosacral (32% vs 2%, P < .0001). Extraspinal infection, such as endocarditis, was identified in only 22% of cases. An overall 98% of patients survived, with only 5% having neurologic sequelae. Septic arthritis of the facet joint is a distinct clinical syndrome typically involving the lumbar spine and is frequently associated with bacteremia, posterior epidural abscesses, and paraspinal pyomyositis. Neurologic outcomes are usually good with medical management alone.

Cervical Spondylodiscitis with Epidural and Paraspinal Abscess: case report and literature review

Cervical Spondylodiscitis with Epidural and Paraspinal Abscess: case report and literature review

Simultaneous presentation of membranoproliferative glomerulonephritis and tuberculous spondylitis: a case report

Genitourinary tuberculosis is not uncommon. Skeletal tuberculosis with tuberculous spondylitis is also a well-known entity. However, spinal tuberculosis presenting with nephrotic syndrome due to glomerular involvement is rare. We report a patient with tuberculous spondylitis and membranoproliferative glomerulonephritis. A 40-year-old man presented with bilateral lower limb swelling of two weeks duration, a non-inflammatory type of back pain of one year duration, and constitutional symptoms. He had nephrotic range proteinuria and hypoalbuminemia, with normal renal function and normal size kidneys on ultrasound scanning. MRI spine revealed tuberculous spondylitis involving T12 and L1 vertebrae with associated para-spinal and psoas abscess formation. Renal biopsy revealed membranoproliferative glomerulonephritis. Aspirate from psoas abscesses was positive for Mycobacterium tuberculosis. The patient was treated with anti-tuberculous therapy and required spinal fixation. With treatment both proteinuria and other symptoms improved.

Hounsfield Units as an Independent Predictor of Failed Percutaneous Drainage of Spinal Tuberculosis Paraspinal Abscess Under Computed Tomography Guidance.

To investigate the value of Hounsfield units (HUs) as an independent predictor of failed percutaneous drainage of spinal tuberculosis paraspinal abscess under computed tomography (CT) guidance. A retrospective analysis was conducted on 61 patients who underwent CT-guided percutaneous drainage for spinal tuberculosis paraspinal abscess between October 2017 and October 2020. Preoperative CT scans were used to measure the HUs of the abscess. Patients were categorized into successful drainage (n = 49) and failed drainage (n = 12) groups. Statistical analysis involved independent sample t-tests and chi-square tests to compare between the 2 groups. Binary logistic regression was performed to identify independent predictive factors for drainage failure. Receiver operating characteristic (ROC) curves were employed to ascertain risk factor thresholds and diagnostic performance. Among the patients, 49 experienced successful drainage while 12 faced drainage failure. The mean HUs of abscesses in the failed drainage group were significantly higher than those in the successful drainage group (p < 0.001). ROC analysis revealed an area under the curve of 0.897 (95% confidence interval, 0.808-0.986) for predicting drainage failure based on HUs. The optimal HU cutoff value for predicting drainage failure was 22.3, with a sensitivity of 91.7% and specificity of 69.4%. HUs are an independent predictor of failed percutaneous drainage of spinal tuberculosis paraspinal abscess under CT guidance. The HU value of 22.3 can be used as an initial screening threshold for predicting the success or failure of drainage.

Reconstruction of complicated spinal tuberculosis with long-segment fibula transplantation: a case report

BackgroundTreating complex cases of spinal tuberculosis (STB) that involve multiple vertebral bodies and cause destruction of the spinal structure, kyphotic deformity, and acute nerve injury can be challenging. This report describes the course of treatment and 5-year follow-up of a complex case of multisegmental STB.Case presentationThis report describes a case of tuberculosis affecting the vertebrae extending from thoracic 12 to lumbar 5 in a 60-year-old woman who suffered sudden paralysis in both lower extremities. The patient underwent emergency posterior paraspinal abscess clearance, laminectomy with spinal decompression. Partial correction of the kyphotic deformity via long-segment fixation from the T9 vertebral body to the ilium in a one-stage posterior procedure. The patient’s neurological status was diagnosed as grade E on the American Spinal Injury Association (ASIA) scale after the one-stage operation. Following standardized 4-combination anti-tuberculosis drug therapy for three months in postoperative patients, the patient underwent two-stage transabdominal anterior abscess removal, partial debridement of the lesion and bilateral fibula graft support. One year after the two-stage operation, the patient’s visual analog scale (VAS) score of back pain was 1 point, and the patient’s erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels returned to normal. Five years after the second-stage operation, the Oswestry disability index (ODI) of patient quality of life was 14 points. There was a 4-degree change in the Cobb angle over five years. During the five-year follow-up period, the grafted fibula did not experience any subsidence.ConclusionFor patients with spinal tuberculosis and acute paralysis, it is essential to relieve spinal cord compression as soon as possible to recover spinal cord function. For lesions that cannot be debrided entirely, although limited debridement combined with anti-tuberculosis drug therapy has the risk of sinus formation and tuberculosis recurrence, it is much safer than the risk of thorough debridement surgery. In this case, an unconventional long-segment fibula graft, pelvis-vertebral support, was an effective reconstruction method.

Development of a Diagnostic Model for Differentiating Tuberculous Spondylitis and Pyogenic Spondylitis with MRI: A Multicenter Retrospective Observational Study.

Multicenter retrospective observational study. This study aimed to distinguish tuberculous spondylitis (TS) from pyogenic spondylitis (PS), using magnetic resonance imaging (MRI). Further, a novel diagnostic model for differential diagnosis was developed. TS and PS are the two most common spinal infections. Distinguishing between these types clinically is challenging. Delayed diagnosis can lead to deficits or kyphosis. Currently, there is a lack of radiology-based diagnostic models for TS and PS. We obtained radiological images from MRI imaging of patients with TS and PS and applied least absolute shrinkage and selection operator (LASSO) regression to select the optimal features for a predictive model. Predictive models were built using multiple logistic regression analysis. Clinical utility was determined using decision curve analysis (DCA) and internal validation was performed using bootstrap resampling. A total of 201 patients with TS (n=105) or PS (n=96) were enrolled. We identified significant differences in MRI features between both groups. We found that non-contiguous multi- and single-vertebral body involvement were common in TS and PS, respectively. Vertebral bone lesions were more severe in the TS group than in the PS group (Z=-4.553，P<0.001). The patients in the TS group were also more prone to vertebral intraosseous, epidural, and paraspinal abscesses (P<0.001). A total of 8 predictors were included in the diagnostic model. Analysis of the calibration curve and area under the receiver operating characteristic curve suggested that the model was well-calibrated with a high prediction accuracy. This is the largest study comparing MRI features in TS and PS and the first to develop an MRI-based nomogram which may help clinicians distinguish between TS and PS.

A clinical prediction model to differentiate tuberculous spondylodiscitis from pyogenic spontaneous spondylodiscitis.

Microbiological diagnosis of tuberculous spondylodiscitis (TS) and pyogenic spontaneous spondylodiscitis (PS) is sometime difficult. This study aimed to identify the predictive factors for differentiating TS from PS using clinical characteristics, radiologic findings, and biomarkers, and to develop scoring system by using predictive factors to stratify the probability of TS. A retrospective single-center study. Demographics, clinical characteristics, laboratory findings and radiographic findings of patients, confirmed causative pathogens of PS or TS, were assessed for independent factors that associated with TS. The coefficients and odds ratio (OR) of the final model were estimated and used to construct the scoring scheme to identify patients with TS. There were 73 patients (51.8%) with TS and 68 patients (48.2%) with PS. TS was more frequently associated with younger age, history of tuberculous infection, longer duration of symptoms, no fever, thoracic spine involvement, ≥3 vertebrae involvement, presence of paraspinal abscess in magnetic-resonance-image (MRI), well-defined thin wall abscess, anterior subligamentous abscess, and lower biomarker levels included white blood cell (WBC) counts, erythrocyte-sedimentation-rate (ESR), neutrophil fraction, and C-reactive protein (all p < 0.05). Multivariate logistic regression analysis revealed significant predictors of TS included WBC ≤9,700/mm3 (odds ratio [OR] 13.11, 95% confidence interval [CI] 4.23-40.61), neutrophil fraction ≤78% (OR 4.93, 95% CI 1.59-15.30), ESR ≤92 mm/hr (OR 4.07, 95% CI 1.24-13.36) and presence of paraspinal abscess in MRI (OR 10.25, 95% CI 3.17-33.13), with an area under the curve of 0.921. The scoring system stratified the probability of TS into three categories: low, moderate, and high with a TS prevalence of 8.1%, 29.6%, and 82.2%, respectively. This prediction model incorporating WBC, neutrophil fraction counts, ESR and presence of paraspinal abscess accurately predicted the causative pathogens. The scoring scheme with combination of these biomarkers and radiologic features can be useful to differentiate TS from PS.

Microbiological profile of abscesses of different body sites in a tertiary care hospital – the silent killer

Background: Abscess, an infection with viable infecting organisms and polymorphonuclear cells, contained within a fibrous capsule, limiting the infection, and preventing its further spread. It may be monomicrobial or polymicrobial. Aims and Objectives: The aims of the study were to determine microbiological profile of abscesses of different body sites and associated complications. Materials and Methods: An observational study was conducted in our department with 35 pus samples from abscesses of different body sites between August 2022 and December 2022. Gram stain, Z-N stain, fungal stain, aerobic, anaerobic, and fungal culture were performed. Statistical analysis was done by statistical tool R. Results: Out of 35 samples-limb, liver,paraspinal, psoas, appendicular, breast, perineal, ear, brain and lung abscesses were 11,4,2,3,1,7,2,2,2,1 respectively. Most common organisms from limb,ear,paraspinal and breast abscesses was MRSA (Methicillin resistant Staphylococcal aureus). Also most common organisms were – Escherichia coli from liver abscess, Enterobacteriaceae and Pseudomonas aeruginosa from psoas and appendicular abscess, Enterobacter aerogenes from perineal, Escherichia coli and Actinomyces species from brain and Candida auris from lung abcesses. No growth were also found in few samples. Their susceptibility testing showed-MRSA strains susceptible to both Vancomycin and Linezolid, gram negative bacteria were susceptible to Cephalosporins, Piperacillin-tazobactam, Carbapenems, polymixins, etc. C.auris was resistant to all antifungals. Their blood samples were also collected - ten patients showed fever with bacteremia and one with candidemia . They were treated with systemic antimicrobials along with drainage and/or surgical resection. Conclusion: Abscesses must be suspected in cases with non-resolving fever with/without septicemia and treated promptly with appropriate antimicrobials based on susceptibility report and with drainage and/or surgical resection.

A case of successful treatment of a multimorphic form of nonspecific purulent-inflammator y disease of the spine

The article presents a clinical case of surgical treatment of a patient with a multimorphic form of nonspecific purulent-inflammatory lesions of the spine. This patient had spinal epiduritis, paraspinal and subdural abscesses, and purulent meningitis; the course was complicated by bilateral lower lobe pneumonia, systemic inflammatory response syndrome, and sepsis. The main stages of surgical correction were laminectomy, sanitation, and drainage of paraspinal, epidural and subdural abscesses, tracheostomy, puncture and drainage of the psoas abscess on the left side under ultrasound navigation. In addition, the patient received targeted antibiotic therapy. After treatment in the neurosurgical department, the patient was transferred to rehabilitation treatment. Based on the results of surgical treatment, a conclusion was made about the clinical validity of using a combination of methods for the treatment of patients with a multimorphic form of nonspecific purulent-inflammatory lesions of the spine.

A CASE OF SPINAL ABSCESSES IN A POORLY CONTROLLED DIABETIC PATIENT

This is a case report of a poorly controlled diabetic patient who presented with high grade fever and back pain. He was found to have epidural and paraspinal abscesses. The abscesses were drained and antibiotics were given as per culture sensitivity and the patient showed a good response to the same.

Imaging study to establish the classification criteria of brucellar spondylitis based on MRI findings

Objective: Establishment of brucellosis spondylitis of imaging classification; provision reference for clinical treatment methods. Methods: Form January 2008 to July 2012, 89 cases imaging data confirmed by clinical examination and laboratory of brucellosis spondylitis patients were analyzed retrospectively, based on X-ray, CT and MRI imaging of their clinical manifestations- Vertebral inflammatory infiltration and extent of the damage, the extent of damage to the intervertebral space, periostitis inflammatory changes, paraspinal abscess, spinal cord, cauda equina and nerve root compression. All this imaging indicators above were the evaluation criteria. Acquisition and analysis of the imaging data was implemented by the blinded reading group which was composed of Imaging Center physicians and orthopedic surgeons. According to these imaging performances, develop the imaging classification. Results: Brucellosis spondylitis image was made up of I-VI type: type I: vertebral inflammation; type II: Discitis; type III: periostitis; type IV: abscess; type V: spinal nerve and type VI: compound. The group of 54 cases accounted for 60.67% of the compound, in which the incidence of type I Image companied by type II was maximum: 22 cases accounted for 40.74% (22/54) and second type II Image and companied by V type was 20 cases: accounted for 37.03% (20/54). In the group, 35 cases of simple type accounted for 39.33%: type I: 4 cases; type II: 12 cases; type III: 3 cases; type IV: 2 cases; type: 4 cases. Simple and complex type of type II imaging accounted for 59.55% (53/89) the highest occurrence rate, in which the type I was 47 cases: accounted for 52.81% (47/89). Based on imaging classification, 67 cases was treated by surgery, in which 59 cases was treated by debridement and 8 cases was treated by percutaneous minimally invasive surgery, 22 cases was not treated by surgery. The group of 89 cases had been followed for 1 year: 83 cases had been cured without prognosis, and 6 cases had been improved. Conclusion: Brucellosis spondylitis images classification has a reference value and guiding significance for the strategies of clinical treatment. According to this classification, simply type I, type II, type III, and IV type can be used in clinical conservative treatment, and when the evolution of the disease has surgical indications, or type V and VI type the patients should be treated actively by surgery

Pyogenic spondylitis due to Streptococcus agalactiae with paraspinal abscess and vertebral destruction in a diabetic patient: time course of imagings.

A 76-year-old female with type 2 diabetes mellitus presented with hematuria, low back pain, and intermittent fever for 7 days. She was admitted to our hospital and diagnosed with Streptococcus agalactiae (GBS) bacteremia. CT showed an air density within the right iliopsoas muscle, and an MRI of the spine revealed hyperintensity in the right half of the L1-L2 intervertebral disk, leading to the diagnosis of a paraspinal abscess and L1-L2 pyogenic spondylitis. Antibiotic therapy was started and the clinical symptoms, as well as serologic biomarkers and radiologic images of the paraspinal abscess, were improved. The therapy was stopped on day 72 despite vertebral destruction progression. Vertebral endplate ossification was observed on day 108, and further bone formation was noted on day 177. Our case study with radiologic findings over 6 months demonstrated how bone destruction with pyogenic spondylitis, which had been treated with antibiotic therapy, improved after cessation of antibiotics. Although GBS is a rare cause of spondylitis, diabetic mellitus is a risk factor for the development of invasive GBS infections, especially under poor glycemic control. Bone destruction of pyogenic spondylitis can improve after discontinuation of antibiotic therapy. It may be important to decide the period of antibiotic therapy based on clinical conditions, serologic biomarkers, and soft tissue findings rather than bone findings. When elderly diabetic patients present with back pain and fever, spondylitis should be considered in the differential diagnosis to avoid potential diagnostic delays or misdiagnosis.

A Rare Case of Tuberculosis in the Lumbar Facet Joint

Tuberculosis of the posterior elements is a rare and destructive form characterised by the destruction of the lamina, pedicle, or facet joints. Delay in clinical diagnosis and presentation is common because of poor visualisation of facet joints in X-rays. A 55-year-old male presented with back and left leg pain lasting for six months, accompanied by weakness in dorsiflexion of the left foot and ankle. Magnetic Resonance Imaging (MRI) revealed features suggestive of L4-L5 facetal arthritis on the left side, including marrow oedema, bone erosions, a posterior paraspinal abscess, and nerve root compression. The patient underwent posterior decompression and stabilisation, along with abscess drainage. The specimen was sent for histopathological examination, confirming the diagnosis of facetal joint tuberculosis. Antituberculous treatment was given for 12 months, that showed improved neurological status. This case is presented due to its rarity, highlighting the importance of considering facetal joint tuberculosis as a potential cause in cases of progressively increasing lower back pain, even in the absence of constitutional symptoms.

Primary Septic Costotransverse Arthritis with Secondary Destructive Osteomyelitis and Paraspinal Abscess: A Case Report and Review of Literature

Primary Septic Costotransverse Arthritis with Secondary Destructive Osteomyelitis and Paraspinal Abscess: A Case Report and Review of Literature

S41 Unusual Case of Tongue Deviation

Case: Background: Anti-tumor necrosis factor-α (TNFα) therapy is the mainstay of treatment for inflammatory bowel disease such as Crohn’s Disease (CD) and ulcerative colitis (UC). Despite its widespread use, anti-TNFα leads to significantly altered inflammatory response and increased risk of severe skin and soft tissue infections. Here, we highlight an uncommon presentation of severe soft tissue infection in a patient with ileal CD maintained on anti-TNFα therapy. Case Presentation: A 50-year-old female with a 25-year history of Crohn's ileitis maintained on certolizumab for 3 years presented to the emergency department (ED) with an expanding left, lateral neck mass resulting in decreased cervical range of motion. This was accompanied by a left-sided tongue deviation. She first presented to our ED 8 weeks earlier with severe throbbing headaches without focal neurologic symptoms. A head MRI only showed non-specific T2/FLAIR hyperintensities. Her vital signs and labs were normal, and these headaches were presumed to be complex migraines. Three weeks after her first presentation, she came back to the ED with worsening headaches, neck pain and a new left-sided tongue deviation. Again, her vital signs and laboratory evaluation were normal apart from an ESR of 68 mm/hr (nl: 0-30 mm/hr) and CRP of 10.34 mg/dL (nl<0.5 mg/dL). Her repeat imaging studies did not show any evidence of stroke; however, opacification of the paranasal sinuses and left mastoid air cells were observed. Nonetheless, given her lack of systemic inflammatory symptoms, she was discharged home with close outpatient otolaryngology (ENT) referral. As an outpatient, she was diagnosed with bacterial sinusitis which was treated with a 15-day course of cefdinir and dexamethasone. Her symptoms initially improved; however, she eventually experienced dysphagia with pus drainage from her sinuses. Another antibiotic and steroid course was prescribed. Despite this, approximately 8 weeks after her initial presentation, she developed a rapidly expanding neck mass which prompted her return to the ED. Physical examination revealed a tender neck mass limiting her cervical range of motion and a more pronounced tongue deviation. She was afebrile, non-tachycardiac, and normotensive. Laboratory testing again revealed elevated inflammatory markers (ESR 83 mm/hr, CRP 8.59 mg/dL) but otherwise her WBC was normal (8310 cells/ µL, nl: 10400 cells/µL) with no evidence of sepsis-related end-organ dysfunction (Cr 0.89 mg/dL, AST 20, ALT 55 mg/dL, T-bili 0.3 mg/dL, platelets 348000 platelets/µL). Neck imaging showed multifocal ring-enhancing collections within the left paravertebral soft tissue with left hypoglossal nerve involvement. Intravenous vancomycin, cefepime, and metronidazole were started. Surgical debridement of the left posterior paraspinal abscess was performed. Intraoperative cultures were positive for Streptococcus anginosus. She completed a 6-week course of ceftriaxone but follow up imaging 2 weeks later showed recurrence of her neck abscesses. This again required surgical debridement. Her infections finally cleared with 24 weeks of piperacillin/tazobactam. Her certolizumab remains permanently discontinued. Conclusions: Hallmark symptoms of severe infection may not be present in patients on anti-TNF therapy. A high index of suspicion for an underlying infectious etiology must be maintained when treating this population.

Spinal Cord Injury in Tuberculous Spinal Epidural Abscess Patient with Deficiency of Vitamin D : A Case Report with Literature Review

Background: Spinal cord injury is not only caused by trauma but also by non-trauma, such as spinal epidural abscess (SEA). Tuberculous SEA is a rare infectious disorder, a delayed diagnosis associated with morbidity and mortality. The problems of tuberculous SEA is not only infection but also neurological deficit, axial back pain, pathological fracture, deformity, and socioeconomic and psychogenic problem. There are a few cases of SEA caused by Mycobacterium tuberculosis, mostly caused by Staphylococcus aureus with decreasing body’s defense mechanism caused by a deficiency of vitamin D. This study aimed to evaluate the neurological recovery of non-traumatic spinal cord injury caused by spinal tuberculosis with spinal epidural abscess and vitamin D deficiency that treated with vitamin D as an adjuvant. Case Report: A 31-year-old female came to the orthopedic clinic with paraparesis ASIA grade C, axial back pain, and spinal deformity for three months, with vitamin D levels of 15.5 ng/ml. MRI showed epidural abscess at the level of the 10th-11th thoracic vertebrae, spondylodiscitis of the 10th-11th thoracic vertebrae accompanied by paraspinal abscess of the 8th thoracic vertebrae to the 1st lumbar vertebra. The diagnosis was confirmed by cultured and histopathological examination. The treatment was surgery, followed by anti-TB drugs and daily vitamin D 5000 IU for one year. After one year of follow-up, the patient returned to work without a neurological deficit and axial back pain. Conclusion: This report describes the importance of early diagnosis and proper treatment of spinal cord injury in tuberculous SEA with a deficiency of vitamin D.