Paravertebral Abscess Research Articles

A Rare Case of Spinal Leprosy Mimicking Spinal Tuberculosis

Introduction: Spinal tuberculosis is the most common manifestation of extrapulmonar y tuberculosis. A combination of leprosy and tuberculosis is a rare entity.Case report: A 44-year-old male patient working as a laborer presented to our hospital with complaints of severe back pain and swelling over the back, difficulty in walking, associated with constitutional symptoms. On admission, he was febrile and had leukocytosis. Initial spine X-ray showed end plate destruction and increase in soft tissue shadow at the level of T8-T9. CT spine revealed thoracic paravertebral collection extending from T7 to T9 levels, suggest ive of tuberculous spondylitis with cold abscess. Patient refused a transpedicular biopsy and was started on anti-tubercular therapy. Two weeks after commencement of treatment, he developed worsening back pain and weakness of the lower extremities. MRI spine showed a paravertebral abscess and posterior soft tissue edema involving level of T7 to T11. Patient underwent a posterior decompression, debridement and posterior instrumentation. He was discharged well, there was improvement of his lower limb power. Upon clinic review, he complained of multiple hyperpigmented, painless, nonpruritic skin lesions over the trunk and back. No previous history of eczema, psoriasis and Tinea corporis. Given the history of allergy, initial impression was hypersensitivity reaction towards the titanium implants, and he was started on anti-histamines. However, there was no improvements seen. Histopathological examination of skin lesions revealed presence of granuloma within the dermis layer, composed of epitheloid, histiocytes, lymphocytes and plasma cells. Wade-Fite stain for Mycobacterium leprae is positive. Slit skin smear shows multibacillary leprosy. Patient was started on multidrug therapy (rifampicin, clofazimine and dapsone) for 1 year. He has recovered well.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 33

1418. Clinical Characteristics of Vertebral Osteomyelitis in Cancer Patients

BackgroundVertebral osteomyelitis (VOM) is an infection of vertebrae or intervertebral disc and associated with high mortality, decreased functional status, prolonged antibiotic use and recurrent infection. Although most of the patients with VOM often embody immunodeficiency or other comorbidities, characteristics of VOM in cancer patients remain to be fully elucidated. The aim of this study was to describe clinical profile, underlying disease, lesion site, pathogen, comorbidities, treatment, and outcome in patients with cancer.MethodsThis study was a retrospective observational study in a tertiary care cancer hospital with 801 beds. All patients with VOM were diagnosed by computed tomography or magnetic resonance imaging from July 2004 to March 2019. Culture-confirmed VOM was defined when causative pathogens were identified from the lesion site including vertebra, intervertebral disc, paravertebral or epidural abscess or when the result of blood culture was positive with compatible clinical symptoms. Data including patient characteristics, underlying diseases, lesion sites, type of infection, entry site of infection, results of bacterial culture, treatment, and outcome were collected by electronic medical records. We analyzed data of patients with culture-confirmed VOM between patients with cancer (C-VOM) and patients without cancer (NC-VOM). Death or re-treatment was the primary outcome. Statistical analysis was performed by STATA Version 15.ResultsTotal number of patients diagnosed with VOM was 101, of which culture-confirmed VOM was 61 (C-VOM: 30 and NC-VOM: 31). Age, lesion sites, pathogen, or comorbidities were not significantly different between two groups (table). On the other hand, the rate of contiguous infection in C-VOM was significantly higher than NC-VOM (20.0 % vs. 0.0 %; P = 0.01). Univariate cox proportional hazard model revealed that cancer was risk of death or re-treatment (HR:3.14, 95% CI:1.07–9.24).ConclusionPoor prognosis and contiguous infection from adjacent infection sites should be concerned cancer patients with culture-confirmed VOM. Disclosures All authors: No reported disclosures.

Clinical value of MRI in the diagnosis of Brucellosis spondylitis

Objective: To analyze the MRI characteristics of Brucellosis spondylitis (BS) and evaluate the clinical value of MRI in the diagnosis of BS. Methods: A total of 47 patients clinically diagnosed as BS from General Hospital of Jizhong Energy Xingtai Mining Industry Bloc and Xingtai Second Hospital from January 2015 to December 2017 were collected, including 32 males and 15 females, aged 24-77 years, with an average age of (57±11) years, and the course of disease was 1 month-2 years. Routine spinal MRI sequence were acquired for patients. Images were assessed by two senior imaging diagnostic physician independently. The evaluation included signal changes in the affected area of the vertebral body, vertebral body and intervertebral disc, the signal of paravertebral soft tissue, the signal of abscess around the vertebral body, whether the dural sac, spinal cord and nerve root were compressed or not, and its signal changes. Results: (1) Spinal involvement, in 47 patients with BS, 112 vertebral bodies were involved, including 11 cervical vertebrae (9.8%), 5 thoracic vertebrae (4.5%), 91 lumbar vertebrae (81.2%), and 5 sacral vertebrae (4.5%), the lumbar vertebrae was dominant. (2) MRI features, 112 vertebral bodies were involved, including 105 (93.8%) vertebral bodies morphology showed no significant changes, only 7 (6.2%) vertebral bodies showed mild collapse changes; 71 vertebral bodies showed diffuse destruction (63.4%), and 41 vertebral bodies showed localized destruction (36.6%). Among the 47 cases, 40 cases were continuous destruction of adjacent vertebral bodies, 6 cases showed non-adjacent damage; 37 cases of intervertebral disc involvement; 29 cases of narrowing of intervertebral space; 11 cases of paravertebral soft tissue swelling and 28 cases showed paravertebral abscess. Conclusion: MRI has certain characteristics in the diagnosis of Brucella spondylitis and has a high clinical value in the differential diagnosis of spinal disease.

Spinal brucellosis in Hulunbuir, China, 2011-2016.

Purpose: To investigate the demographic, epidemiological, clinical, and laboratory characteristics; treatment options; and outcome of human brucellosis with spine involvement at a major hospital in Hulunbuir, a brucellosis epidemic region of China.Patients and methods: A total of 842 patients with human brucellosis treated in the Department of Brucellosis, Hulunbuir People’s Hospital from January 2011 to December 2016 were included and analyzed in this study. The results of 67 brucellar spondylodiscitis (BS) cases were compared with those that were negative for spine involvements.Results: The mean age of spinal brucellosis patients was 50.5±10.2 years (43 males and 24 females; age range 29–70). The risk factors for transmission are direct contact with animals, such as working in the farm, and consumption of unpasteurized milk or daily products. Back pain (92.5%), fever (85.1%), sweating (62.7%), and fatigue (52.8%) were the most common symptoms. Magnetic resonance imaging (MRI) was performed in all the patients with spondylodiscitis. The sites of involvement were lumbar (81.2%), thoracic (8.7%), cervical (4.3%), thoracolumbar (2.9%), and lumbosacral (2.9%). All isolates from blood culture were identified as Brucella melitensis, with 61% biovar 3 and 39% biovar 1 isolates. The antimicrobial therapy for BS lasted for at least 3 months. In the presence of paravertebral or epidural abscess, longer treatment was conducted to avoid possible sequelae.Conclusion: In endemic areas such as Hulunbuir, BS should be considered in patients with back pain and fever. MRI is a highly sensitive imaging modality that can be used to differentiate BS from other spinal infections. This study will be helpful to establish strategies for prevention, surveillance, and management of spinal brucellosis in China.

Mycobacterium abscessus ssp. abscessus infection progressing to empyema from vertebral osteomyelitis in an immunocompetent patient without pulmonary disease: a case report

BackgroundPleural involvement by non-tuberculous mycobacteria (NTM) in patients without distinct pulmonary disease is extremely rare. Vertebral osteomyelitis (VO) with or without pulmonary disease is also a rare clinical presentation of NTM infection, and pleural spread of NTM from VO has not been reported.Case presentationA 63-year-old woman was admitted to our hospital with back pain persisting for 4 months and a 2-day history of fever and right chest pain. The patient was initially treated as right-sided empyema due to general bacteria. However, after removal of the chest tube, a previously overlooked paravertebral lesion was observed on CT. MRI confirmed VO at T7/8. Mycobacterium abscessus ssp. abscessus was detected in both the thoracic cavity and the paravertebral lesion. Both VO and the paravertebral abscess were improved by antimycobacterial treatment.ConclusionVO of the thoracic spine due to non-tuberculous mycobacterial infection should be considered as a cause of pleuritis or empyema without pulmonary disease, especially in patients with back pain.

Hindlimb paralysis in a Holstein heifer with pathologic lumbar fracture caused by vertebral and paravertebral body abscess

Hindlimb paralysis in a Holstein heifer with pathologic lumbar fracture caused by vertebral and paravertebral body abscess

Comparison of short-term effectiveness of structural and non-structural bone graft fusion in treatment of single segment thoracic tuberculosis

To compare the short-term effectiveness of one-stage posterior debridement with non-structural bone graft and structural bone graft in the treatment of single segment thoracic tuberculosis. The data of 61 patients with single segment thoracic tuberculosis, who were treated by one-stage posterior debridement, bone graft fusion, and internal fixation between June 2011 and August 2015, was retrospectively analyzed. All of them, 26 cases were treated with structural bone graft (group A) and 35 cases with non-structural bone graft (group B). No significant difference was found between the two groups in gender, age, disease duration, comorbidity, involved segments, paravertebral abscess, and preoperative American Spinal Injury Association (ASIA) grade, C reactive protein (CRP), visual analogue scale (VAS) score, and Cobb angle of involved segments ( P>0.05). But the preoperative erythrocyte sedimentation rate (ESR) in group B was significantly lower than that in group A ( t=3.128, P=0.003). The operation time, intraoperative blood loss, hospitalization stay, VAS score, ESR, CRP, ASIA grade, postoperative complications, Cobb angle of involved segments and its correction rate and loss rate, and bone fusion time were recorded and compared between the two groups. Compared with group A, group B had shorter operation time, less intraoperative blood loss, and longer hospitalization stay, showing significant differences ( P<0.05). The follow-up time of group A was (36.3±10.0) months, which was significantly longer than that of group B [(18.4±4.2) months] ( t=10.722, P=0.000). At last follow-up, the VAS score, ESR, and CRP in the two groups all significantly improved when compared with those before operation ( P<0.05); the CRP of group B was significantly higher than that of group A ( t=-2.947, P=0.005); but there was no significant difference in ESR and VAS score between the two groups ( P>0.05). At last follow-up, the ASIA grade of the two groups significantly improved when compared with those before operation, and there was no significant difference between the two groups ( Z=-1.104, P=0.270). There were 9 cases and 10 cases of complications in groups A and B, respectively, and there was no significant difference ( χ 2=0.254, P=0.614). The Cobb angle in group B was significantly higher than that in group A at 3 days after operation ( t=-2.861, P=0.006), but there was no significant difference in Cobb angle between the two groups at last follow-up ( t=-1.212, P=0.230). The postoperative correction rate and loss rate of Cobb angle in group A were higher than those in group B, and there was a significant difference in the loss rate between the two groups ( t=2.261, P=0.031). All patients got bone graft fusion and the bone fusion time of group B was significantly shorter than that of group A ( t=4.824, P=0.000). Non-structural and structural bone graft can both achieve good effectiveness in the treatment of single segment thoracic tuberculosis, but the former has the advantages of less surgical trauma and shorter fusion time.

A systematic review: characteristics, complications and treatment of spondylodiscitis.

This systematic review focuses on 5 key elements that may improve the decision-making process in spondylodiscitis: the infective agent, segmental instability, abscess development, neurological compromise and focus of infection. We included 64 studies published between May 2012 and May 2017, that reported both a description of the discitis and comparative data regarding the disease and its complications. The majority of cases were caused by Staphylococcus spp (40.3%) and involved the lumbosacral region (52.3%). 27.8% of cases were associated to neurological compromise, 30.4% developed an abscess, 6.6% were associated to instability, and 54.7% underwent surgery. The abscesses mostly involved the lumbosacral region (60.4%) with paravertebral localization; 32.6% of cases involved the thoracic region, showing mostly epidural localization; a small number of cases (7%) involved the cervical region, mostly with epidural localization. 95% of paravertebral abscesses were treated percutaneously, while 85.7% of epidural cases underwent "open" surgery. Spinal cord compression mainly occurred in the cervical region (55.9%), neurological deficit was observed in over half of cases (65%), and surgery was required in most of the cases (83.9%). The majority of cases of instability involved the lumbosacral region (53.3%) and underwent surgery (87%). The focus of infection was mostly lumbosacral (61%) and almost all cases (95%) were treated surgically. Spondylodiscitis is a complex and multifactorial disease, whose diagnosis and management are still challenging. Due to its potential morbidity, it is extremely important to investigate the 5 key elements discussed in this paper in order to provide an early diagnosis and initiate the most effective treatment.

Tuberculous Spondylitis involving Sacrum- a rare location and presentation of Pott’s disease: Case report and review of the Literature

Background: Spinal tuberculosis is a common form of extrapulmonary manifestation of tuberculosis. Among them tubercular involvement of the lumbosacral region or isolated involvement of sacram is very rare presentation.&#x0D; Aim of the work: The aim of this case presentation is to describe two rare cases of Pott’s disease which clinically mimicked spinal tumor.&#x0D; Case report: A 60-year-old hypertensive, diabetic male patient admitted with low back pain radiating to both lower limbs for 7 months along with low grade fever, generalized weakness and weight loss for the same duration. Clinically, patient had features of flaccid paraparesis, tenderness at the lumbosacral junction, restricted SLR on both sides. There was no features of autonomic dysfunction. MRI of lumbosacral spine showed infective spondylodiscitis at L4 to S1 level with collapse of L5 vertebrae along with paravertebral and epidural abscess. Diagnosis was confirmed by CT guided FNAC from the lesion. Next case was a 23-year-old male patient presented with back pain and walking difficulty for 5 months with some constitutional symptoms.MRI of the dorsal spine with whole spine screening showed multifocal skipped lesion involving whole spine with presence of huge presacral collection. Percutaneous transpedicular aspiration of the purulent material under C-Arm guidance was done and tuberculous infection confirmed by Gene Xpert.&#x0D; Conclusion: Though sacral tuberculosis is rare presentation of Pott’s disease but it should be considered as one of the differential diagnosis in any lytic lesion involving the sacrum in perspective of our country.&#x0D; Bangladesh Journal of Medical Science Vol.18(2) 2019 p.440-445

Moderne radiologische Diagnostik in der Wirbelsäulenchirurgie

Radiological imaging is important in the preoperative diagnosis of many forms of spinal pathology and plays afundamental role in the assessment of p.o. effects, which can be verified on the spinal column as well as on the surrounding soft tissues, depending on the imaging method used. The article provides an overview of the current status and possibilities of radiological diagnostic methods for the verification of possibly recommended spine surgery in the context of degenerative, inflammatory-infectious, post-traumatic or p.o. pathologies and changes in the spine: X‑rays, computed tomography (CT), magnetic resonance imaging (MRI). The supplementary nuclear medicine procedures (scintigraphy, PET[-CT], SPECT, etc.) which may be required for special questions are not discussed. The merits and limitations of the techniques used in the investigation of advanced degenerative spinal pathologies and post-traumatic conditions are discussed, with multidetector CT being the focus of attention in spinal clearance for traumatic injuries. In most cases of spinal infection, MRI images, as acentral diagnostic tool, show typical findings such as destruction of adjacent endplates, bone marrow and intervertebral disc abnormalities, and paravertebral or epidural abscesses. However, it is not always easy to diagnose aspinal infection, especially if atypical MR patterns of infectious spondylitis are present. Knowledge of them means misdiagnosis and improper treatment can be avoided. It is shown that high-quality modern radiological examinations are essential for diagnosis and p.o. management, as these provide answers to the main questions in the treatment: Is the entity/injury stable or unstable, acute or old, benign or malign; is there amyelopathy or p.o. complication? The main indications for p.o. diagnostic imaging, difficulties such as metal artefact formation, and potential pitfalls are analyzed. Entity-specific radiological image patterns, imaging algorithms and differential diagnostic peculiarities are presented and discussed based on current literature and selected case studies.

A case of paravertebral abscess presented with ataxic gait

A case of paravertebral abscess presented with ataxic gait

Treatment of tuberculosis of lumbar spine in elderly patients with percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation

To explore the clinical effects and advantages of percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation in the treatment of tuberculosis of lumbar spine in elderly. The clinical data of 32 patients with tuberculosis of lumbar spine received percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation from May 2013 to May 2016 were retrospectively analyzed. There were 13 males and 19 females, aged from 62 to 85 years old with an average of 75 years. Lesion segmental Cobb angle was 13° to 21° with an average of (16.52±3.20)°. Tuberculosis focal involved L₁-L₂ of 1 case, L₂-L₃ of 4 cases, L₃-L₄ of 15 cases, L₄-₅ of 10 case, L₅-S₁ of 2 cases. Cobb angle, VAS score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and ASIA grade were compared before and after operation. The stability of the spine and the recurrence of tuberculosis were evaluated. All patients were followed up for 12-36 months with the mean of 24 months. Three patients complicated with giant paravertebral psoas abscess occurred sinus tract in canal orifice of drainage tube after irrigation, and healed in 3 months after operation. Other 29 patients obtained healing of phase I without sinus tract formation. The clinical symptoms of all patients obvious improved at 2 weeks to 3 months after operation and no complications such as severe heart and lung, liver and kidney dyfunction were found. VAS scores and Cobb angles were improved from preoperative(6.77±1.23) points and(16.52±3.20)° to(4.71±0.69) points and (4.24±1.22)° at 1 week after operation. No infection and tuberculosis recurrence were found at follow-up period. ESR and CRP were normal at final follow-up and ASIA grade had obvious improved. Percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation is a simple, effective and safe method for tuberculosis of lumbar spine in elderly, and is worthy to recommend its clinical use.

A rare widespread tuberculous spondylitis extended from the T5-T10 levels – a case report

Tuberculous spondylitis is an infection of Mycobacterium tuberculosis in the spine and might compromise the vertebrae. Patients often come to treatment at an advanced stage; whilst early diagnosis might be quite tricky. Twenty two years old male patient experienced a weakness, tingling and thickness in both lower limbs that worsened since 1 week before the admission. The imaging results of the multi-slice computed tomography (MSCT) with contrast and X-ray was obtained by impression of pulmonary tuberculosis and lead to the diagnosis of tuberculous spondylitis. Infection developed into a paravertebral abscess in the form of back swelling that is clearly observed at the radiological features with T5-T10 levels of lesion. In this case, neuropathology may be caused by compression of the spinal cord by the abscess; worsened by an ongoing infection and inflammation. Motor deficits might be due to the extended lesion in the anterior horn of the spinal cord; whilst the sensory deficits due to the posterior horn lesion. After medication with anti-tuberculosis and stabilization of the back, patient achieved significant improvement. This underlining the importance of basic anatomy knowledge and its clinical correlation for optimizing patient’s diagnosis and treatment.

BLAST IN THE VERTEBRAL BODY

SESSION TITLE: Medical Student/Resident Lung Pathology 3 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Bone is the third most frequent site of disease in patients with blastomycosis, and the vertebrae are among the bones affected most often. We describe the clinical features and treatment of a patient with vertebral blastomycosis. This case is very interesting because of its unusual presentation and symptoms. CASE PRESENTATION: A 25 year old male who lives in Wisconsin with no medical history presented to the emergency room (ER) with upper chest and back pain for past 6 months. He denies any travel history, no intravenous drug abuse, no sick contacts, no unintentional weight loss and no sexual contact in last 12 months. He does complaints of night sweats that began 2 weeks prior to his ER visit. Upon further questioning, the patient mentioned that he had some dry cough 6-8 months ago for which he was seen at the outside hospital. He was prescribed Azithromycin and discharged home. He did not follow up with his primary care doctor. Request was sent to obtain the records from the other hospital.CT angiogram was obtained during this hospitalization , it was negative for active pulmonary embolism but revealed posterior mediastinal mass in the superior mediastinum involving the posterior aspect of the thoracic spine, vertebral body with lytic ad sclerotic changes. MRI of cervical and thoracic spine showed large infiltrative enhancing lesion which extends from C7-T5,extensive osseous involvement, posterior mediastinal involvement with mass effect, foraminal obliteration and possible partial encasement of the vertebral arteries. This changes appeared to be of some sort of malignancy. To further evaluate the pathology cardiothoracic surgery was consulted. They recommended that esophageal ultrasound should be obtained to get the biopsy of the mass. The biopsy showed acute inflammatory debris with histiocytes and multi-nucleated giant cells including double refractile yeast forms with broad-based budding, Kinyoun stain negative for acid-fast bacilli and no evidence of malignant cells. After carefully reviewing the old images, it showed that he had a left middle lobe infiltrate which could have been an primary infection with Blastomycosis. The patient was discharged on long term Itraconazole. DISCUSSION: This case teaches us the importance of broad differential diagnoses in evaluating a patient. It is also very important to get detailed history and physical exam in evaluating the patient. Teamwork played a major role in this patients correct diagnosis and successful treatment. This case also gives us insight into how uncommon diseases present with uncommon manifestations. CONCLUSIONS: This case is of utmost clinical significance because it teaches us important aspect to approach a patient with unique presentation. It is also important to obtain detail history and also important to review images on your own to get the complete picture. Reference #1: Ralph ED, Plaxton WR, Sharpe MD. Treatment of severe pulmonary blastomycosis with oral itraconazole: case report. Reference #2: Saccente M, Abernathy RS, Pappas PG, Shah HR, Bradsher RW. Vertebral blastomycosis with paravertebral abscess: report of eight cases and review of the literature. Clin Infect Dis 1998;26:413–418 Reference #3: Sobel JD. Practice guidelines for the treatment of fungal infections. For the mycoses study group, Infectious Diseases Society of America. Clin Infect Dis 2000;30:652. DISCLOSURES: No relevant relationships by Vimalkumar Patel, source=Web Response

Imaging diagnosis of brucella spondylitis and tuberculous spondylitis

Objective: To compare the characteristics of X-ray, CT and MRI of Brucella spondylitis and tuberculous spondylitis and its significance for differential diagnosis. Methods: A total of 10 cases of Brucella spondylitis and 20 cases of tuberculous spondylitis confirmed from the clinical, laboratory or pathological department were enrolled between January 2014 and August 2017 in the Fifth Affiliated Hospital of Sun Yat-sen University and the Third Affiliated Hospital of Southern Medical University. The CT, MRI findings were retrospectively analyzed to improve the differential diagnosis of these two diseases. Results: Of the 10 cases of Brucella spondylitis, 8 were located only in the lumbosacral vertebrae, 1 in the thoracic vertebrae only, 1 in the cervical and thoracic vertebrae, 8 with invasive bone destruction, and 8 with narrowed intervertebral space. In 9 cases of intervertebral disc destruction, 7 cases developed paravertebral abscesses, 3 cases had sclerotic edges, all cases had no vertebral body flattening, 5 cases invaded the accessory, 4 cases formed sequestrum, and 6 cases invaded the spinal canal. There were 3 cases showing invasion of surrounding muscles. In 20 cases of tuberculous spondylitis, 12 cases were located in the lumbosacral vertebrae, 6 cases in the thoracic vertebrae only, 1 involved the thoracic vertebrae and lumbosacral vertebrae, 1 involved the neck, chest, and lumbosacral vertebrae. Bone destruction of bone, 19 cases of intervertebral space narrowing, 20 cases of intervertebral disc destruction, 18 cases of paraspinal abscess formation, 10 cases of sclerotic edge formation, 6 cases of vertebral body flattened, 16 cases of invading attachment. There were 17 cases of sequestrum formation, 13 cases of invasion of the spinal canal, and 12 cases of violation of surrounding muscles. There were statistical differences between the two types of imaging signs such as the type of vertebral destruction and the presence or absence of sequestrum. Conclusion: The type of vertebral destruction and the presence or absence of imaging features such as sequestrumwill facilitate the differential diagnosis of Brucella spondylitis and tuberculous spondylitis.

Outcomes of multilevel vertebrectomy for spondylodiscitis

BACKGROUND CONTEXTThe incidence of pyogenic vertebral osteomyelitis (PVO) continues to increase in the United States, highlighting the need to recognize unique challenges presented by these cases and develop effective methods of surgical management. To date, no prior research has focused on the outcomes of PVO requiring two or more contiguous corpectomies. PURPOSETo describe our experience in the operative management of PVO in 56 consecutive patients who underwent multilevel corpectomies (≥2 vertebral bodies) via a combined approach. STUDY DESIGN/SETTINGSingle institution retrospective cohort review between January 2002 and December 2015. All patients had been treated at an academic tertiary referral center by one of two fellowship-trained orthopedic spine surgeons. PATIENT SAMPLEPatient records were cross-referenced with International Classification of Diseases osteomyelitis codes and paravertebral abscess code. Inclusion criteria for the study were patients within the cohort who had adequate medical records for review, a minimum patient age of 18 years, active vertebral osteomyelitis as an indication for surgical intervention, a minimum of 1-year radiographic follow-up, and surgical intervention that included at least two complete vertebral corpectomies. Subsequently, 56 patients met the inclusion criteria and were reviewed for this retrospective analysis. OUTCOME MEASURESOutcomes of interest were readmission and reoperation rates related to treatment of PVO, 30-day and 1-year mortality rates, radiographic outcomes, perioperative complications, infection control, and length of stay. METHODSAfter obtaining approval from the Institutional Review Board, retrospective review was performed on records of all adults with PVO refractory to standard nonoperative treatment who underwent complete corpectomy of two or more contiguous vertebrae at a single institution between January 2002 and December 2015. This study was not funded, and no potential conflict of interest-associated biases were present. RESULTSFifty-six patients were identified (63% men; mean age 56.8 years; mean radiographic follow-up 2.8 years). Median length of stay was 13 days with nearly half readmitted (47%) after a median of 222.5 days after surgery. Twelve (22%) posterior revisions were required after a median 54 days for infection, painful or failed hardware, proximal junction kyphosis, adjacent level disease, or extension of the fusion. Thirty-day and 1-year mortality rates were 7.14% and 19.6%, respectively, with an infectious etiology as the most common cause of death. CONCLUSIONSMultilevel vertebral corpectomy for treatment of refractory vertebral osteomyelitis is associated with relatively high rates of complications and mortality compared with historical controls for 1 or 2 level procedures. We found clinical resolution and absence of complications requiring return to the operating room in 75% of patients when complete extirpation of the involved vertebrae is achieved. Our findings suggest multilevel anterior corpectomies with posterior stabilization may be a reasonable surgical option when approaching patients with complicated spondylodiscitis.

Spondylitis - Spondylodiscitis - an Update.

Spondylodiscitis is an infection of the intervertebral disc with subsequent infection of the adjacent vertebral bodies. The main causes are 3 pathogen groups: bacteria, particularly tuberculosis pathogens, fungi and parasites. In pyogenic spondylodiscitis, infections with Staphylococcus aureus are the most common, with an incidence of up to 80%. Mortality is around 2 - 3%. Infections with tuberculosis are often associated with psoas and paravertebral abscesses. Neurological deficits are registered in up to 50% of patients. For microbiological diagnostic testing, blood cultures are used for aerobic and anaerobic bacteria. However, histological examination leads significantly more frequently to positive pathogen detection. In tissue samples, results with 16S rRNA PCR results are clearly superior to results from microbiological examination. The MRI exhibits high sensitivity and specificity and is therefore superior to other radiological methods. Elimination of the infection, pain reduction and stabilisation of the spine are the main objectives of any treatment. A standardised antibiotic therapy for spondylodiscitis has not been clearly defined. Pathogen detection is important, with focused antibiotic therapy. Antibiotic therapy should initially be administered intravenously for 2 - 4 weeks. This should be followed by oral administration for 6 - 12 weeks. In the case of antibiotic-resistant infections with neurological deficiencies, it is recommended to perform a surgical procedure, with careful debridement and instrumentation as well as i. v. administered antibiotics for 3 weeks followed by three month oral antibiotic treatment. Surgical procedures are indicated with neurological deficits, progressive increase in spinal deformities, failure of conservative therapy with insufficient pain relief and unreliable pathogen identification. The selection of the surgical procedure should mainly be based on the extent and localisation of bone destruction and the individual circumstances of the patients. The prognosis is good if there is a clear reduction in CRP and ESR in the first few weeks.

Imaging-Assisted Diagnosis and Characteristics of Suspected Spinal Brucellosis: A Retrospective Study of 72 Cases.

BackgroundWe clarified the imaging features of Brucella spondylitis to enhance our understanding of the disease and to minimize misdiagnosis.Material/MethodsImaging data (X-ray, computed tomography [CT], and magnetic resonance imaging [MRI] data) of 72 Brucella spondylitis patients treated from 2010 to 2017 were retrospectively analyzed; diagnoses was made by evaluating laboratory and pathological data.ResultsX-ray films revealed changes in intervertebral space heights, the number of lateral osteophytes, and bone destruction, which were more severe in the following order: lumbosacral vertebrae (56 cases, 77.8%), cervical spine (6 cases, 8.3%), thoracic spine (5 cases, 6.9%), and multi-segmental mixed vertebrae (5 cases, 6.9%). CT revealed osteolytic destruction attributable to early-stage Brucella spondylitis (endplate and vertebral lamellar osteolysis), usually associated with multiple vertebral involvement, with the middle and late disease stages being characterized by osteophytes in the vertebral margins and bony bridges, endplate sclerosis, and vertebral osteosynthesis. We encountered 54 cases (75%) with endplate lamellar osteolysis, 37 (51.4%) with vertebral lamellar osteolysis, 59 (81.9%) with marginal osteophytes, 10 (13.9%) with bony bridges, 25 (34.7%) with vertebral laminar sclerosis, and 17 (23.6%) with vertebral osteosynthesis. MRI revealed early, low-intensity, differential T1WI vertebral and intervertebral signals, with occasional iso-signals, T2WI iso-signals or high-intensity signals; and T2WI-FS vertebral and intervertebral high-intensity signals, commonly from vertebral soft tissues and rarely from paravertebral abscesses.ConclusionsA better understanding of the X-ray, CT, and MRI features of Brucella spondylitis could aid in diagnosis when combined with epidemiological and laboratory data, thus minimizing misdiagnosis.

Clinical outcomes of percutaneous suction aspiration and drainage for the treatment of infective spondylodiscitis with paravertebral or epidural abscess

Background ContextPatients with infective spondylodiscitis who failed conservative treatment are generally indicated for open surgery. However, some patients are poor candidates for standard surgery, hence the need to evaluate less invasive approaches. Good outcomes were previously reported for percutaneous suction aspiration and drainage (PSAD) in the treatment of infective spondylodiscitis resistant to conservative therapy. We recently extended the surgical approach of PSAD to allow drainage of paravertebral or epidural abscesses in patients with progressive infective spondylodiscitis. PurposeTo evaluate the clinical outcomes of PSAD for infective spondylodiscitis with paravertebral or epidural abscess. DesignRetrospective case series. Patient SamplePatients with infective spondylodiscitis and associated epidural or paravertebral abscess treated using PSAD at our institution, between 1998 and 2014. Outcome MeasuresSerum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and imaging data obtained via plain radiography, computed tomography, and magnetic resonance imaging were analyzed. Serum measurements were taken preoperatively and at several time points postoperatively. Clinical outcomes were evaluated using the modified MacNab criteria for overall functional mobility. MethodsData were obtained from the patients' case notes, radiological images, and medical records. Student t test was used to assess the relevance of changes in serum levels of CRP and ESR at each evaluated time point, as well as the change in sagittal Cobb angle between the preoperative state and the state at final follow-up. ResultsFifty-two patients (31 men and 21 women; average age, 70.6 years) were included in our analysis. The median (range) CRP levels and ESR values at the time of diagnosis were 6.86 (0.04–20.15) mg/dL and 78.8 (26–120) mm/h, respectively. At 1 year postoperatively, these values had decreased to 0.18 (0.0–1.2) mg/dL and 13.8 (4–28) mm/h for CRP and ESR, respectively. At final follow-up, bone union was observed in 80.8% (42 of 52) of patients, with instability identified in five patients. Regarding functional mobility, excellent outcomes were obtained in 26.9% (14 of 52) of patients, whereas good, fair, and poor outcomes were noted in 42.3% (22 of 52), 3.9% (2 of 52), and 26.9% (14 of 52) of patients, respectively. Overall, treatment was considered effective in 69.2% (36 of 52) of patients. ConclusionsPercutaneous suction aspiration and drainage can serve as an effective alternative to open surgery for the treatment of patients with progressive infective spondylodiscitis and associated paravertebral or epidural abscess.

Pyogenic spondylitis and paravertebral abscess caused by Salmonella Saintpaul in an immunocompetent 13-year-old child: a case report

BackgroundSalmonella spondylitis is an uncommon complication of Salmonella infection in immunocompetent children. To prevent treatment failure and neurological deficits, it needs prompt diagnosis and sufficient effort to identify the causative organism. There are some options to identify the causative organism such as Computed Tomography (CT) guided biopsy or surgical debridement, however when to perform these invasive interventions remains controversial.Case presentationA 13-year-old boy presented with occasional high fever and lower back pain. He was diagnosed with spondylitis of the L4–5 vertebral bodies and paravertebral abscess. Initial blood cultures were negative, therefore empirical antibiotic treatment was started. He responded well to conservative management, and was discharged after clinical improvement. However, he was re-hospitalized 2 weeks after discharge, and surgical debridement was performed which led to the detection of Salmonella Saintpaul as the causative pathogen. It was revealed that the possible source of infection was consumption of raw poultry eggs, or contact with poultry. Definitive antibiotic therapy was started. He was discharged with good recovery after a 6-week hospitalization.ConclusionsThis is the very first case report of pyogenic spondylitis caused by Salmonella Saintpaul. Salmonella should be considered as a causative pathogen of pyogenic spondylitis in immunocompetent children. Identifying the causative organism is essential to prevent treatment failure, and a high index of suspicion is needed for prompt diagnosis especially when blood cultures are negative. Invasive interventions such as CT-guided biopsy should be considered even if the clinical course seems to be uncomplicated.