Paravertebral Abscess Research Articles

Acute flaccid paralysis in young children: “Watch their back”

Background : Congenital dermal sinus is a developmental malformation which may be associated with sinus tract between the skin and the deeper tissues even spinal cord. Hence, can have complicated presentations like gait abnormalities, infections, urinary symptoms or mass lesions. We hereby describe a case series of six children with spinal abscesses complicating dermal sinus. Methods : All children with flaccid paralysis presented to our center during the period January 2016 to May 2017 were reviewed. The children were evaluated by Spinal imaging, Nerve conduction studies, and cerebrospinal fluid analysis or biochemical and microbiology investigations as indicated. The clinical symptoms, neurodeficits, radiological findings, culture of Cerebrospinal fluid or blood and treatment provided were analyzed. These children were followed up clinically for assessment of neurodeficits. Results : Of a total of 111 children of acute flaccid paralysis admitted during this period, six children had spinal abscess associated with dermal sinus. (The other diagnosis were Guillain Barre syndrome, myositis, myelitis). The median age of diagnosis and median duration of symptoms was 8.5 months and 33 days. All six children presented with progressive weakness of lower limbs; fever and urinary symptoms were present in only two children. In none of the children was spinal cord infection kept as an initial differential diagnosis. All children had evidence of intra-medullary abscess, cord edema and spinal archanoiditis. One child had holocord involvement, while rest had involvement of dorso-lumbosacral spine involvement. Two children had epidural abscess while one child had paravertebral abscess. Four children needed spinal laminotomy. The offending organism was isolated in two children (E.coli). All except one (parents declined treatment) were treated with intravenous antibiotics for 6-8 weeks. All children had motor improvement after treatment but all were left with severe deficits and residual neurogenic bladder Conclusion : The infection of the spinal cord and meninges due to a dermal sinus is rare cause of paralysis and can present without fever. In any child with flaccid paralysis, a careful examination of back for dermal sinus is critical to suspect this diagnosis.

Unexpected Death by Sepsis ofStaphylococcus aureuswith Infective Endocarditis and Paravertebral Abscess in a Fisherman during Sailing out for Fish: An Autopsy Case

Unexpected Death by Sepsis of<i>Staphylococcus aureus</i>with Infective Endocarditis and Paravertebral Abscess in a Fisherman during Sailing out for Fish: An Autopsy Case

COMPLICATED LUMBAR TUBERCULOUS SPONDYLODISCITIS IN DISSEMINATED TUBERCULOSIS, TREATED USING A NON-CONVENTIONAL ANTERIOR SUPPORT SYSTEM FOR HYDROSTATIC DISTRACTION: A CASE REPORT.

ABSTRACTObjective:To describe a case of disseminated tuberculosis affecting the lumbar spine that was treated using a non-conventional anterior support system.Background:Tuberculous spondylodiscitis is the most common and most severe form of extrapulmonary tuberculosis. Although antibiotic therapy is the most frequently used treatment, surgery is necessary in cases of neurological deficit, spinal instability, significant deformity, severe sepsis, paravertebral and epidural abscesses or in cases wherein clinical treatment has failed. A surgical procedure is also indicated when a biopsy is required. With the development of new methods for reconstruction and fixation of the spine, complete debridement of the tuberculous foci has become an increasingly common approach, but there is a lack consensus on the best technique.Methods and results:The patient suffered from disseminated tuberculosis affecting the lumbar region of the spine, with an abscess in the psoas muscle. He underwent extensive debridement via both anterior and posterior approaches, using a non-conventional anterior support system that promotes hydrostatic distraction.Conclusions:Treatment using the hydrostatic distraction system was able to reestablish both the stability and anatomy of the lumbar curve. Level of evidence IV, Case report.

Spinal Infections: Timing of MRI Findings in Dogs

Objective: To assess timing of magnetic resonance imaging (MRI) findings of spontaneous pyogenic spinal infections in dogs. Method: This retrospective observational study included 61 dogs that underwent MRI for spinal infection (48 cases of diskospondylitis, 10 cases of paravertebral abscess or phlegmon, 3 cases of epidural abscess or phlegmon), confirmed by bacteriology, cytology or histopathology. Data collected included the site of infection, the type of lesion, the degree of neurological dysfunction, the interval between the onset of symptoms and the MRI examination, and the characteristics of vertebral bodies, intervertebral discs, dorsal arthrodial joints, the vertebral canal and paravertebral soft tissues. Results: The frequency of spinal infections at the different sites differed significantly. The presence and type of vertebral and diskchanges associated with diskospondylitis were significantly different according to the time elapsed between the first onset of symptoms and the examination. All patients examined within 5 days from the onset of symptoms showed a reduction in thickness associated with contrast medium uptake of discs involved, as well as vertebral signal hyperintensity on T2-weighted sequences associated with areas of somatic contrast medium enhancement. The magnitude of contrast enhancement was greater in fat-suppressed sequences.Conclusions: The MRI findings of spontaneous spinal infections are highly distinctive. Changes vary with time and MRI allows early detection, within 5 days from the onset of symptoms. In cases of suspected spinal infection, MRI must be preferred to other diagnostic procedures.

Clinical case of epidural and paravertebral abscesses associated with HIV infection

Clinical case of epidural and paravertebral abscesses associated with HIV infection

Thoracic Paravertebral Abscess and Secondary Meningitis in a Hemodialysed Patients: Case Presentation

Thoracic Paravertebral Abscess and Secondary Meningitis in a Hemodialysed Patients: Case Presentation

Analysis of infectious spondylodiscitis: 7-years data.

Objective:Infectious spondylodiscitis (SD) is an infectious disease that is rare and difficult to diagnose due to its non-specific clinical features. In this study, we aimed to describe the clinical and diagnostic features of infectious spondylodiscitis.Methods:All patients who were diagnosed with SD at our hospital during a 7-year period from January 1, 2011 through December 31, 2017 were included in the study. Spondylodiscitis is divided into the following three types: pyogenic, tuberculous, and brucellar. Clinical and laboratory data were collected retrospectively from the medical records of the patients.Results:Of the 118 patients, 66 (55.9%) were female, 81 (68.6%) had pyogenic SD (PSD), 21 (17.8%) had tuberculous SD (TSD), and 16 (13.6%) had brucellar SD (BSD). The mean age was 59.3 ± 14.6 years. Leucocytosis was significantly higher in patients with PSD (p=0.01) than in patients with other types of SD. Thoracic involvement (47.6%) was significantly higher in patients with TSD (p=0.005) than in other patients. Sacral involvement (12.5%) was significantly higher in patients with BSD (p=0.01) than in other patients. Paravertebral abscess formation (42.8%) occurred most frequently in patients with TSD. Microbiologic agents were defined in 50% (18/36) of the surgical specimens and in 12.5% of the fine needle aspiration biopsy (FNAB) specimens. Staphylococcus aureus was the most common microbiological agent in patients with PSD. Spinal surgery was defined as a risk factor for PSD (p = 0.0001). Binary logistic regression analysis revealed that female gender, thoracic involvement and night sweats were the predictive markers for TSD (OR 4.5 [95% CI 1.3-15.3] and OR 5 [95% CI 1.7-14.6]).Conclusion:PSD is the most frequent form of SD. Leucocytosis is most common in patients with PSD. Thoracic involvement and paraspinal abscess were prominent in patients with TSD. Sacral involvement was most common in patients with BSD. Thoracic involvement, female gender and night sweats were the predictive markers for TSD. The microbiological culture positivity rate was higher in surgical specimens compared to FNAB specimens. The need for surgical treatment was most common in patients with TSD.

Case reports on integrated management of tubercular disease

Host immunity plays an important role in prevention of disease as is evident by the increased incidence of Tuberculosis (TB) in immuno-compromised population of HIV infected, diabetes inflicted, immune-suppressant therapy and elderly people. Rising incidence of antibiotic resistance has led to resurgence of TB of epidemic proportions. Integrated treatment with add on homeopathy in addition to anti-tuberculosis treatment (ATT) appears to improve outcome in TB. The intervention has been integrated treatment with homeopathy regime, which is using a patient specific, disease specific and supportive medicine simultaneously, all individualized for the patient and the disease. CASE 1: Pott's spine with paravertebral abscess, not responding to ATT. Addition of homeopathy led to fall in temperature, improved appetite, increase in weight and reduction of abscess. CASE 2: Recurrent sub-acute intestinal obstruction. The patient could not tolerate ATT but responded to homeopathy by reduction of abdominal pain and distension, vomiting, loose stools and queasiness. CASE 3: Pulmonary TB, treated with both ATT and homeopathy from beginning, led to rapid recovery and shortened treatment time. The addition of homeopathy to ATT is patient friendly, cost effective and appears to reduces the duration of treatment. Its role as immuno-modulatory therapy should be evaluated and explored.

Diagnosis and classification in MRI of brucellar spondylitis

ObjectiveTo explore the magnetic resonance imaging (MRI) features of patients with brucellar spondylitis and try to classify them depending on the MRI findings. Material and methods67 patients (male&female: 50&17) with brucellar spondylitis were recruited in this study. MRI examinations were performed in all patients. Firstly, MRI data were analyzed by two senior radiologists. Secondly, according to the imaging findings, patients were divided into different types. ResultsIn all 67 patients with spinal brucellosis, 5 cases only had paravertebral soft tissue involved, 62 cases showed abnormal signal in single or multiple adjacent vertebrae. Thirty-five patients focused on the L4 vertebral involvement. 18 cases had appendage involvement. 27 cases hand intervertebral disc narrowing and cystic signal. Paravertebral, epidural and psoas abscesses were detected in 35, 20 and 8 cases.Patients were grouped according to MRI findings. The vertebral inflammatory type was the most frequently type with the rate of 35.8%, followed by discitis type 32.9%, adnexitis type 11.9%, paravertebral and psoas abscess type 11.9% and paravertebral soft tissue type 7.5%. ConclusionIt is not difficult to diagnose brucellar spondylitis in MRI findings based on clinical background and laboratory tests. According to the performance of MRI, five types can be classified.

Spinal Coccidioidomycosis: A Current Review of Diagnosis and Management.

Coccidioidomycosis is an invasive fungal disease that may present with extrathoracic dissemination. Patients with spinal coccidioidomycosis require unique medical and surgical management. We review the risk factors and clinical presentations, discuss the indications for surgical intervention, and evaluate outcomes and complications after medical and surgical management. A review of the English-language literature was performed. Eighteen articles included the management of 140 patients with spinal coccidioidomycosis. For the 140 patients, risk factors included male sex (95%), African American ethnicity (52%), and a recent visit to endemic areas (16%). The most frequent clinical presentation was pain (n= 80, 57%), followed by neurologic compression (52%). One-third of patients had concurrent pulmonary disease. The sensitivity of culture and histology for coccidioidomycosis was 80% and 90%, respectively. Complement fixation titers >1:128 suggest extensive or refractory vertebral infection. The most commonly affected spinal segments were the thoracic and lumbar spine (69%); an additional 40 patients (29%) had epidural and paravertebral abscesses. All patients received therapy with azoles (60%) and/or amphotericin B (43%). Surgical and medical management were used conjunctively to treat 110 patients (79%), with debridement (95% [105/110]) and fusion (64% [70/110]) being the most common surgical procedures. Clinical outcome improved/remained unchanged in 83 patients (59%) and worsened in 4 patients (3%). The mortality was 7%. Infection recurrence and disease progression were the most frequent complications. Emphasis should be placed on continuous and lifelong appropriate azole therapy. Spinal instability and neurologic compromise are surgical indications for decompression and fusion.

Video-Assisted Thoracoscopic Surgery for Drainage of Dorsal Paravertebral Abscess

Tuberculosis of the spine is the second most common extrapulmonary presentation of the disease and is associated with significant morbidity. The drainage of the abscess may be needed in patients who fail to respond to medical treatment and present with a significant or deteriorating neurologic status. The dorsal spine gives a unique opportunity for decompression alone as it is supported by the rib cage, decreasing the chances of collapse. Drainage of the abscess in the dorsal spine usually needs an open thoracotomy. Open thoracotomy is associated with increased blood loss, pain, and increased postoperative rehabilitation period. Video-assisted thoracoscopic surgery (VATS) is an excellent alternative for decompression of dorsal paraspinal abscess with significantly decreased blood loss, soft tissue dissection, scarring, and hospital stay. Overall, this leads to significantly decreased postoperative morbidity and faster recovery. The purpose of this article was to describe the indications and procedure of VATS for drainage of dorsal spine paravertebral abscess.

Noncontiguous multi-tiered spinal tuberculosis associated with sternal localization: a case report

BackgroundTuberculous spondylodiscitis is a frequent localization of tuberculosis. Multi-tiered involvement and an association with sternal localization are rare.Case presentationWe report a case of multi-tiered tuberculous spondylodiscitis with sternal localization in an immunocompetent 41-year-old Arab woman who had inflammatory bilateral sciatica L5 and S1 and a history of low back pain caused by a trauma. Radiography, computed tomography, and a vertebral biopsy were useful for diagnosis. She reacted well to anti-bacillary treatment despite the occurrence of multiple paravertebral and subcutaneous abscesses. The medullar magnetic resonance imaging control performed at 4 months, 12 months, and 1 year after the end of treatment showed a favorable evolution.ConclusionsTo avoid the delay of diagnosis, especially in our endemic context, tuberculosis must be evoked usually. This will improve the prognosis of our patients.

Integrated meta-omic analyses of the gastrointestinal tract microbiome in patients undergoing allogeneic hematopoietic stem cell transplantation

In patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT), treatment-induced changes to the gastrointestinal tract (GIT) microbiome have been linked to adverse outcomes, most notably graft-versus-host disease (GvHD). However, it is presently unknown whether this relationship is causal or consequential. Here, we performed an integrated meta-omic analysis to probe deeper into the GIT microbiome changes during allo-HSCT and its accompanying treatments. We used 16S and 18S rRNA gene amplicon sequencing to resolve archaea, bacteria, and eukaryotes within the GIT microbiomes of 16 patients undergoing allo-HSCT for the treatment of hematologic malignancies. These results revealed a major shift in the GIT microbiome after allo-HSCT including a marked reduction in bacterial diversity, accompanied by only limited changes in eukaryotes and archaea. An integrated analysis of metagenomic and metatranscriptomic data was performed on samples collected from a patient before and after allo-HSCT for acute myeloid leukemia. This patient developed severe GvHD, leading to death 9 months after allo-HSCT. In addition to drastically decreased bacterial diversity, the post-treatment microbiome showed a higher overall number and higher expression levels of antibiotic resistance genes (ARGs). One specific Escherichia coli strain causing a paravertebral abscess was linked to GIT dysbiosis, suggesting loss of intestinal barrier integrity. The apparent selection for bacteria expressing ARGs suggests that prophylactic antibiotic administration may adversely affect the overall treatment outcome. We therefore assert that such analyses including information about the selection of pathogenic bacteria expressing ARGs may assist clinicians in "personalizing" regimens for individual patients to improve overall outcomes.

The changing epidemiology of spinal tuberculosis: the influence of international immigration in Catalonia, 1993-2014.

The overall incidence of spinal tuberculosis (TB) appears to be stable or declining in most European countries, but with an increasing proportion of cases in the foreign-born populations. We performed a retrospective observational study (1993-2014), including all cases of spinal TB diagnosed at a Barcelona hospital to assess the epidemiological changes. Fifty-four episodes (48·1% males, median age 52 years) of spinal TB were diagnosed. The percentage of foreign-born residents with spinal TB increased from 14% to 45·2% in the last 10 years (P = 0·017). Positive Mycobacterium tuberculosis testing in vertebral specimens was 88·2% (15/17) for GeneXpert MTB/RIF. Compared with natives, foreign-born patients were younger (P < 0·01) and required surgery more often (P = 0·003) because of higher percentages of paravertebral abscess (P = 0·038), cord compression (P = 0·05), and persistent neurological sequelae (P = 0·05). In our setting, one-third of spinal TB cases occurred in non-native residents. Compared with natives, foreign-born patients were younger and had greater severity of the disease. The GeneXpert MTB/RIF test may be of value for diagnosing spinal TB.

Novel Mutation in SH2 Domain of STAT3 (p.M660T) in Hyper-IgE Syndrome with Sterno-Clavicular and Paravertebral Abscesses

Novel Mutation in SH2 Domain of STAT3 (p.M660T) in Hyper-IgE Syndrome with Sterno-Clavicular and Paravertebral Abscesses

Diagnostic Yield of Multidetector Computed Tomography in Patients with Acute Spondylodiscitis.

In 34 of 43 patients with acute spondylodiscitis on MRI, correct diagnosis was already made by the initial MDCT scan. The specificity and positive predictive value were 100 % for MDCT. The sensitivity was 79 % and the negative predictive value was 72 %. The overall accuracy was 87 %. Accuracy was higher for CECT (89 %) than for NECT(84 %), however without statistical significance (p = 0.55). MDCT detected 90 % of paravertebral abscesses (34/38), but only 6 % of epidural abscesses (2/36). Conclusion MDCT has moderate sensitivity, but high specificity for acute spondylodiscitis. Thus, if MDCT is positive for spondylodiscitis, treatment can be started without further delay. However, MRI should be added to both MDCT negative and positive cases to rule out complications such as epidural abscesses that cannot reliably be detected by MDCT. Key Points: · Patients with acute spondylodiscitis are often initially suspected of having other differential diagnosis because of nonspecific symptoms.. · Therefore, MDCT is frequently performed prior to MRI in patients with acute spondylodiscitis.. · MDCT proved moderate sensitivity but high specificity for the diagnosis of acute spondylodiscitis.. · Paravertebral abscess is a strong indicator for the presence of spondylodiscitis on MDCT.. · However, MRI is crucial to rule out epidural abscesses, an important complication.. Citation Format · Rausch VH, Bannas P, Schoen G et al. Diagnostic Yield of Multidetector Computed Tomography in Patients with Acute Spondylodiscitis. Fortschr Röntgenstr 2017; 189: 339 - 346.

Computed Tomography-Guided Catheterization Drainage to Cure Spinal Tuberculosis With Individualized Chemotherapy.

The goal of this study was to investigate the effect of individualized chemotherapy delivered via percutaneous catheter drainage on paravertebral abscesses in spinal tuberculosis (TB). Data from 48 patients with spinal TB with paravertebral abscesses who received individualized chemotherapy via computed tomography-guided catheterization between 2009 and 2012 were retrospectively analyzed. The paravertebral abscesses affected the thoracic vertebra (n=12), the lumbar spine (n=20), the thoracolumbar vertebra (n=10), and the lumbosacral (n=6). All patients achieved clinical healing with no recurrence. Erythrocyte sedimentation rate and visual analog scale scores decreased significantly by the endpoint of follow-up. Although C-reactive protein values increased slightly right after treatment, they were also significantly lower at last follow-up. The kyphotic angle and Oswestry Disability Index values also exhibited significant decreases. No neurologic function impairment was reported. Computed tomography-guided catheterization for continuous administration of individualized chemotherapy was a safe and effective treatment for spinal TB with paravertebral abscesses in the cohort examined, and thus, it warrants further study. [Orthopedics. 2017; 40(3):e443-e449.].

Tuberculosis vertebral cervical y lumbar no contigua

A 35 year-old woman with chronic neck pain for two years and with fever and cervical adenomegaly in the last five weeks. The lymph node aspirate was acid fast bacili (+). The images showed collapse of vertebra L2, spondylodiscitis L2-L3 and paravertebral abscesses. The patient’s pain and fever improved with TB treatment.

One-stage Posterior Approach in the Treatment of Consecutive Multi-segment Thoracic Tuberculosis with Kyphosis.

To evaluate the clinical efficacy of the one-stage posterior approach in treating consecutive multiple-segment thoracic tuberculosis with kyphosis. A retrospective study was performed. The data of 22 patients with consecutive multi-level thoracic tuberculosis and kyphosis who underwent the one-stage posterior approach of debridement, bone grafting, drainage and pedicle screws fixation were collected. The kyphotic angle was 61.6°±3.1° pre-operatively. The neurologic status based on American Spinal Injury Association (ASIA) scoring was A in 5 cases, B in 4 cases, C in 9 cases, D in 3 cases and E in 1 case. The average follow-up period was 43.4±5.0 months. The kyphotic angle was 19.8°±0.7° after operation (p < 0.01), and 21.9°±1.2° at the last visit (p < 0.01). No neurological deterioration was observed in any patients after surgery. A significant difference in ASIA score was detected when the state before the operation and at the last visit was compared (p < 0.01). There was no recurrent paravertebral abscess of thoracic tuberculosis in any of these cases. The one-stage posterior approach of debridement and drainage is a feasible surgical option for consecutive multisegment thoracic tuberculosis with kyphosis. It can achieve debridement, decompression, and stabilization simultaneously.

VERTEBRAL COMPLICATIONS OF LATE-ONSET NEONATAL SEPSIS

Objective. To analyze characteristic features of spinal lesions as a manifestation of late-onset neonatal sepsis. Material and Methods . Medical histories, clinical, and instrumental data of 9 children operated on for consequences of spinal lesions associated with late-onset neonatal sepsis were studied. Design: retrospective clinical study. Level of evidence - IV. Results . Neonatal sepsis occurred at the age of 5 days to 2.5 months after birth. Main clinical manifestations of the disease were caused by pneumonia observed in 7 of 9 children. Spinal lesion was diagnosed within 3-12 months after the disease onset. Its main manifestation was kyphotic deformity caused by the T 4 -T 11 vertebral body destruction. Average age of children at surgery was 13.4 months (range: 7 to 21 months). All patients underwent two-stage surgical treatment including anterior fusion and posterior instrumentation of the spine. Long-term results were followed for up to 5 years. Conclusion . Spinal lesions as a manifestation of late-onset neonatal sepsis are rare disorders, and are characterized by vast destruction of vertebral bodies and development of paravertebral and epidural abscesses in neurologically intact patients. However, they are diagnosed only after the onset of kyphosis. Verification of spondylitis etiology fails due to the prior massive antibiotic therapy and insufficient examination in the acute phase of sepsis. Surgical treatment of spondylitis caused by late-onset neonatal sepsis is carried out when the infection is under control, and aims at the anterior column reconstruction and the correction of kyphotic deformity.