Spinal Abscess Research Articles

Intramedullary Spinal Cord Abscess in an Adult Patient: A Case Report

Intramedullary Spinal Cord Abscess in an Adult Patient: A Case Report

Intramedullary spinal cord abscess due to disseminated hypermucoviscous Klebsiella pneumoniae infection: A rare case report

Intramedullary spinal cord abscess due to disseminated hypermucoviscous Klebsiella pneumoniae infection: A rare case report

Neuromelioidosis – A retrospective review of thirteen cases from a tertiary care centre from South India

Neurologic melioidosis warrants attention in view of its rarity and lethal consequences. We performed a retrospective review of culture confirmed neurologic melioidosis reported between 2017 and 2023. Thirteen patients were identified with median age 43 years and all but three were males. Brain parenchyma was involved in 57% cases (7/13) as cerebritis, encephalitis and macro abscess or micro abscess. Three patients had myelitis with spinal cord micro abscess and cerebral venous thrombosis in three other patients. Five patients died during hospitalization. Two were discharged against medical advice due to financial constraints. Six survivors were followed between one and eight months.

Intramedullary Spinal Cord Abscess Caused by Acupuncture.

Intramedullary Spinal Cord Abscess Caused by Acupuncture.

A Rare Case of Cervical Intramedullary Spinal Cord Abscess

A Rare Case of Cervical Intramedullary Spinal Cord Abscess

Case of successful treatment of spinal infection in a patient with high comorbidity and septic manifestations

The study presents a clinical case of complex treatment of a patient with high comorbidity (Charlson comorbidity index = 6 points) who had severe sepsis (SOFA score = 8 points) with multiple foci of pyogenic infection (spinal epiduritis, paravertebral and subdural abscesses, purulent meningitis, bilateral lower lobe pneumonia). The syndrome-based approach with the use of minimally invasive approaches in the early stages (no later than 12 hours from the onset of clinical manifestations of the disease) ensured a favorable outcome. Based on the results of surgical treatment, a conclusion was made about the tactics of surgical treatment in patients with spinal infection against the background of sepsis.

Is it Really a Stroke? Cervical Spinal Abscess Presenting with Unilateral Weakness (P6-13.010)

Is it Really a Stroke? Cervical Spinal Abscess Presenting with Unilateral Weakness (P6-13.010)

Intramedullary Spinal Cord Abscess Due to Traumatic Esophageal Perforation Associated with Cervicothoracic Anterior Osteophytes: A Case Report

Intramedullary Spinal Cord Abscess Due to Traumatic Esophageal Perforation Associated with Cervicothoracic Anterior Osteophytes: A Case Report

How to play with the tools: trans-odontoid drainage of spinal abscess in a multidisciplinary approach. Case report.

How to play with the tools: trans-odontoid drainage of spinal abscess in a multidisciplinary approach. Case report.

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.

Diagnostics, Management, and Outcomes in Patients with Pyogenic Spinal Intra- or Epidural Abscess.

Owing to the lack of evidence on the diagnostics, clinical course, treatment, and outcomes of patients with extremely rare spinal intradural abscess (SIA) and spinal epidural abscess (SEA), we retrospectively analyzed and compared a cohort of patients to determine the phenotyping of both entities. Over a period of 20 years, we retrospectively analyzed the electronic medical records of 78 patients with SIA and SEA. The patients with SIA showed worse motor scores (MS scores) on admission (SIA: 20 ± 26 vs. SEA: 75 ± 34, p < 0.001), more often with an ataxic gait (SIA: 100% vs. SEA: 31.8%, p < 0.001), and more frequent bladder or bowel dysfunction (SIA: 91.7% vs. SEA: 27.3%, p < 0.001) compared to the SEA patients. Intraoperative specimens showed a higher diagnostic sensitivity in the SEA patients than the SIA patients (SIA: 66.7% vs. SEA: 95.2%, p = 0.024), but various pathogens such as Staphylococcus aureus (SIA 33.3% vs. SEA: 69.4%) and Streptococci and Enterococci (SIA 33.3% vs. SEA: 8.1%, p = 0.038) were detected in both entities. The patients with SIA developed sepsis more often (SIA: 75.0% vs. SEA: 18.2%, p < 0.001), septic embolism (SIA: 33.3% vs. SEA: 8.3%, p = 0.043), signs of meningism (SIA: 100% vs. 18.5%, p < 0.001), ventriculitis or cerebral abscesses (SIA: 41.7% vs. SEA: 3.0%, p < 0.001), and pneumonia (SIA: 58.3% vs. SEA: 13.6%, p = 0.002). The mean MS score improved in both patient groups after surgery (SIA: 20 to 35 vs. SEA: 75 to 90); however, the SIA patients showed a poorer MS score at discharge (SIA: 35 ± 44 vs. SEA: 90 ± 20, p < 0.001). C-reactive protein (CrP) (SIA: 159 to 49 vs. SEA: 189 to 27) and leukocyte count (SIA: 15 to 9 vs. SEA: 14 to 7) were reduced at discharge. The SIA patients had higher rates of disease-related mortality (SIA: 33.3% vs. SEA: 1.5%, p = 0.002), had more pleural empyema (SIA: 58.3% vs. SEA: 13.6%, p = 0.002), required more than one surgery (SIA: 33.3% vs. SEA 13.6%, p = 0.009), were treated longer with intravenous antibiotics (7 ± 4 w vs. 3 ± 2 w, p < 0.001) and antibiotics overall (12 ± 10 w vs. 7 ± 3 w, p = 0.022), and spent more time in the hospital (SIA: 58 ± 36 vs. SEA: 26 ± 20, p < 0.001) and in the intensive care unit (SIA: 14 ± 18 vs. SEA: 4 ± 8, p = 0.002). Our study highlighted distinct clinical phenotypes and outcomes between both entities, with SIA patients displaying a markedly less favorable disease course in terms of complications and outcomes.

Risk Factors Influencing the Degree of Tuberculous Spondylitis Based on MRI Modality

The high prevalence and mortality of tuberculosis (TB) is serious threats to the world. Tuberculous spondylitis accounts for 50% of all bone and joint TB cases. The accuracy of diagnosis to detect disease severity using Magnetic Resonance Imaging (MRI) modalities is important when considering potential risk factors. This study aimed to analyze the association of risk factors, including age, sex, spinal lesion location, and abscess location, with the severity of tuberculous spondylitis based on MRI modality using the Gulhane Askari Tip Akademisi (GATA) classification. This study had a cross-sectional design. The study sample consisted of 50 patients who met the inclusion criteria and underwent MRI. The statistical analysis performed in this study was multivariate analysis using multiple linear regression. The results showed that 84% (n = 42) of tuberculous spondylitis affected patients aged 18-65 years, and 70% (n = 35) of cases were found in female patients. In addition, 42% (n = 21) of cases were classified as tuberculous spondylitis grade III according to the GATA classification and were the most common cases in this study. Statistical tests showed no association between age, the location of spinal lesions, and the degree of tuberculous spondylitis. However, there was an association between sex, spinal abscess location, and degree of tuberculous spondylitis. There was no significant association between age and spinal lesion location or degree of tuberculous spondylitis. However, there was a significant association between sex, spinal abscess location, and the degree of tuberculous spondylitis.

The Appearance of Optic Neuritis in Non-Infectious Uveitis with Cystoid Macula Edema

&lt;p&gt;本文宗旨：報告一位23歲女性和41歲男性罹患非感染性葡萄膜炎，引起囊狀黃斑部水腫並合併產生視神經炎，使用口服類固醇成功治療的兩個病患。方法：回顧性病例報告。結果：病例1是23歲女性主訴雙眼模糊，雙眼呈現玻璃體炎、囊狀黃斑部水腫和視神經炎。病例2是41歲有HLA-B27陽性前房葡萄膜炎病史的男性，主訴打完COVID-19高端疫苗一天後右眼模糊，右眼呈現玻璃體炎、囊狀黃斑部水腫和視神經炎。腦部核磁共振呈現視神經顯影增加，確立視神經炎診斷。兩位病患使用局部和口服類固醇藥物後逐漸好轉，黃斑部水腫和視神經炎完全改善，6個月後追蹤沒有復發。結論：平坦部炎相關的非感染性葡萄膜炎，可以合併產生視神經炎。有可能因為相同基因例如HLA-DR15介入而造成兩者疾病。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Spinal epidural abscess is an uncommon but critical central nervous infection. It can be life threatening and result in severe morbidity. We presented with a case of pan-spinal epidural abscess with relation to deep neck infection, empyema and shock. He had sudden quadriplegia with numbness below shoulder, unstable hemodynamic status and respiratory failure. Emergency intubation, surgical debridement of the em-pyema and prescription of antibiotics were the initial treatments. His vital signs grad-ually stabilized and then he received surgical decompression of C1-3 laminectomy and debridement of the spinal abscess. After the antibiotic treatment and rehabilitation for 6 weeks his hands and legs weakness got much improving and can have oral intake by himself. Pan-spinal epidural abscess usually involves many other medical problems, therefore resulting poor physical condition and poor prognosis. With interdisciplinary teamwork and critical care medicine there is more and more evidence supporting that surgical intervention with antibiotic treatment and rehabilitation is recommended for the patient with pan-spinal epidural abscess&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Spinal abscess after epidural block and radiofrequency ablation in a patient with post-herpetic neuralgia

A 67-year-old man was admitted due to a two-week history of pain on the right side of his chest, upper back, and armpit, and progressive lower-limb weakness. The results of Magnetic Resonance Imaging and colour ultrasound supported the diagnosis of spinal abscess. The patient underwent a series of debridement and antibacterial treatments, but no obvious recovery of muscle strength was observed. This case highlights the potentially serious complications of invasive analgesic therapy. Keywords: Case report, Epidural block, Spinal abscess, Post-herpetic neuralgia, Radiofrequency ablation.

Epidural Steroid Injection Prior to Spinal Surgery: A Step-Wise and Wise Approach.

An epidural steroid injection (ESI) is used to treat a number of morbid central nervous system pathologies and is considered a reasonably safe procedure. This study aimed to determine the relative infection risk after spinal surgery by comparing outcomes in spinal surgery patients who received an ESI shortly prior to the surgery against those who did not receive an ESI shortly prior to the surgery. The present study is a retrospective cohort study using a multi-institutional healthcare database, TriNetX, to collect data on patients who received spinal surgery with and without having had ESIs six months before surgery. Two cohorts were generated: Cohort 1 included patients who had received an ESI in the six months prior to spinal surgery, and cohort 2 included patients who did not have an ESI in the six months prior to spinal surgery. The patients in cohort 2 had propensity scores matched 1:1 to those in cohort 1 using common baseline demographics, comorbidities and spinal procedure indications. The spinal procedures and surgeries considered for the analysis includedopen procedures for any purpose, including exploration, decompression, resection, revision or biopsy. Multiple outcomes were compared across these two cohorts in the three months following the spinal procedure/surgery, including the occurrence of death, surgical site infection, epidural and/or spinal abscess, and dural tear. An ESI in the six months prior to spinal surgery was associated with a significant decrease in the likelihood epidural/spinal abscess in the three months after surgery.There was no change in mortality, wound infection or identification of dural tear in the three months after spinal surgeryfor those who received an ESI six months before spinal surgery. This data suggests that epidural steroid injections' anti-inflammatory effects provide benefits before surgery beyond symptomatic relief. Given that the degeneration of spinal pathologies is typically advanced rather than corrected by the body's inflammatory response, it is likely that preventing hyperactivation of the body's immune system in the months preceding surgical intervention, a traumatic insult, is protective compared to no intervention and, importantly, without major adverse effects.

Pan-spinal Epidural Abscess Caused by Complicated Deep Neck Infection with Shock: Case Report and Literature Review

&lt;p&gt;脊椎長節硬腦膜外膿瘍為罕見的嚴重感染病症，常為其他部位嚴重感染導致之複雜感染。其臨床表現通常會導致誤導性體徵和症狀。感染病變本身會擴大以壓迫脊髓，導致嚴重症狀、永久性並發症，甚至死亡。本個案報告研究並分析一名 69 歲男子因突然四肢癱瘓、肩下麻木、血流動力學狀態不穩定和呼吸衰竭被送入急診室。影像學檢查顯示頸部深部感染、右側胸膜外膿胸和頸-胸-腰椎硬膜外膿腫。病人接受先於急診接受插管、膿胸手術清創和抗生素治療，待生命徵象穩定後接受頸椎第1-3節椎板切除術及膿腫清創術。經過6週的抗生素治療和復健治療，病人手腳無力的症狀得到很大改善。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Spinal epidural abscess is an uncommon but critical central nervous infection. It can be life threatening and result in severe morbidity. We presented with a case of pan-spinal epidural abscess with relation to deep neck infection, empyema and shock. He had sudden quadriplegia with numbness below shoulder, unstable hemodynamic status and respiratory failure. Emergency intubation, surgical debridement of the em-pyema and prescription of antibiotics were the initial treatments. His vital signs grad-ually stabilized and then he received surgical decompression of C1-3 laminectomy and debridement of the spinal abscess. After the antibiotic treatment and rehabilitation for 6 weeks his hands and legs weakness got much improving and can have oral intake by himself. Pan-spinal epidural abscess usually involves many other medical problems, therefore resulting poor physical condition and poor prognosis. With interdisciplinary teamwork and critical care medicine there is more and more evidence supporting that surgical intervention with antibiotic treatment and rehabilitation is recommended for the patient with pan-spinal epidural abscess&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Effectiveness of oral cephalexin in antibiotic-course completion for methicillin-susceptible Staphylococcus aureus-induced bacteremic vertebral osteomyelitis

BackgroundMethicillin-susceptibleStaphylococcus aureus (MSSA) is the most common causative microorganism of pyogenic vertebral osteomyelitis (PVO). Although oral antimicrobial therapy with first-generation cephalosporins can treat MSSA infection, data on PVO are scarce. This study evaluated the treatment efficacy of cephalexin as oral antibiotic therapy for MSSA-induced PVO.MethodsThis retrospective study included adult patients treated with oral cephalexin as the completing treatment for PVO with MSSA bacteremia from 2012 to 2020. Treatment effectiveness of cephalexin was evaluated by comparing improvement (5-point scale; score ≥ 4/5 indicates treatment success) in symptoms and laboratory and imaging results between intravenous antimicrobial and oral cephalexin treatment.ResultsAmong 15 participants (8 [53%] women; median [interquartile range, IQR], age 75 [67.5–80.5] years; Charlson Comorbidity Index 2 [0–4]), 10 (67%) had lumbar spine lesions, 12 (80%) had spinal abscesses, and 4 (27%) had remote abscesses; no patients had concomitant endocarditis. In 11 patients with normal renal function, cephalexin 1,500–2,000 mg/day was administered. Five patients (33%) underwent surgery. Median (IQR; range) duration (days) of intravenous antibiotics, cephalexin, and total treatment was 36 (32–61; 21–86), 29 (19–82; 8–251), and 86 (59–125; 37–337), respectively. Cephalexin had an 87% treatment success rate without recurrence during a median follow-up of 119 (IQR, 48.5–350) days.ConclusionsIn patients with MSSA bacteremia and PVO, antibiotic treatment completion with cephalexin is a reasonable option, even in cases with spinal abscess, if at least 3 weeks of effective intravenous antimicrobial therapy is provided.

A Therapeutic Dilemma of Venous Thromboembolism in the Setting of Odontogenic Brain and Intramedullary Spinal Cord Abscesses: Case Report and Review of Literature (P12-7.004)

A Therapeutic Dilemma of Venous Thromboembolism in the Setting of Odontogenic Brain and Intramedullary Spinal Cord Abscesses: Case Report and Review of Literature (P12-7.004)

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.

Concomitant brain abscess and spinal cord abscess in an immunocompetent teenage male: illustrative case.

Multiple bilateral brain abscesses occur rarely in immunocompetent patients. Hematogenous spread to the central nervous system (CNS) allows suppuration and abscess formation in the privileged immune environment of the CNS; hematogenous spread to the spinal cord is extremely rare and the combination of multifocal brain abscesses and intramedullary abscesses has not been reported. This report presents a rare presentation and diagrams a treatment algorithm involving iterative minimal access surgeries and prolonged medical management. The authors present a case of an 18-year-old male with numerous multifocal and bilateral intraparenchymal abscesses and a medically resistant C5 intramedullary spinal cord abscess. The symptomatic patient had a left oculomotor palsy and left hemiparesis, ultimately undergoing ultrasound-guided aspiration of abscesses in the left frontal and left cerebral peduncle. Following transient motor improvement, he evolved tetraparesis prompting spinal cord imaging and emergent ultrasound-guided needle aspiration of an occult C5 intramedullary spinal cord abscess. The patient received appropriate medical therapy, completed inpatient rehabilitation, and made a full recovery. Needle- and ultrasound-guided catheter drainage of CNS abscesses should be considered for symptomatic lesions. Following the neurological examination closely is extremely important; if the expected neurological improvement is delayed or regresses, then expanded imaging is warranted.