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Cureus 2022 May 20;14(5):e25162. Epub 2022 May 20.

Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA.

Treatment for vertebral osteomyelitis varies depending on the extent of pathology and includes both medical and surgical approaches. Pathogen-directed antibiotic therapy is often the first-line treatment, however, refractory cases or those with sepsis, segmental instability, or epidural abscess may be candidates for surgical treatment. Patients with extensive bony destruction often require a corpectomy with the placement of a cage for anterior column reconstruction. Read More

Spine J 2022 Jun 20. Epub 2022 Jun 20.

Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address:

Background Context: Spinal epidural abscess is a rare but severe condition with high rates of postoperative adverse events.

Purpose: The objective of the study was to identify independent prognostic factors for reoperation using two datasets: an institutional and national database.

Study Design/setting: Retrospective Review PATIENT SAMPLE: : Database 1: Review of five medical centers from 1993 to 2016. Read More

Orthop Surg 2022 Jun 22. Epub 2022 Jun 22.

Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.

Background: Spinal epidural abscess (SEA) is an uncommon clinical entity that is often subject to delayed diagnosis and suboptimal treatment. Untreated disease leads to compression of the spinal cord, resulting in devastating complications.

Case Presentation: A 56-year-old man visited our hospital for progressive lower back and lower extremity pain of several days' duration. Read More

Am J Case Rep 2022 Jun 16;23:e936179. Epub 2022 Jun 16.

Department of Orthopaedic and Spine Surgery, Evangelismos Hospital, Paphos, Cyprus.

BACKGROUND Pyogenic spondylitis comprises several clinical entities, including native vertebral osteomyelitis, septic discitis, pyogenic spondylodiscitis, and epidural abscess. The lumbar spine is most often infected, followed by the thoracic and cervical areas. It mainly develops (i) after spine surgery; (ii) from history of blunt trauma to the spinal column; (iii) from infections in adjacent structures (such as soft tissues); (iv) from iatrogenic inoculation after invasive procedures (such as lumbar puncture); and (v) from hematogenous bacterial spread to the vertebra (mainly through the venous route). Read More

JBJS Case Connect 2022 04 15;12(2). Epub 2022 Jun 15.

Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India.

Case: An elderly obese woman with comorbidities presented with acute-onset altered sensorium. She was diagnosed with meningitis and started on empirical antibiotics. She became oriented after 48 hours and mentioned that she had severe low backache in the previous week. Read More

Int J Surg Case Rep 2022 Jun 7;96:107287. Epub 2022 Jun 7.

Community Memorial Hospital, Graduate Medical Education, 147 N. Brent Street, Ventura, CA 93003, United States of America.

Introduction And Importance: Iliopsoas abscesses (IPA) are rare and typically present with a non-specific triad of fever, back pain, and antalgic gait. Staphylococcus aureus is the organism responsible for nearly 90 % of IPA cases. We present a case of primary IPA with progression to osteomyelitis and discitis due to Salmonella enterica bacteremia, an exceedingly rare etiology occurring in an otherwise healthy individual. Read More

Am J Emerg Med 2022 May 30;58:148-153. Epub 2022 May 30.

Department of Military and Emergency Medicine, Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; United States Air Force En route Care Research Center, 59th MDW/ST, JBSA-Fort Sam Houston, TX 78234, USA.

Background/objective: Contrast-enhanced magnetic resonance imaging (MRI) is the preferred imaging modality for diagnosing pyogenic spinal infection (PSI), but it is not always available. Our objective was to describe pyogenic spinal infection imaging characteristics in patients presenting to a community emergency department (ED) and estimate the computed tomography (CT) sensitivity for these infections.

Methods: We examined the MRI reports from a cohort of 88 PSI patients whom we enrolled in a prospective cohort study and report the prevalence of each PSI type (spinal epidural abscess/infection, vertebral osteomyelitis/discitis, septic facet, and paravertebral abscess/infection) according to contemporary nomenclature. Read More

Cureus 2022 May 4;14(5):e24735. Epub 2022 May 4.

Department of Neurological Surgery, Montefiore Medical Center, Moses Campus, Bronx, USA.

Spinal epidural abscess (SEA) is a rare and potentially devastating neurologic disease that is commonly treated with neurosurgical decompression and evacuation. We describe the case of an 11-month-old immunocompetent infant who presented with a large multiloculated methicillin-resistant abscess in the left lung apex with likely mediastinal involvement, extending into the epidural space from C7 down to L2 causing cord compression which was successfully treated with percutaneous placement of an epidural drainage catheter and antibiotic therapy. Although there are rare reports of percutaneous drainage of SEAs, to our knowledge, there are no reports of successful use of percutaneous indwelling catheters resulting in the complete resolution of an SEA. Read More

Clin Case Rep 2022 Jun 2;10(6):e05931. Epub 2022 Jun 2.

Spine Center Schoen Clinic Düsseldorf Germany.

Spinal cord stimulation (SCS) for intractable pain syndromes has become a pillar of modern pain management. Common complications include lead migration, implant infection, cerebral spinal fluid leak, and lead fracture. Spinal epidural abscess due to spinal cord stimulator implantation is a very rare occurrence with only two cases reported in the literature so far. Read More

Eur J Trauma Emerg Surg 2022 Jun 3. Epub 2022 Jun 3.

Treatment Centre for Spinal Cord Injuries, BG Hospital Unfallkrankenhaus Berlin, Trauma Hospital Berlin, Warener Straße 7, 12683, Berlin, Germany.

Introduction: This study on pyogenic spinal infections with intraspinal epidural involvement (PSI +) compared the outcome of patients with spinal cord injury (SCI) to those without (noSCI) taking diagnostic algorithm, therapy, and complications into account.

Methods: Patients were enrolled in an ambispective study (2012-2017). Diagnostic and therapeutic algorithms, complications, and neurological outcome were analyzed descriptively. Read More

Case Rep Infect Dis 2022 20;2022:5028335. Epub 2022 May 20.

Ochsner Health System, New Orleans, Louisiana, USA.

Background: SEAs are infrequent; however, panspinal infections are even rarer, especially when GBS infection is involved. The cornerstone of treatment is based on early diagnosis and use of targeted antimicrobial therapy; in case of cord compression or neurological compromise, urgent surgical intervention should be pursued. Overall, it is an infrequent condition and therefore requires prospective multicenter studies. Read More

J Infect Chemother 2022 May 27. Epub 2022 May 27.

Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi, Japan.

In the treatment of head and neck cancer, radiation therapy is an effective modality and is often used in routine clinical practice. Although rare, pyogenic spondylitis has been reported as a complication of radiation therapy. Here, we report a case of nasopharyngeal carcinoma resulting in pyogenic spondylitis from a catheter-related bloodstream infection after chemoradiotherapy. Read More

Medicine (Baltimore) 2022 May 27;101(21):e29426. Epub 2022 May 27.

Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea.

Rationale: Esophageal cancer is one of the leading causes of death worldwide; the treatments vary according to the stage at diagnosis. Advanced esophageal cancer is usually treated by concurrent chemoradiation which is associated with complications including esophagitis, esophageal stricture or perforation, radiation pneumonitis, and/or cardiac toxicity. Herein, we describe epidural abscess, which is a very rare but severe complication that can occur after concurrent chemoradiation therapy for advanced esophageal cancer. Read More

Acta Neurochir (Wien) 2022 May 27. Epub 2022 May 27.

Neurocritical Care Unit, Dept. of Neurosurgery and Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.

Background: Data on critically ill patients with spontaneous empyema or brain abscess are limited. The aim was to evaluate clinical presentations, factors, and microbiological findings associated with the outcome in patients treated in a Neurocritical Care Unit.

Methods: In this retrospective study, we analyzed 45 out of 101 screened patients with spontaneous epidural or subdural empyema and/or brain abscess treated at a tertiary care center between January 2012 and December 2019. Read More

Pediatr Emerg Med Pract 2022 Jun 2;19(6):1-16. Epub 2022 Jun 2.

Fellowship and Education Director, Children's Hospital of Los Angeles; Associate Professor of Clinical Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Although rare in children, spinal epidural abscess (SEA) is a rapidly progressive clinical entity that can lead to irreversible neurologic damage if untreated. The rarity and variability in presentation can lead to initial misdiagnosis. Diagnosis requires a high index of suspicion and is often delayed until neurologic deficits are present. Read More

Int J Ophthalmol 2022 18;15(5):848-850. Epub 2022 May 18.

Department of Ophthalmology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Gyeongnam 50612, Republic of Korea.

Cureus 2022 Apr 16;14(4):e24189. Epub 2022 Apr 16.

Internal Medicine, University of Illinois College of Medicine, Peoria, USA.

Septic arthritis of the facet joint (SAFJ) is an uncommon etiology of low back pain that usually affects the elderly population and immunocompromised patients but is rare in immunocompetent and young patients. When such a clinical presentation occurs, it is imperative to diagnose the source of the infection. We report a case of septic arthritis of the left third and fourth lumbar vertebrae facet joint due to in a young immunocompetent adult, and the source of infection was found to be subacute infective endocarditis of a bicuspid aortic valve which was undiagnosed till now. Read More

Neurosurgery 2022 May 20. Epub 2022 May 20.

Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA.

Background: The optimal management of spinal epidural abscesses (SEA) secondary to primary spinal infections has demonstrated large variability in the literature. Although some literature suggests a high rate of neurological deterioration, others suggest failure of medical management is uncommon.

Objective: To develop a predictive model to evaluate the likelihood of failure of medical therapy in the setting of SEA. Read More

Neurosurg Rev 2022 May 10. Epub 2022 May 10.

Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.

Despite increased life expectancy due to health care quality improvements globally, pyogenic vertebral osteomyelitis (PVO) treatment with a spinal epidural abscess (SEA) remains challenging in patients older than 80 years. We aimed to assess octogenarians for PVO prevalence with SEA and compare after-surgery clinical outcomes of decompression and decompression and instrumentation. A retrospective review of electronic medical records at a single institution was conducted between September 2005 and December 2020. Read More

Am J Emerg Med 2022 Jul 30;57:162-163. Epub 2022 Apr 30.

Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA.

Am J Emerg Med 2022 Jul 28;57:160-161. Epub 2022 Apr 28.

Department of Diagnostic Imaging, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria.

Surg Neurol Int 2022 22;13:159. Epub 2022 Apr 22.

Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy.

Background: Spinal epidural abscesses are rare and are misdiagnosed in up to 75% of cases. Fever, back pain, and neurological deficits are part of the classical triad. Here, the authors report a patient with a L2-L5 spinal epidural abscess with the left paravertebral extension attributed to acute pyelonephritis. Read More

World Neurosurg 2022 Apr 30;164:118-127. Epub 2022 Apr 30.

Department of Spine Surgery, Indian Spinal Injuries Centre, New Delhi, India.

Objective: This case series looks at the role of intraoperative ultrasound in spine surgery for extradural pathologies.

Methods: Ten cases of different pathologies were included. Following posterior laminectomy, intraoperative ultrasound was used to determine the adequacy of decompression. Read More

Cureus 2022 Mar 29;14(3):e23623. Epub 2022 Mar 29.

Neurological Surgery, Northwell Health, New York City, USA.

Mucormycosis is an extremely rare, invasive infection commonly isolated to patients with known immunosuppressed status. In the present case, a 36-year-old woman, with a history of T-cell acute lymphoblastic leukemia in remission, presented with T4 osteomyelitis and an associated epidural collection. Biopsy was consistent with mucormycosis, and the patient was recommended for surgical debridement. Read More

Cureus 2022 Mar 25;14(3):e23483. Epub 2022 Mar 25.

Medical Education, Hamad Medical Corporation, Doha, QAT.

Methicillin-susceptible (MSSA) is quite common in the environment. It can lead to a wide range of infections varying from simple boils to disseminated and metastatic infections. Disseminated multifocal MSSA infection without infective endocarditis is extremely rare. Read More

World Neurosurg 2022 Jul 23;163:e673-e677. Epub 2022 Apr 23.

Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA. Electronic address:

Background: Spinal epidural abscess (SEA) is a rare but serious pathology that may result in delayed neurologic injury despite treatment with antibiotic therapy or surgery. Given this, the development of predictive scores for risk stratification has value in clinical decision making; however, external validation is necessary to understand their generalizability and reliability.

Methods: A retrospective review was conducted of all patients presenting with SEA at a single institution. Read More

J Bone Jt Infect 2022 13;7(2):75-79. Epub 2022 Apr 13.

Division of Infectious Diseases, University of Arizona, Tucson, Arizona, USA.

We describe a case of native vertebral osteomyelitis (NVO) secondary to in a patient with polymyalgia rheumatica receiving chronic steroids. Treatment required surgical debridement of the epidural phlegmon and combination therapy with intravenous ampicillin and gentamicin. Read More

Infection 2022 Apr 23. Epub 2022 Apr 23.

Biomedical Research Institute Galicia Sur, Vigo, Spain.

Purpose: The management of post-surgical subdural empyema and subdural abscess is not standardised. The objective was to analyse the efficacy and safety of oral sequential therapy (OST).

Methods: Retrospective observational study in a tertiary hospital in Vigo (Spain). Read More

J Clin Med 2022 Apr 15;11(8). Epub 2022 Apr 15.

Department of Orthopaedic Surgery, Chonnam National University Hospital, Gwangju 61469, Korea.

Primary cervical spine infections progress quickly and cause neurological impairment at an early stage. Despite their clinical significance, few studies have investigated primary cervical spine infections, owing to the rarity of the condition. This study analyzed the characteristics of 59 patients treated for primary cervical spine infections between 1992 and 2018 at our hospital. Read More

J Neurol Surg A Cent Eur Neurosurg 2022 Apr 22. Epub 2022 Apr 22.

Neurosurgery, Technical University of Munich, Munich, Germany.

Introduction Surgery for pyogenic spondylodiscitis as an adjunct to antibiotic therapy is an established treatment. However, the technique and extent of surgical debridement remains a matter of debate. Some propagate discectomy in all cases. Read More