Infecciones piógenas de la columna vertebral / Pyogenic spinal infections

Las infecciones espinales son cuadros clínicos poco frecuentes, que exigen un alto índice de sospecha. La prevalencia de infecciones piógenas de la columna ha ido en aumento, en parte debido al envejecimiento de la población y a un mayor número de pacientes inmunocomprometidos. El estudio imagenológico se puede iniciar con radiografías simples, pero la resonancia magnética es el examen imagenológico de elección, ya que puede dar resultados positivos de forma precoz, entregando información más detallada del compromiso vertebral y tejidos blandos adyacentes. Aunque la clínica y los hallazgos imagenológicos nos pueden orientar, es importante intentar un diagnóstico microbiológico tomando cultivos y muestras para identificar al agente causal antes de iniciar los antibióticos; aunque es óptimo un tratamiento agente-específico, hasta un 25% de los casos queda sin diagnóstico del agente. El tratamiento es inicialmente médico, con antibióticos e inmovilización, pero se debe considerar la cirugía en casos de compromiso neurológico, deformidad progresiva, inestabilidad, sepsis no controlada o dolor intratable. El manejo quirúrgico actual consiste en el aseo y estabilización precoz de los segmentos vertebrales comprometidos. Descartar una endocarditis concomitante y el examen neurológico seriado son parte del manejo de estos pacientes.

Spinal infections are unusual conditions requiring a high index of suspicion for clinical diagnosis. There has been a global increase in the number of pyogenic spinal infections due to an aging population and a higher proportion of immunocompromised patients. The imaging study should start with plain radiographs, but magnetic resonance imaging (mri) is the gold standard for diagnosis. Mri can detect bone and disc changes earlier than other methods, and it provides detailed information on bone and adjacent soft tissues. Blood cultures and local samples for culture and pathology should be obtained, trying to identify the pathogen. According to the result, the most appropriate drug must be selected depending on susceptibility and penetration into spinal tissues. Treatment should start with antibiotics and immobilization; surgery should be considered in cases with neurological impairment, progressive deformity, spine instability, sepsis, or non-controlled pain. Current surgical treatment includes debridement and early stabilization. Practitioners should rule out endocarditis and perform a serial neurological examination managing these patients.

Infecção cervicofacial grave de origem odontogênica: relato de caso / Severe cervicofacial infection of odontogenic origin: case report

Introdução: as infecções odontogênicas tem como principal origem a necrose pulpar com invasão bacteriana no tecido periapical e periodontal, podendo levar à formação de quadros de celulite e posteriormente de abscesso, além disso, possuem o potencial de disseminar-se pelos espaços faciais profundos e comprometer a vida do paciente. Complicações graves, decorrentes dos quadros de infecções odontogênicas, podem ocorrer, se o tratamento instituído não for adequado, como: trombose do seio cavernoso, abscesso cerebral, mediastinite e até óbito. Objetivo: discutir o manejo das infecções odontogênicas disseminados em espaços faciais profundos, através do relato de caso clínico. Caso clínico: paciente de 52 anos, portador de diabetes mellitus tipo 2, com infecção odontogênica, no exame clínico inicial apresentava trismo, disfonia, dispneia, disfagia, hiperemia e edema em lado esquerdo da face, envolvendo os espaços canino, bucal, submandibular e cervical além de unidades dentárias com foco infeccioso. Em exame de tomográfica computadorizada, observou-se desvio da via área, presença de um grande volume de gás e de lojas de infecção. Optou-se como tratamento a remoção dos focos dentários e drenagem intraoral foi realizada pela equipe da CTBMF com anestesia local e posteriormente drenagem sob anestesia geral, intubação com uso de fibroscopia pela equipe de cirurgia cabeça e pescoço. Considerações finais: as infecções odontogênicas que envolvem espaços faciais profundos devem ser tratadas com urgência e o tratamento de escolha dessa condição deve ser remoção imediata do foco infeccioso, exploração e drenagem rápida e agressiva dos espaços faciais envolvidos e associação com antimicrobianos de amplo espectro com características bactericidas.(AU)

Introduction: the main origin of odontogenic infections is pulp necrosis with bacterial invasion in the periapical and periodontal tissue, which may lead to the formation of cellulitis and later abscess, besides having the potential to spread to the deep facial spaces and compromise the patient's life. Severe complications from dental infections may occur if the treatment is not appropriate, such as cavernous sinus thrombosis, brain abscess, mediastinitis and even death. Objective: to discuss the management of disseminated odontogenic infections in deep facial spaces through a case report. Case report: a 52-year-old patient with type 2 diabetes mellitus, with odontogenic infection, presented at the initial clinical examination trismus, dysphonia, dysphagia, dysphagia, hyperemia and edema on the left side of the face involving the canine, buccal, submandibular and cervical spaces. of dental units with infectious focus. CT scan revealed deviation of the airway, presence of a large volume of gas and infection stores. The treatment was chosen to remove dental foci and intraoral drainage was performed by the CTBMF team under local anesthesia and subsequently under general anesthesia drainage, intubation with fibroscopy by the head and neck surgery team. Final considerations: odontogenic infections involving deep facial spaces should be treated urgently and the treatment of choice for this condition should be immediate removal of the infectious focus, rapid and aggressive exploration and drainage of the involved facial spaces and association with broad-spectrum antimicrobials with bactericidal characteristics.(AU)

Criptococosis vertebral: comunicación de un caso y revisión bibliográfica / Vertebral cryptococosis: case report and literature review

Resumen La criptococosis es una micosis sistémica producida por un hongo levaduriforme encapsulado denominado Cryptococcus neoformans. Es una enfermedad universal, que ocurre con mayor frecuencia en pacientes inmunocomprometidos, manifestándose principalmente como una enfermedad diseminada con compromiso meníngeo o pulmonar. Sin embargo, la osteomielitis ocurre solo en 5-10% de los casos, siendo el compromiso vertebral el más frecuente. Presentamos un caso de criptococosis vertebral aislada y una búsqueda bibliográfica sobre el tema. Se recomienda realizar una terapia antifúngica de inducción intravenosa y continuar con una fase de consolidación, vía oral, de duración variable. La indicación quirúrgica se considera en lesiones que comprometen la estabilidad vertebral y aquellas que presentan un compromiso neurológico, producen deformidad y para reducir el inóculo infeccioso.

Cryptococcosis is an infectious disease caused by a ubiquitous encapsulated yeast called Cryptococcus neoformans, it is usually associated with immunosuppressed patients. Osteomyelitis occurs in 5-10%, the spine involvement is one of the most reported. The purpose of this work is to present a case of isolated vertebral cryptococcosis and detail the results of a literature review. The treatment protocol is not yet established but it is recommended to start with aggressive intravenous therapy and continue with a suppressive treatment orally during a variable time. Surgical indication is considered in lesions that affect the spinal stability, deformity or neurological compromise and for local infectious control.

Successful medical drainage and surgical treatment for vertebral osteomyelitis and bilateral psoas abscess with gas formation caused by klebsiella pneumoniae in a diabetic patient

SUMMARY OBJECTIVE: We describe the case of a diabetic patient who developed vertebral osteomyelitis and bilateral psoas abscess with gas formation due to klebsiella pneumoniae. METHODS: A 64-year-old woman with a 4-year history of type-2 diabetes mellitus was admitted to the Emergency Department. The subject had a 2-day history of high-grade fever associated with chills and a 5-hour history of consciousness. She received empirical treatment with febrifuge, after which her fever decreased. RESULTS: Her fever recurred after an interval of three hours. A computed tomography scan of the abdomen revealed vertebral osteomyelitis and bilateral psoas muscle abscess with gas formation. Blood culture and purulent fluid described the growth of the Klebsiella pneumoniae. The patient received antibiotic therapy and bilateral drainage therapy after the drainage catheter was placed into the abscess cavity by CT-guidance. Due to the serious damage to the vertebral column and permanent pain, the patient underwent minimally invasive internal spinal fixation and recovered successfully. CONCLUSION: A case of vertebral osteomyelitis and bilateral psoas abscess with gas formation caused by Klebsiella pneumoniae in a diabetic patient. Antibiotic therapy, drainage, and minimally invasive internal spinal fixation were performed, which enabled a good outcome.

RESUMO OBJETIVO: Descrever o caso de uma paciente diabética que desenvolveu osteomielite vertebral e abcesso bilateral do psoas com formação de gás causada por klebsiella pneumoniae. MÉTODOS: Uma mulher de 64 anos de idade, com 4 anos de histórico de diabetes mellitus tipo 2, foi admitida no Serviço de Emergência. A paciente apresentava um quadro de dias de febre alta acompanhada de calafrios e um histórico de 5 horas de consciência. Ela recebeu tratamento empírico com antitérmico, após o qual a febre diminuiu. RESULTADOS: A febre retornou após um intervalo de três horas. Uma tomografia computadorizada do abdome revelou osteomielite vertebral e abcesso bilateral do músculo psoas com formação de gás. A cultura do sangue e o fluido purulento revelaram o crescimento de Klebsiella pneumoniae. A paciente recebeu antibióticos e terapia de drenagem bilateral após o cateter de drenagem ser posicionado na cavidade do abscesso com auxílio de TC. Devido a sérios danos à coluna vertebral e a dor permanente, a paciente foi submetida à fixação vertebral interna minimamente invasiva e recuperou-se com sucesso. CONCLUSÃO: Um caso de osteomielite vertebral e abscesso do psoas bilateral com a formação de gás causada por Klebsiella pneumoniae em uma paciente diabética. Antibioticoterapia, drenagem e fixação vertebral interna minimamente invasiva foram realizadas, o que permitiu um bom resultado.

Linfadenitis cervical por Salmonella no Typhi en una paciente diabética / Cervical lymphadenitis caused by no typhoid Salmonella in a diabetic patient

Resumen La infección por Salmonella no Typhi es una de las enfermedades transmitidas por alimentos más común y ampliamente extendida en el mundo. Aunque la mayoría de los casos se limitan al tracto gastrointestinal, el compromiso extraintestinal no es infrecuente. Sin embargo, la adenitis como manifestación aislada, es una forma inusual de presentación de la enfermedad. Comunicamos el caso clínico de una mujer de 67 años de edad con diagnóstico de diabetes mellitus y una linfadenitis cervical por Salmonella no Typhi tratada con ciprofloxacina y y que requirió resección quirúrgica.

No Typhoid Salmonella infection is one of the most common and widely spread foodborne diseases worldwide. Although most cases are limited to the gastrointestinal tract, extraintestinal involvement is not uncommon. However, adenitis as an isolated manifestation, is an unusual form of the disease. We report a case of Salmonella no Typhoid cervical lymphadenitis in a 67-year-old female with a recent diagnosis of diabetes mellitus, who was treated with surgery and ciprofloxacin.

Absceso del psoas y osteomielitis de la columna lumbar: Caso clínico / Psoas abscess and lumbar spine osteomyelitis: Case report

El absceso del psoas es una enfermedad infrecuente en niños. Puede tener una presentación clínica inespecífica, ser de inicio insidioso y relacionarse o no con fiebre. El tipo más frecuente en pediatría es primario; sin embargo, en ocasiones, puede ser de origen secundario y asociarse a infecciones graves, como la osteomielitis, por lo que se requiere un alto índice de sospecha para detectarlo y tratarlo oportunamente. Presentamos un caso atípico de absceso del psoas con infiltración del cuerpo vertebral de L2 en un paciente masculino de 14 años previamente sano, sin antecedente de traumatismo ni fiebre al momento del ingreso. Se realizaron una radiografía y una ecografía, pero el diagnóstico se confirmó a través de una resonancia nuclear magnética de columna lumbosacra. Conhemocultivos positivos para Staphylococcus aureus meticilino resistente, completó 2 semanas de tratamiento antibiótico endovenoso y 4 semanas por vía oral con negativización de cultivos y resolvió por completo la sintomatología inicial.

Psoas abscess is a common disease in children. It can have a nonspecific clinical presentation, insidious onset and sometimes fever. The most common type in children is the primary one; however, it can sometimes be of secondary origin and associated with severe infections such as osteomyelitis so a high index of suspicion is required to detect and treat it promptly. We present an unusual case of psoas abscess with infiltration of the vertebral body of L2 in a 14 year old male patient previously healthy with no history of trauma or fever on admission. X-ray and ultrasound were performed but the diagnosis was confirmed by magnetic resonance imaging of the lumbosacral spine. With positive blood cultures for methicillin-resistant Staphylococcus aureus he completed 2 weeks of intravenous antibiotic therapy and 4 weeks of oral antibiotic therapy with blood cultures negativization and resolution of symptoms.

Espondilodiscitis: experiencia clínica en un hospital general de Chile / Spondylodiscitis: clinical experience in a Chilean general hospital

Introducción: La espondilodiscitis (ED) implica prolongados períodos de hospitalización, de latencia diagnóstica y riesgo de complicaciones a largo plazo. No existen publicaciones recientes en Chile al respecto. Objetivos: Caracterizar un grupo de pacientes con ED. Pacientes y Métodos: Serie clínica, que incluyó pacientes en un período de ocho años. Resultados: 37 pacientes, 37,8% mujeres y 62,2% hombres, con promedio etario 66,8 años; 64,9% adultos mayores, 35,1% diabéticos y 21,6% con co-morbilidad urológica. Los principales síntomas fueron dolor y fiebre. 89,2% tuvo elevación de VHS. 86,5% contó con resonancia magnética, que siempre fue confirmatoria, siendo la columna lumbar la localización más frecuente (43,2%). Se identificó etiología en 28/37 pacientes: en 71,4% cocáceas grampositivas (Staphylococcus aureus predominantemente), sólo en 10,7% M. tuberculosis. Staphylococcus aureus estuvo asociado a co-morbilidades médicas en forma significativa (p < 0,05) y el grupo de bacilos gramnegativos a historia hepatobiliar y/o intestinal (p < 0,05). El método de mayor rendimiento fue el cultivo obtenido por punción quirúrgica. El tratamiento antimicrobiano fue indicado en promedio por 63,8 días (IQR 53-72), con reacciones adversas en 18,9%. La estadía hospitalaria fue 38,9 días promedio, no existiendo fallecidos durante este período. 18,9% presentó secuelas motoras. Discusión: La mayoría de pacientes con ED correspondió a adultos mayores, siendo S. aureus la principal etiología. Hubo una baja frecuencia de M. tuberculosis. Resultó considerable la magnitud de efectos adversos asociados a la terapia antimicrobiana y las complicaciones neurológicas.

Background: Spondylodiscitis (SD) involves long periods of hospitalization, diagnostic latency and risk of long-term complications. No updated series are available in Chile and a change in demographic features and etiology is suspected. Aim: To characterize a group of patients with SD. Patients and Methods: Clinical series including patients over an 8 year period. Results: We identified 37 patients; 37.8% women and 62.2% men (mean age 66.8 years); 64.9% were elderly; 35.1% had diabetes and 21.6% urological comorbidity. Main symptoms were pain and fever. Erythrocyte sedimentation rate was elevated in 89.2%, and 86.5% patients had MRI, which was always confirmatory. Lumbar spine was the most common site of infection (43.2%). Etiology was identified in 28/37 patients: 71.4% yielded grampositive cocci (Staphylococcus aureus predominantly), Mycobacterium tuberculosis was identified in only 10.7%. Staphylococcus aureus was associated to medical comorbidities (p < 0,05) and gramnegative bacilli to hepatobiliar or intestinal symptoms (p < 0,05). Culture obtained by a surgical procedure had the highest yield. The average duration of antibiotic therapy was 63.8 days (IQR 53-72). Treatment-related side effects were detected in 18.9% of patients. The average hospital stay was 38.9 days. No deaths occurred during hospitalization. Motor sequelae were present in 18.9% of this series. Discussion: Most patients with SD were older adults. Staphylococcus aureus was predominant and M. tuberculosis was uncommon. Antibiotic side effects were relevant as well as the neurological complications.

Risk factors associated with the presentation of brucellosis in the spine / Fatores de risco associados à apresentação de brucelose na coluna vertebral / Factores de riesgo asociados a la presentación de brucelosis en la columna vertebral

OBJECTIVE: The aim of this study is to describe the risk factors associated with the presentation of brucellosis on the spine, and determine the strength of association between these factors. METHODS: The medical records of patients with brucellosis on the spine were analyzed and a spreadsheet was created to compile the following data: age, sex, place of origin and residence, risk factors (exposure at work, consumption of unpasteurized products and comorbidities), clinical presentation (lumbar pain, anorexia, headache, myalgia, fatigue, paresthesia, dysesthesia, muscle weakness, weight loss, fever), affected spine level, presence of abscesses, disease duration (acute, subacute, chronic), laboratory studies (erythrocyte sedimentation rate, C-reactive protein, serology, blood culture, Rose Bengal test, histopathological reports), imaging studies (x-rays, MRI, bone gammagraphy), established treatment (medical and/or surgical), therapeutic failure and sequelae. RESULTS: A total of 17 patients, 10 women (58.8%) and seven men (41.2%), were reviewed from January 2007 to January 2011. The group had a mean age of 57.8 years with a standard deviation of +13.91 and age range between 16-74 years. CONCLUSIONS: There is no significant difference between the groups compared with respect to age and sex, however, improvement of the neurological deficit was observed in eight patients who underwent surgical procedure. .

OBJETIVO: O objetivo deste estudo é descrever os fatores de risco associados à apresentação de brucelose na coluna vertebral e determinar a força da associação entre esses fatores. MÉTODOS: O prontuários médicos dos pacientes com brucelose na coluna foram analisados e uma planilha foi criada para reunir os seguintes dados: idade, sexo, local de origem e residência, fatores de risco (exposição no trabalho, consumo de produtos não pasteurizados e comorbidades), quadro clínico (dor lombar, anorexia, cefaleia, mialgia, fadiga, parestesia, disestesia, fraqueza muscular, perda de peso, febre), nível da coluna afetado, presença de abscessos, duração da doença (aguda, subaguda, crônica), exames laboratoriais (velocidade de hemossedimentação, proteína C-reativa, sorologia, hemocultura, teste de Rosa Bengala, exames histopatológicos), exames de imagem (radiografia, ressonância magnética, gamagrafia óssea), tratamento estabelecido (médico e/ou cirúrgico), falha terapêutica e sequelas. RESULTADOS: Dezessete pacientes, 10 mulheres (58,8%) e sete homens (41,2%), foram analisados entre janeiro de 2007 e janeiro de 2011. A idade média do grupo foi 57,8 anos com desvio padrão de +13,91 e variação de 16-74 anos. CONCLUSÕES: Não há diferença significativa entre os grupos comparados em relação à idade e ao sexo, mas foi observada melhora no déficit neurológico de oito pacientes que foram submetidos a procedimentos cirúrgicos. .

OBJETIVO: El objetivo del presente estudio es describir los factores de riesgo asociados a la presentación de brucelosis en la columna vertebral, y determinar la fuerza de asociación que existe entre dichos factores. MÉTODOS: Se analizaron a través de los expedientes, las historias clínicas de pacientes con brucelosis en columna vertebral, y se elaboró una hoja de captura obteniéndose los datos registrados en el expediente clínico: edad, sexo, lugar de origen y residencia, factores de riesgo (exposición laboral, consumo de productos no pasteurizados, enfermedades concomitantes), cuadro clínico (dolor lumbar, anorexia, cefalea, mialgias, fatiga, parestesias, disestesias, debilidad muscular, pérdida de peso, fiebre) nivel afectado en columna, presencia de abscesos, duración de la enfermedad (aguda, subaguda, crónica), estudios de laboratorio (Velocidad de sedimentación globular, Proteína C reactiva, pruebas serológicas, cultivos, Rosa de Bengala, reportes histopatológicos), estudios de gabinete (radiografías, resonancia magnética, gammagrama óseo), tratamiento establecido (médico y/o quirúrgico), falla terapéutica y secuelas. RESULTADOS: Se revisaron un total de 17 pacientes de 10 (58,8%) mujeres, siete (41,2%) hombres de enero de 2007 a enero de 2011, el grupo tuvo un promedio de edad de 57,8 años con una desviación estándar + 13,91 y un rango de 16 a 74 años. CONCLUSIONES: No existe diferencia significativa entre los grupos comparados con respecto a edad y sexo, sin embargo, se observó mejoría del déficit neurológico en ocho pacientes a los que se les realizó un procedimiento quirúrgico. .

Cervical spondylitis and spinal abscess due to Actinomyces meyeri

Human actinomycosis with involvement of the spine is a rare condition although it has been first described a long time ago. It is probably underrecognized since its clinical presentation is often misleading and accurate bacteriological diagnosis is challenging. We herein report a rare case of cervical actinomycosis with paravertebral abscess and spondylitis imputed to an infection by Actinomyces meyeri in a 52-year-old immunocompetent Caucasian man. A. meyeri should be considered as a potential cause for subacute or chronic spondylitis, even in immunocompetent subjects. Modern diagnostic tools such as Matrix-Assisted Laser Desorption–Ionization Time of Flight mass spectrometry and 16S rRNA sequencing are efficient for accurate microbiological identification.

Vertebral osteomyelitis and epidural abscesses caused by Prevotella oralis: a case report

An interesting case of pyogenic vertebral osteomyelitis with multiple epidural abscesses caused by non-pigmented Prevotella oralis is reported. The patient was a 68-year-old female who presented to the emergency room (ER) with severe pain and tenderness in her lower back with fever. She had recently undergone esophagogastroduodensoscopy (EGD) for complaints of esophageal reflux, which showed submucosal cyst in the esophagus. Magnetic resonance imaging (MRI) of the thoracic spine revealed multiple spinal epidural abscesses with signal enhancement at the level of T6 and T7, suggestive of vertebral osteomyelitis. Two blood cultures drawn one hour apart grew Prevotella oralis. The body fluid aspirated from the abscesses was also positive for the anaerobic commensal P. oralis. Necrosis associated with the submucosal cyst was implicated as the cause of sepsis and osteomyelitis due to this organism.

Osteomielitis vertebral piógena / Pyogenic vertebral osteomyelitis

La osteomielitis vertebral piógena (OVP) es una localización poco frecuente (2-7%) Se confirma con el aislamiento de un microorganismo de una vértebra, disco intervertebral, absceso epidural o paravertebral. Se describe una serie de casos por la infrecuente presentación de esta enfermedad, que puede ser consulta inicial en los servicios de clínica médica y por su sintomatología inespecífica que supone una dificultad diagnóstica. Tanto la columna lumbar como la dorsal fueron los sitios más afectados. El dolor dorsolumbar y la paraparesia fueron los síntomas más frecuentes de presentación. En ocho pacientes se aislaron Staphylococcus aureus, en uno Escherichia coli y en el restante Haemophylus sp. Se observó leucocitosis sólo en tres pacientes, y en dos velocidad de sedimentación globular mayor de 100 mm/h. Los diez pacientes presentaron imágenes características de osteomielitis vertebral piógena en la resonancia nuclear magnética. Dentro de las complicaciones, los abscesos paravertebrales y epidurales fueron los más frecuentes (en cinco enfermos). Además, un paciente presentó empiema pleural. De los diez pacientes de esta serie, siete recibieron inicialmente tratamiento médico empírico y luego específico para el germen aislado. En los restantes el tratamiento fue guiado de acuerdo al antibiograma. A dos enfermos fue necesario realizarles laminectomía descompresiva por compromiso de partes blandas y a otros dos estabilización quirúrgica por inestabilidad espinal, observándose buena evolución en todos los casos. Esta serie demuestra que, ante un paciente con dolor dorsolumbar y síntomas neurológicos se deberá tener en cuenta esta entidad para evitar un retraso en el tratamiento.

Pyogenic osteomyelitis seldom affects the spine (2-7%). It is diagnosed by the isolation of a bacterial agent in the vertebral body, the intervertebral disks or from paravertebral or epidural abscesses. We report a retrospective study of ten patients who attended a medical clinic with this disease to emphasize its unusual presentation and difficult diagnosis. Lumbar and dorsal spine were the most common sites affected. Dorsolumbar pain and paraparesis were the most frequent symptoms. Staphylococcus aureus were isolated in eight patients, Escherichia coli in one and Haemophilus sp. in other Leukocytosis was observed in only three patients. Erythrocyte sedimentation rate was higher than 100 mm in the first hour in two patients. Typical images of pyogenic vertebral osteomyelitis were observed in all these patients with magnetic resonance imaging. The main complications were paravertebral and epidural abscesses that were found in five patients. One patient also presented an empyema, seven of them initially received empiric medical treatment, and later specific antibiotics according to the culture and sensitivity results. The rest of the patients were initially treated according to the sensitivity of the isolated germ. Surgical intervention was performed in two patients to drain soft tissue involvement, and in two other to stabilize the spine. All four surgical patients had a full recovery. This report is intended to point out that in patients with dorsolumbar pain and neurological symptoms pyogenic vertebral osteomyelitis is a possible diagnosis and has to be treated without delay.

Desbridamiento percutáneo de la espóndilo-disquitis piógena con el nucleotomo / Percutaneous debridement of the pyogenic spondilo-discitis by nucleotome

Se estudiaron 22 pacientes con espóndilo-disquitis piógena de la columna lumbar, siendo 15 hombres y siete mujeres con edad promedio de 54 años. En sólo 2/3 se encontró el foco de infección con predominio de: Salmonella, Brucella y cocos Gram positivos. El nivel más afectado fue L3-L4 y clínicamente todos tuvieron una lumbociatalgia con irradiación a algún dermatoma y los estudios radiológicos mostraron un proceso óseo destructivo en las plataformas vertebrales con reacción esclerosa, espículas óseas, compresión neurológica por el absceso e inestabilidad segmentaria. Tradicionalmente existen dos tipos de tratamiento: el conservador, con antibióticos y reposo en cama hasta por nueve meses y el quirúrgico, con un riesgo alto de morbimortalidad. Nosotros proponemos otra alternativa viable de tratamiento, con el uso de menos nucleotomo, para el desbridamiento percutáneo del absceso por ser invasivo y proporcionar muestra para estudio bacteriológico e histopatológico. Con el desbridamiento percutaneo del absceso, se descomprimen las estructuras neurológicas y la lumbociatalgia remitió en uno a cinco días con recuperación neurológica progresiva de uno a cuatro semanas en el 95 por ciento de los casos. Al drenar el absceso se observó una pronta reparación del defecto óseo y una función intersomática espontánea de cuatro a cinco meses de los 22 casos, estabilizándose la columna

Absceso paravertebral y síndrome lumbociático / Paravertebral abscess nd lumbosciatic syndrome

Los autores comunican dos casos de absceso paravertebral cuya forma de presentación fue síndrome lumbociático. Se comentan las características del cuadro clínico, destacando el tipo de dolor. Se discuten los exámenes de laboratorio señalando la utilidad de la tomografía computada de abdomen y pelvis. Se sugiere el drenaje quirúrgico amplio como el tratamiento de elección y se menciona la posibilidad de meningitis como complicación grave