High cervical spine spondylodiscitis management and literature review / Espondilodiscite da coluna cervical alta: manejo e revisão da literatura

Summary Spondylodiscitis affecting the cervical spine is the most unusual type. Disease progression can be dramatic, even causing quadriplegia and death. We present an unusual case that progressed with osteolytic lesions between C2 and C3, causing cord compression and epidural abscess. The patient was treated surgically by a double approach and improved without neurological deficits and with better inflammatory markers. We reviewed the current literature on the subject.

Resumo A espondilodiscite, que acomete a coluna cervical, é a de localização mais rara. Pode ter uma evolução dramática, inclusive causando tetraplegia e óbito. Apresentamos um caso atípico que evoluiu com lesões osteolíticas entre C2 e C3, causando compressão medular e abscesso epidural. O paciente foi submetido a tratamento cirúrgico por dupla abordagem e evoluiu bem, sem déficits neurológicos e com melhora dos marcadores inflamatórios. Revisamos a literatura vigente sobre o assunto.

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.

Espondilitis tuberculosa en adultos: revisión de una serie de casos en un hospital de tercer nivel, Lima-Perú / Tuberculous spondylitis in adults: a case series from a reference hospital in Lima, Peru

Describimos las características clínicas y demográficas en pacientes adultos con espondilitis tuberculosa así como un análisis exploratorio que buscó establecer características que contribuyeron al desarrollo de esta enfermedad, en un hospital de tercer nivel de Lima. Realizamos un estudio tipo serie de casos y describimos 33 casos recolectados entre 1999-2009. 18 pacientes (55 por ciento) fueron varones, la media de edad fue 31 años (IQ 23 a 51 años) y un tiempo de enfermedad de 3 meses (IQ 1 a 8 meses). El principal síntoma fue lumbalgia en 28 (85 por ciento). Los segmentos más comprometidos fueron el torácico en 28 (60 por ciento) casos y lumbar en 13 (28 por ciento). Tuberculosis pulmonar se encontró en 14 (42 por ciento) casos. Veinticuatro (73 por ciento) recibieron esquema I. La duración de tratamiento fue 10,5 ± 4,2 meses . Las características clínicas, diagnósticas fueron similares a series nacionales previas e internacionales.

We describe the demographic and clinical characteristics of adult patients with tuberculous spondylitis as well as an exploratory analysis that seeked to establish patient characteristics that contributed to the development of this disorder at a reference hospital in Lima. This is a case-series descriptive study where data collection from 33 medical records of patients from 1999 to 2009 was done. Eighteen (55 percent) were male. Median age was 31 years (IQR 23 to 51 years). Median time of symptoms was 3 months (IQR 1 to 8 months). The most frequent symptom was back pain in 28 (85 percent). The most frequently affected areas were the thoracic spine involved in 28 (60 percent) cases and lumbar spine in 13 (28 percent). Pulmonary tuberculosis was present in fourteen (42 percent) cases. Twenty four (73 percent) patients received first line treatment. Treatment duration was 10.5 ± 4.2 months. Clinical and diagnostic characteristics were similar to previous Peruvian case reports and current literature.

Management of spinal infection

This review of spinal infections was conducted to better define the population at risk, the affected levels, presentation, causative organisms, duration of antibiotic treatment and indications for surgery. A retrospective analysis of 70 consecutive patients with primary spinal infection [epidural abscess and/or vertebral osteomyelitis] that presented between January 2001 and August 2004 was performed. These patients had not undergone immediate prior spinal surgery. We analyzed patient demographics, co-morbidities, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] and white blood cell count [WBC], management and outcomes. The mean age at presentation was 56.4 years [range 8 to 85], with 69% over the age of 50. Over half [56%] were male and 44% were female. Over a quarter [27%] presented with vertebral osteomyelitis, 40% with spinal epidural abscess, and 33% with both. Pain was the most common symptom, occurring in 77% at presentation. Co-morbid diseases included hypertension [41%], diabetes [33%], heart disease [27%] and pulmonary disease [20%]. Forty-one percent were treated with antibiotics alone while 59% underwent a surgical procedure. Ten percent failed initial medical management and required surgery. Time from diagnosis to surgery ranged from 3 to 10 weeks. Surgery was undertaken for decompression or stabilization. All but one patient improved at last follow-up. Declines in ESR and CRP correlated strongly with treatment success while WBC had less correlation. Parenteral antibiotic therapy averaged 8 weeks. This retrospective study further defines the population at risk for spinal infection, outlines current strategies of medical and surgical management, demonstrates the usefulness of laboratory values and conveys outcomes

[Brucella spondylitis and paraspinal abscess]

Brucellosis is a zoonosis with a variety of clinical syndromes including spondylitis. Spondylitis and sacroiliitis are the most frequent complications of skeletal system involvement in brucellosis, but muscle infection and abscess formation are a rare complication and frequently secondary to spondylitis. In this article two cases of brucella spondylitis are presented which has led to abscess formation in one of them, these patients referred with back pain, fever, and with subsequeint MRI examination, wright positive test, were diagnosed as spondylitis. The antibiotic regiment including Doxycycline, Refampin, were prescripted for four months. The clinical signs were disapeared subsequently

Aspergillus Spondylitis involving the Cervico-Thoraco-Lumbar Spine in an Immunocompromised Patient: a Case Report

Aspergillosis is a rare cause of spondylitis. Moreover, early diagnosis by MR imaging and adequate treatment can prevent the serious complications of fungal infection. To our knowledge, the MR findings of multilevel aspergillus spondylitis in the cervico-thoraco-lumbar spine have not been previously described. Here, we report the MR findings of aspergillus spondylitis involving the cervical, thoracic, and lumbar spine in a liver transplant recipient.