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.

First Case of Human Brucellosis Caused by Brucella melitensis in Korea

No abstract available.

Correlation between clinical, radiological and operative findings in management of tuberculous and pyogenic spondylitis

Spinal infection is a major category of spinal diseases that is difficult to differentiate clinically from degenerative diseases or spinal neoplasm. Evaluation of the vertebral osteomyelitis and tuberculous spondylitis need an accurate and specific imaging modality to guide the invasive procedures for a definitive microbiological diagnosis and to spare patients with other disorders that might mimic these entities as aggressive neoplastic lesions of the spine. The aim of this study was to determine the accuracy of MRI for discrimination between different types of spinal infections mainly between tuberculous spondylitis and pyogenic spondylitis. We did a retrospective study of MRI images of 30 patients who had confirmed spondylitis either tuberculous or pyogenic in their MRI of the spine. Then we correlate the clinical and operative findings with the preoperative radiology of the patients. Statistical analysis was performed with the Fisher exact test and Monte Carlo test. The incidence of the following MRI findings was significantly higher in patients with tuberculous spondylitis than in those with pyogenic spondylitis a well-defined paraspinal abnormal signal was present in 14 patients 88% in tuberculous spondylitis vs 4 patients 28% in pyogenic spondylitis, a thin and smooth abscess wall was present in 14 patients 88% in TB vs 2 patients 14% in pyogenic spondylitis, presence of paraspinal or intraosseous abscess [15 patients 93% in TB vs 6 patients 42% in pyogenic infection, subligamentous spread or more than two vertebral levels was detected in 12 patients 75% in TB vs 5 patients 35% in pyogenic spondylitis. thick and irregular abscess wall was present in 5 patients 35% in pyogenic spondylitis vs 0% in TB, a horizontal bandlike sparing of the body was present in 4 patients 28% in pyogenic spondylitis vs 0% in TB. Hyperintense signal on T2-weighted images was more commonly observed in tuberculous spondylitis 15 patients 93% in tuberculous vs 8 patients 57% in pyogenic. The accuracy and specificity of preoperative MRI diagnosis correlated to the postoperative pathological findings was 100% of both types of spondylitisMRI is an accurate and sensitive modality in diagnosis of spinal infection. It also has a high specificity in differentiation of tuberculous spondylitis and pyogenic spondylitis

Psoriatic spondylitis: Clinical and radiological study

This study included 60 psoriatic patients. They were 34 males and 26 females. Their age ranged from 9 to 64 years with a mean of 46.8 years. Clinical evidences of sacroilitis [SI] was encountered in 9 patients [51%]. Peripheral arthritis was encountered in 10 patients [16.7%], and in 24 patients [40%] there was clinical and radiological evidences spondylitis. Radiological evidences of SI was demonstrated in 13 patients. Radiological evidences of cervical atlantoaxial subluxation were present in 13 patients and none of the patients had odontoid erosions or subaxial subluxation. Marginal and paramarginal syndyesmophytes were encountered in 30 patients in one or more spinal level [cervical or dorsolumbar]. Out of 51 psoriatic patients, 14 [27%] had positive HLA B27 antigen typing