ABSTRACT
Vertebral infections after spinal puncture are rare and often inadequately documented. Their incidence does not exceed that of spontaneous epidural abscesses and we should therefore be cautious about assuming a causal relation between puncture and an abscess. After analyzing 10 published cases we saw that only half of them reported on aseptic conditions and only 2 patients seem to have had a prior infection. In 3 cases, the abscesses appeared after technically simple punctures whereas half the reports did not even mention the type of puncture. This complication should be considered whenever a patient develops back pain and fever, even if there are no neurological deficits and even after a simple spinal puncture. Given that early diagnosis and treatment have proven effective in improving the survival rate and reducing the rate of neurological sequelae, magnetic resonance images should be ordered urgently so that early treatment can be established.
Subject(s)
Anesthesia, Spinal , Bacteroides Infections/etiology , Discitis/etiology , Epidural Abscess/etiology , Gram-Negative Bacterial Infections/etiology , Lumbar Vertebrae , Pilonidal Sinus/surgery , Punctures/adverse effects , Aged , Anti-Bacterial Agents/therapeutic use , Bacteremia/etiology , Bacteroides Infections/diagnosis , Bacteroides Infections/drug therapy , Bacteroides Infections/surgery , Combined Modality Therapy , Debridement , Discitis/diagnosis , Discitis/drug therapy , Discitis/surgery , Epidural Abscess/diagnosis , Epidural Abscess/drug therapy , Epidural Abscess/epidemiology , Epidural Abscess/surgery , Fatal Outcome , Fever/etiology , Gram-Negative Anaerobic Cocci , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/surgery , Humans , Incidence , Low Back Pain/etiology , Magnetic Resonance Imaging , Male , Shock, Septic/etiologyABSTRACT
Las infecciones vertebrales tras punción subaracnoidea son excepcionales y a menudo están insuficientemente documentadas. Su incidencia no supera la de los abscesos epidurales espontáneos, lo que debería obligarnos a ser prudentes antes de afirmar la relación causal entre punción y absceso. Tras analizar 10 casos publicados observamos que sólo en la mitad de ellos se aportan datos sobre las condiciones de asepsia de las punciones y únicamente en dos pacientes parece haber una infección previa. En tres casos los abscesos aparecen tras punciones técnicamente sencillas, mientras que en la mitad de ellos ni siquiera se menciona este evento. Debe considerarse esta complicación ante un paciente con dolor de espalda y fiebre, aunque no aparezcan déficit neurológicos, e incluso tras punción subaracnoidea sencilla. Es importante solicitar urgentemente una resonancia magnética, con el fin de establecer con premura un tratamiento adecuado, puesto que el diagnóstico y tratamiento precoces han demostrado su eficacia para mejorar la supervivencia y disminuir el porcentaje de pacientes con secuelas neurológicas
Vertebral infections after spinal puncture are rare and often inadequately documented. Their incidence does not exceed that of spontaneous epidural abscesses and we should therefore be cautious about assuming a causal relation between puncture and an abscess. After analyzing 10 published cases we saw that only half of them reported on aseptic conditions and only 2 patients seem to have had a prior infection. In 3 cases, the abscesses appeared after technically simple punctures whereas half the reports did not even mention the type of puncture. This complication should be considered whenever a patient develops back pain and fever, even if there are no neurological deficits and even after a simple spinal puncture. Given that early diagnosis and treatment have proven effective in improving the survival rate and reducing the rate of neurological sequelae, magnetic resonance images should be ordered urgently so that early treatment can be established
