[Abscesses in the lumbo-sacral spine area - a case report]. / Ropnie w okolicy kregoslupa odcinka ledzwiowo-krzyzowego ­ opis przypadku.

Infection of the surgical operation site is found in approximately 3% of patients and 20% of patients undergoing urgent surgery. The occurrence of this type of complications is affected both by coexisting diseases and the presence of infection in the environment in which the patient is staying. It should also be taken into account that the bacteria found in the implanted material and surrounding tissues have the ability to adhere to the implant, creating a biofilm structure there. The presented patient is an illustration of such a problem, because after L5 laminectomy and extensive L2-L3 and L3-L4 one-sided fenestration and L2-L3-L4-L5 facetectomy, interbody bone arthrodesis and transpedicular stabilization, he reported for fever and pain in right lumbar area. In the patient, the presence of inflammatory infiltrate in the lumbar region of the lumbar tissues was found in imaging studies, with fluid reservoirs that surrounded pedicle screws and spinous processes, as well as abscesses and inflammatory changes in the spinal canal at the L4-L5 level. Empirical antibiotic therapy was ordered and decision about surgical treatment was made. A large amount of purulent and odorous secretion was evacuated at the site of previously performed laminectomy. In the postoperative period, targeted antibiotic therapy was applied based on the culture result obtained from the surgical site. The culture showed Staphylococcus aureus MSSA (methicillin-susceptible S. aureus) which was sensitive to the majority of antibiotics tested. The low effectiveness of this treatment caused the necessity to broaden the research, blood culture revealed Turicella otitidis, which was sensitive to gentamycin, vancomycin, linezolid and rifampicin. The applied rifampicin caused improvement of the patient's condition and the possibility of starting motor rehabilitation. The described case indicates real difficulties in the treatment of post-operative infections, despite invasive procedures and antibiotic therapy.

Spinal epidural empyema extending from a pleural empyema: case description and anatomical overview.

We present a case of a patient with diabetes with a pleural empyema originated from a pyomyositis process established after a central line procedure. This empyema later on extended into the spinal canal deriving into an epidural empyema, leading towards a spinal neurogenic shock and death. We discuss the anatomical substrate for this extension as well as the anatomopathological findings observed in the autopsy.

Empyema in spinal canal in thoracic region, abscesses in paravertebral space, spondylitis: in clinical course of zoonosis Erysipelothrix rhusiopathiae.

OBJECTIVES: Erysipelas is an animal disease caused by Gram-positive bacteria Erysipelothrix rhusiopathiae. Among the domestic animals, domestic pig (Sus scrofa f. domestica) suffers most frequently from the disease in human environment. This is a typical animal-borne disease observed mainly in occupational groups employed in agriculture, farming (of animals and birds), fishing and manufacturing industry. METHODS: We are presenting the clinical course of infection (E. rhusiopathiae) and discuss clinical forms. E. rhusiopathiae in humans may have the following clinical course: mild form of skin infection diagnosed as local erythema (erysipeloid), disseminated form of skin infection and the most serious form of infection of systemic course (endocarditis and sepsis). Mild skin infection and local erythema are the most common forms. Very rare case of animal-borne infection course has been presented in which after initial phase the disease was generalised to the abscesses formation in paravertebral space, spondylitis and empyema formation in spinal canal. In the presented clinical case, the patient was suffering from diabetes. It was probably an additional risk factor of the disease generalisation. Patient underwent drainage of empyema in spinal canal, after which his neurological status gradually improved. Antibiotic therapy was implemented and continued for 8 weeks. Such course of erysipelas was not previously described in the literature. RESULTS: After therapy neurological status was improved. In follow MRI control exam empyema and spondylitis was successfully eliminated. CONCLUSIONS: Various complications of the disease, such as endocarditis and heart valves disturbances, are well known and are the most severe complications of the generalised infection. Proper targeted and long-term antibiotic therapy is crucial.

Clinical characteristics and therapeutic outcome of Gram-negative bacterial spinal epidural abscess in adults.

Gram-negative (G(-)) bacterial spinal epidural abscess (SEA) in adults is uncommon. Of the 42 adult patients with bacterial SEA admitted to the Chang Gung Memorial Hospital - Kaohsiung, between 2003 and 2007, 12 with G(-) SEA were included in this study. Of these 12 patients, seven were men and five were women; their ages ranged between 17 years and 81 years (median=72.5 years, mean=62.5 years). The patients were admitted at different stages of symptom onset (four were in the acute stage and four each in the subacute and chronic stages) and at different levels of neurologic deficit severity, ranging from back pain to paraplegia. Of these 12 patients, 11 had a medical and/or neurosurgical condition as the preceding event and four had a concomitant infection at other sites. Back pain (83%, 10/12) was the most common clinical presentation, followed by paraparesis (50%, 6/12), radiating pain (33%, 4/12), and urinary retention (25%, 3/12). The following causative G(-) pathogens were detected: Klebsiella pneumoniae (three patients), Salmonella spp. (three), Escherichia coli (two), Enterobacter spp. (two), Aeromonas hydrophila (one), and Prevotella melaninogenica (one). Both Enterobacter strains were resistant to multiple antibiotics. Of the 12 patients, eight (66.7%) had spontaneous SEA, whereas the remaining four had postneurosurgical SEA. Thoracic, lumbar, and thoracolumbar spine segments were the most commonly affected. After receiving medical and/or surgical treatment, 10 of the 12 patients (83%) survived, and all 10 recovered well. In conclusion, G(-) bacterial SEA accounted for 28.5% (12/42) of adult SEA. The causative G(-) pathogens found in this study were different from those reported in Western countries, and the strains noted in our study had multiple antibiotic resistance. Our findings suggest that the choice of initial empirical antibiotics for SEA should be carefully considered.

Spinal intradural granuloma as a complication of an infected cerebrospinal fluid drainage tube fragment--case report.

A 69-year-old man presented with subarachnoid hemorrhage due to a ruptured anterior communicating artery aneurysm. The aneurysm neck was clipped and a lumbar drainage tube was inserted for cerebrospinal fluid drainage. However, the tube was accidentally cut during removal and a fragment remained in the spinal canal. A subarachnoid, subcutaneous abscess appeared 7 days later, which was treated with antibiotics. He noted numbness of his left leg after 6 months, and gait disturbance manifested 3 months later. T(1)-weighted magnetic resonance (MR) imaging disclosed a well-enhanced extramedullary mass at the T9-10 intervertebral level, and T(2)-weighted MR imaging showed moderate edema around the peri-lesional spinal cord. The mass containing a drainage tube fragment was surgically removed. Histological examination confirmed granuloma due to chronic infection. This case suggests that retained tube fragments should be removed surgically, especially in the presence of infectious complications.

Extensive spinal epidural abscess as a complication of Crohn's disease.

A spinal epidural abscess is a neurosurgical emergency. Successful treatment frequently requires decompression of the spinal canal in combination with intravenous antibiotics. We report a patient with Crohn's disease who developed an extensive spinal epidural abscess communicating with an intra-abdominal collection.

Papilledema as a manifestation of a spinal subdural abscess.

Papilledema is an uncommon presentation of spinal cord processes. Spinal subdural abscess (SSA) is a rare site of post-operative infection. We report a patient who developed papilledema as the primary manifestation of a post-operative lumbar subdural abscess. A spinal abscess should be considered in the post-operative spinal surgery patient who develops papilledema in the setting of persistent back pain. The increased intracranial pressure associated with lumbar spinal cord abscess most likely results from a markedly elevated cerebrospinal fluid (CSF) protein or the disruption of CSF flow in the spinal cul-de-sac.

Postoperative discitis due to Propionibacterium acnes: a case report and review of the literature.

BACKGROUND: No previous report has described a progressive, destructive postoperative discitis requiring operative stabilization due to Propionibacterium acnes. The clinical and radiographic features and treatment options associated with discitis due to P acnes are presented in a retrospective case study, as well as a review of the current literature. CASE DESCRIPTION: Seven weeks after a routine lumbar discectomy, the patient presented with clinical findings and radiographic imaging consistent with discitis. Intraoperative cultures obtained from irrigation and debridement of the disc space revealed P acnes, and appropriate intravenous antibiotic treatment was instituted. Approximately 2 months later, the patient showed progression to a destructive osteomyelitis requiring operative stabilization. Nine weeks after stabilization, the patient continued to have lower back pain without radiculopathy. Laboratory values had normalized. Radiographic imaging revealed good instrumentation positioning and adequate fusion. The patient was ambulatory with bilateral articulating ankle foot orthoses and a walker. CONCLUSION: The reported case adds to the literature on postoperative discitis due to P acnes and demonstrates that this organism can occasionally be the cause of progressive, destructive osteomyelitis. In addition, we review the incidence, risk factors, and clinical course of discitis due to P acnes.

Subdural empyema with extension to vertebral canal secondary to salmonellosis in a patient with systemic lupus erythematosus.

CASE REPORT: A case of supratentorial subdural empyema extending to the superior subdural cervical space in a 14-year-old patient with systemic lupus erythematosus is presented. The presumed etiology of the empyema was an intestinal nontyphoidal salmonella infection. DISCUSSION: We review the neurological and neurosurgical complications in systemic lupus erythematosus.