Summary
Pyogenic spondylodiscitis associated with epidural abscess is a rare but serious problem in spinal surgery, because it may cause a severe morbidity or mortality, if the diagnosis is established late and the treatment is inadequate.
A case of pyogenic thoracic spondylodiscitis associated with epidural abscess whose symptoms progressed over two months from back pain to acute paraplegia was presented. Magnetic resonance imaging of the spine suggested the presence of T9–10 spondylodiscitis with partial destruction of the T9 and T10 vertebral bodies and concomitant epidural abscess. Treatment consisting of surgical debridement of infected vertebrae and disc material, fusion and anterior spinal instrumentation was performed. Microbiological culture of the material revealed infection with Staphylococcus aureus and after 3 months of antibiotic treatment, recovery was almost complete.
Based on a thorough review of the literature and the case presented in this report, it is concluded that accurate and prompt diagnosis requires high index of suspicion followed by a combination of adequate surgical and conservative treatment prevents severe morbidity in cases of nonspecific pyogenic spondylodiscitis associated with epidural abscess.
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References
JS Butler MJ Shelly M Timlin WG Powderly JM O’Byrne (2006) ArticleTitleNontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center Spine 31 2695–2700 Occurrence Handle17077738 Occurrence Handle10.1097/01.brs.0000244662.78725.37
WH Chen LS Jiang LY Dail (2007) ArticleTitleSurgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation Eur Spine J 16 1307–1316 Occurrence Handle17106664 Occurrence Handle10.1007/s00586-006-0251-4
P Derkinderen X Duval F Bruneel JP Laissy B Regnier (1998) ArticleTitleIntramedullary spinal cord abscess associated with cervical spondylodiskitis and epidural abscess Scand J Infect Dis 30 618–619 Occurrence Handle10225397 Occurrence Handle10.1080/00365549850161241 Occurrence Handle1:STN:280:DyaK1M3jvF2jsQ%3D%3D
SE Emery DP Chan HR Woodward (1989) ArticleTitleTreatment of hematogenous pyogenic vertebral osteomyelitis with anterior debridement and primary bone grafting Spine 14 284–291 Occurrence Handle2652335 Occurrence Handle1:STN:280:DyaL1M3it1KisA%3D%3D
J Finsterer K Mahr V Volker Paral (2003) ArticleTitleFavorable outcome of long-lasting thoracic spondylodiscitis with spinal epidural abscess induced by Staphylococcus aureus South Med J 96 70–73 Occurrence Handle12602721 Occurrence Handle10.1097/01.SMJ.0000047977.75404.1D
AG Hadjipavlou JT Mader JT Necessary AJ Muffoletto (2000) ArticleTitleHematogenous pyogenic spinal infections and their surgical management Spine 25 1668–1679 Occurrence Handle10870142 Occurrence Handle10.1097/00007632-200007010-00010 Occurrence Handle1:STN:280:DC%2BD3cvgslGktw%3D%3D
JR Jinkins (2002) ArticleTitleMagnetic resonance imaging of spinal infectious disease: pathophysiologic concepts of origin and spread Acta Clin Croat 41 IssueIDSuppl 29–30
P Kapeller F Fazekas D Krametter M Koch G Roob R Schmidt H Offenbacher (1997) ArticleTitlePyogenic infectious spondylitis: clinical, laboratory and MRI features Eur Neurol 38 94–98 Occurrence Handle9286631 Occurrence Handle10.1159/000113167 Occurrence Handle1:STN:280:DyaK2svjt1Omsw%3D%3D
RK Khanna GM Malik JP Rock ML Rosenblum (1996) ArticleTitleSpinal epidural abscess: evaluation of factors influencing outcome Neurosurgery 39 958–964 Occurrence Handle8905751 Occurrence Handle10.1097/00006123-199611000-00016 Occurrence Handle1:STN:280:DyaK2s%2FmtFOhsw%3D%3D
P Korovessis P Sidiropoulos G Piperos A Karagiannis (1993) ArticleTitleSpinal epidural abscess complicated closed vertebral fracture: a case report and review of literature Spine 18 671–674 Occurrence Handle8484159 Occurrence Handle10.1097/00007632-199304000-00020 Occurrence Handle1:STN:280:DyaK3s3kvVKjuw%3D%3D
TJ Kowalski EF Berbari PM Huddleston JM Steckelberg DR Osmon (2006) ArticleTitleDo follow-up imaging examinations provide useful prognostic information in patients with spine infection Clin Infect Dis 43 172–179 Occurrence Handle16779743 Occurrence Handle10.1086/505118
W Kuker M Mull L Mayfrank R Topper A Thron (1997) ArticleTitleEpidural spinal infection: variability of clinical and magnetic resonance imaging findings Spine 22 544–551 Occurrence Handle9076887 Occurrence Handle10.1097/00007632-199703010-00017 Occurrence Handle1:STN:280:DyaK2s3jtFGgtA%3D%3D
AR Mackenzie RB Laing CC Smith GF Kaar FW Smith (1998) ArticleTitleSpinal epidural abscess: the importance of early diagnosis and treatment J Neurol Neurosurg Psychiatry 65 209–212 Occurrence Handle9703173 Occurrence Handle1:STN:280:DyaK1czms1OgsQ%3D%3D
F Maiuri G Iaconetta B Gallicchio A Manto F Briganti (1997) ArticleTitleSpondylodiscitis: clinical and magnetic resonance diagnosis Spine 22 1741–1746 Occurrence Handle9259785 Occurrence Handle10.1097/00007632-199708010-00012 Occurrence Handle1:STN:280:DyaK2svgs1ehtg%3D%3D
S Mann M Schutze S Sola J Piek (2004) ArticleTitleNonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients Neurosurg Focus 17 E3 Occurrence Handle15636573 Occurrence Handle10.3171/foc.2004.17.6.3
A Nather V David HT Hee J Thambiah (2005) ArticleTitlePyogenic vertebral osteomyelitis: a review of 14 cases J Orthop Surg (Hong Kong) 13 240–244 Occurrence Handle1:STN:280:DC%2BD2MnnslKqtw%3D%3D
Y Numaguchi D Rigamonti MI Rothman S Sato F Mihara N Sadato (1993) ArticleTitleSpinal epidural abscess: evaluation with gadolinium-enhanced MR imaging Radiographics 13 545–560 Occurrence Handle8316663 Occurrence Handle1:STN:280:DyaK3szgtleiuw%3D%3D
KL Saban RF Ghaly (1998) ArticleTitleSpinal cervical infection: a case report and current update J Neurosci Nurs 30 105–109 Occurrence Handle9642618 Occurrence Handle1:STN:280:DyaK1czgs1GrtA%3D%3D
OEJ Stevens JM Seibly YH Chen RD Dickerman J Noel KA Kattner (2007) ArticleTitleReactivation of dormant lumbar methicillin-resistant Staphylococcus aureus osteomyelitis after 12 years. Case report J Clin Neurosci 14 585–589 Occurrence Handle17188493 Occurrence Handle10.1016/j.jocn.2005.12.006
BP Van de Warrenburg P Wesseling QH Leyten RH Boerman (2004) ArticleTitleMyelopathy due to spinal epidural abscess without cord compression: a diagnostic pitfall Clin Neuropathol 23 102–106 Occurrence Handle15200287 Occurrence Handle1:STN:280:DC%2BD2c3pvFWlsA%3D%3D
C Woertgen RD Rothoerl C Engelert C Neumann (2006) ArticleTitlePyogenic spinal infections and outcome according to the 36-item short form health survey Neurosurg Spine 4 441–446 Occurrence Handle10.3171/spi.2006.4.6.441
HL Yen KH Kong W Chan (1998) ArticleTitleInfectious disease of the spine: outcome of rehabilitation Spinal Cord 36 507–513 Occurrence Handle9670388 Occurrence Handle10.1038/sj.sc.3100609 Occurrence Handle1:STN:280:DyaK1czjsFSntg%3D%3D
WF Young M Weaver B Snyder R Narayan (2001) ArticleTitleReversal of tetraplegia in patients with cervical osteomyelitis-epidural abscess using anterior debridement and fusion Spinal Cord 39 538–540 Occurrence Handle11641798 Occurrence Handle10.1038/sj.sc.3101207 Occurrence Handle1:STN:280:DC%2BD3Mrmt1yruw%3D%3D
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Correspondence: Dr. Mehmet Turgut, Cumhuriyet Mahallesi, Cumhuriyet Caddesi, No: 6 Daire: 7, TR-09020 Aydın, Turkey.
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Turgut, M. Complete recovery of acute paraplegia due to pyogenic thoracic spondylodiscitis with an epidural abscess. Acta Neurochir (Wien) 150, 381–386 (2008). https://doi.org/10.1007/s00701-007-1485-6
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DOI: https://doi.org/10.1007/s00701-007-1485-6