DOCSLIB.ORG

Cervical Spondylodiscitis Mimicking Pott's Disease: a Case Report

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cervical Spondylodiscitis Mimicking Pott's Disease: a Case Report European Review for Medical and Pharmacological Sciences 2019; 23(2 Suppl.): 1-5 Cervical spondylodiscitis mimicking Pott’s disease: a case report G. GASPARINI, M. MERCURIO, B. CAROLEO, O. GALASSO Department of Medical and Surgical Sciences, University Magna Græcia, Catanzaro, Italy Abstract. – INTRODUCTION: The leading cause Timely diagnosis is critical because discitis of pyogenic vertebral osteomyelitis is Staphylo- and epidural abscesses in the cervical region coccus aureus, and its incidence is rising, partic- have been shown to have a mortality ranging ularly in the elderly. We report an unusual case from 2% to 19%4,5. A missed or delayed diag- of cervical spondylodiscitis and epidural abscess nosis may cause severe local effects including mimicking Pott’s disease. CASE REPORT: A 67-year-old man was admit- spinal cord compression due to the smaller ted to our institution with a 15-day history of neck diameter of the cervical spinal canal compared pain radiating to the head, shoulders and left arm with the thoracic and lumbar regions and due that was associated with weakness and paresthe- to systemic effects related to bacteraemia and sia. Laboratory tests showed a mild leucocytosis disseminated infection. and high levels of inflammatory markers. The MRI The leading cause of pyogenic vertebral os- showed contrast enhancement of C6-C7 with an teomyelitis is Staphylococcus aureus, and its abscess infiltration extending to the intervertebral 5-7 disc, the anterior epidural space, and the medul- incidence is rising, particularly in the elderly . lary cord. The patient had a medical history of Haematogenous seeding of infection is still by a positive Mantoux tuberculin skin test 25 years far the most common mechanism of spinal in- prior, and the interferon-gamma release assay fection8,9. Classically, lesions in two adjacent (IGRA) was positive for the identification of latent vertebral bodies are a consequence of the seg- tuberculosis infection. All other examinations for mental nature of the supplying arteries that diagnosis of spinal tuberculosis were inconclu- sive. Intravenous antibiotic therapy was initiated bifurcate to the vertebral bodies with a lower with teicoplanin 800 mg and levofloxacin 750 mg blood flow that supplies the disc. Although less daily with a fast recovery of symptoms. often than by the arterial route, also the venous CONCLUSIONS: Cervical spondylodiscitis can circulation may play a role in the pathogenesis of be an unusual cause of severe neck pain with a spondylodiscitis10. Disc infection usually arises challenging differential diagnosis. Conservative via direct spread from the vertebral body after treatment should always be considered for pa- 11,12 tients without neurological symptoms as long as the endplate has been destroyed . close follow-up evaluations are performed. We report an unusual case of cervical spondy- lodiscitis and epidural abscess mimicking Pott’s Key Words Cervical spondylodiscitis, Spinal tuberculosis, Epi- disease. dural abscess, Neck pain. Case report Introduction A 67-year-old man was admitted to our in- stitution with a 15-day history of neck pain ra- Infectious spondylodiscitis is an infectious pro- diating to the head, shoulders and left arm that cess involving two vertebral bodies and the corre- was associated with weakness and paresthesia. sponding intervertebral disc. The incidence of this The medical history included a BMI of 27.7, disease ranges from 0.4 to 2.4 per 100,000 patients gastritis, hypertension, benign prostatic hyper- per year and increases with the age of the patients1. trophy, steatohepatitis, low-energy trauma to These numbers are expected to increase because the cervical spine one year prior, and a positive of the higher number of immunocompromised pa- Mantoux tuberculin skin test 25 years prior. He tients, the earlier and more frequent use of intrave- was treated with omeprazole, losartan, tamsu- nous access devices, and the increasing prevalence losin and dutasteride. On admission, the patient of genitourinary surgery in the elderly2,3. was awake, alert, and oriented. Corresponding Author: Michele Mercurio, MD; e-mail: [email protected] 1 G. Gasparini, M. Mercurio, B. Caroleo, O. Galasso Figure 1. The plain radiograph showed straightening of cervical spine, narrowing of C5-C6 and C6-C7 disc spaces without destruction or collapse of vertebral bodies. On physical examination, the patient was not a platelet count of 473 x 103/uL (r.r: 130-400), a limping. The osteotendinous reflexes in the left fibrinogen of 594 mg/dL (r.r: 200-400), a total bili- upper limb showed tricipital areflexia, bicipital rubin of 1,18 mg/dL (r.r: < 1,1), a direct bilirubin of and stylo-radial normoreflexia; the osteotendi- 0,48 mg/dL (r.r: < 0,3), an alanine aminotransfer- nous reflexes in the other limbs were normal. Pain ase of 73 UI/L (r.r: < 41), an alkaline phosphatase upon the digital pressure at C6 was noted. The of 186 UI/L (r.r: 40-129) and a gamma-glutamyl- Roger-Bikelas-De Seze manoeuvre was negative. transferase of 248 UI/L (r.r: 8-61). High C-reactive Flexion of the cervical spine was possible up to protein (CRP) levels were found (103 mg/L; r.r: 20° when the patient experienced sharp pain, but 0-5). The interferon-gamma (IFN-γ) release assay the extension was impossible. Rotational move- (IGRA) for identification of latent tuberculosis ments were not affected, but lateral inclinations infection was positive. A blood culture, Wright’s were limited. The patient’s vital signs were sta- serum agglutination test and anti-Brucella IgG and ble, and he had no fever. IgM antibodies were negative. Evaluation for alco- A radiographic examination and an MRI of the hol-resistant bacilli and PCR and culture of urine cervical spine were performed (Figures 1 and 2). and sputum for Mycobacterium tuberculosis were Haematological examination showed a mild inconclusive. Chest X-rays, a computed tomogra- leucocytosis of 16140/uL (reference range - r.r: phy scan of the chest with and without contrast, 5200-12400) with 10150/uL neutrophils (r.r. 1900- echocardiography and abdominal ultrasonography 8000), a haemoglobin level of 13,4 g/dL (r.r: 14-18), failed to find signs of tuberculosis. A CT-guided A B C Figure 2. The sagittal MRI T1-weighted sequences of the cervical spine showed abnormal marrow infiltrations in C5, C6 and C7. The signal is highly hyperintense on the STIR-weighted sequences (A). Intense gadolinium enhancement was observed from C5 to C7 with an abscess infiltration extending to the intervertebral disc, the anterior epidural space and the medullary cord (B). Narrowing of the spinal canal was observed on axial T1-weighted images (C). 2 Cervical spondylodiscitis mimicking Pott’s disease: a case report Table I. Levels of blood inflammatory markers of infection. C-reactive protein ESR Fibrinogen Leukocytes r.r. 0-5 mg/L r.r. <30 mm/h r.r. 200-400 mg/dL r.r. 5200-12400/uL Clinical presentation 103.0 45 594 16140 After 1 week of AB 14.0 25 502 6550 After 4 weeks of AB 11.1 22 473 7710 After 6 weeks of AB 6.2 11 365 5450 1 month after AB conclusion < 3.16 2 247 5450 1 year after AB conclusion < 3.02 4 251 10220 AB indicates antibiotics; r.r., reference range. needle biopsy and the following microbiological A follow-up clinical examination one year lat- analysis of tissue sample failed to isolate the patho- er showed complete recovery of the neurological gen for proper antibiotic choice13. symptoms and no recurrence of the disease. The In light of these findings, pyogenic spondylo- X-ray examination showed C6-C7 intersomatic discitis was suspected, and intravenous antibiotic fusion with no destruction of the vertebral bod- therapy was initiated with 800 mg of teicoplanin ies and normal sagittal spine alignment one year and 750 mg of levofloxacin daily. A semi-rigid after the onset of symptoms (Figure 4). cervical collar was also prescribed. A rapid relief of symptoms and a reduction in inflammatory markers following antibiotic thera- Discussion py was immediately noted. Intravenous antibiotic therapy was administered for four weeks followed We describe an unusual case of cervical by an additional two weeks of daily administra- spondylodiscitis and epidural abscess mimicking tion of 400 mg of intramuscular teicoplanin and Pott’s disease. Two distinctive characteristics of 500 mg of oral levofloxacin. Ten weeks after ad- the present case are worth addressing. First, a mission to the hospital, the inflammatory markers differential diagnosis that includes spinal tuber- definitively normalized (Table I). culosis, brucellar spondylitis, sarcoidosis, metas- A contrast-enhanced MRI performed 8 weeks af- tasis, multiple myeloma, and lymphoma must be ter the conclusion of antibiotic therapy showed slight considered. In addition, a misleading differential contrast enhancement of C6-C7 without any cord diagnosis of cervical tuberculosis must also be compression on sagittal and axial images (Figure 3). considered in this patient. Spinal tuberculosis is an extrapulmonary form of the disease in which the primary infection site is either a pulmonary lesion or an infection of the genitourinary system. The destruction of the disc space and the adjacent vertebral bodies and the severe and progressive kyphosis is known as Pott’s disease. Approx- imately 10% of patients with extrapulmonary tuberculosis have skeletal involvement. Spinal tuberculosis accounts for approximately 50% of cases of skeletal tuberculosis, but the cervical location is uncommon and is found in approxi- mately 4% of spinal tuberculosis cases14,15. The tentative diagnosis of Pott’s disease is based on clinical suspicion (history of tuberculosis), a pos- itive tuberculin skin test (Mantoux test), acid-fast bacillus testing, positive polymerase chain reac- tion (PCR) for M. tuberculosis or positive IGRA Figure 3. T1-weighted sagittal MRI 8 weeks after the sus- test.
Load more

Recommended publications
  • Contrast Vs. No Contrast Reference Sheet – Head/Neck
    Scheduling: 717.291.1016 or 888.MRI.1377 Fax: 717.509.8642 ● Web Site: www.MRIGroup.com Contrast vs. No Contrast Reference Sheet – Head/Neck Body Part Reason for Exam Procedure to Pre-Cert CPT Code Brain Alzheimer’s/Confusion/Dementia MRI Brain without Contrast 70551 Headache/Migraine Memory Loss Mental Status Changes Seizures Stroke, CVA, TIA Trauma Brain Cranial Nerve Lesions MRI Brain without and with 70553 F/U Lesion/Mass Contrast IAC/Hearing Loss/Tinnitus/Vertigo Infection Metastatic Disease Multiple Sclerosis Neurofibromatosis Pituitary Brain Fiducials MRI Brain with Contrast 70552 Gamma Knife Planning Circle of Willis Stroke/CVA/TIA MRA Head without Contrast 70544 (COW) Aneurysm Carotid Stroke/CVA/TIA MRA Neck without Contrast 70547 Carotid Stenosis > 60% on Doppler MRA Neck without and with 70549 Ultrasound Contrast Intracranial Venous Thrombosis MRV Head without and with 70546 Venous Sinus Contrast Orbits Optic Neuritis MRI Orbits/Face/Neck without 70543 Exophthalmos, Proptosis and with Contrast Pseudotumor/Mass/Cancer/Mets Vascular Lesions Visual Disturbances Neck-Soft Tissue Infection MRI Orbits/Face/Neck without 70543 Tumor/Mass/Cancer/Mets and with Contrast Vocal Cord Paralysis 6/14 Scheduling: 717.291.1016 or 888.MRI.1377 Fax: 717.509.8642 ● Web Site: www.MRIGroup.com Contrast vs. No Contrast Reference Sheet – Spine Body Part Reason for Exam Procedure to Pre-Cert CPT Code Spine: Cervical Degenerative Disease MRI Cervical Spine without Contrast 72141 Disc Herniation Extremity Pain/Weakness Neck Pain Radiculopathy Trauma Spine:
    [Show full text]
  • Cervical Neck Pain Or Cervical Radiculopathy
    Revised 2018 American College of Radiology ACR Appropriateness Criteria® Cervical Neck Pain or Cervical Radiculopathy Variant 1: New or increasing nontraumatic cervical or neck pain. No “red flags.” Initial imaging. Procedure Appropriateness Category Relative Radiation Level Radiography cervical spine Usually Appropriate ☢☢ MRI cervical spine without IV contrast May Be Appropriate (Disagreement) O CT cervical spine without IV contrast May Be Appropriate ☢☢☢ CT cervical spine with IV contrast Usually Not Appropriate ☢☢☢ MRI cervical spine without and with IV Usually Not Appropriate contrast O CT cervical spine without and with IV Usually Not Appropriate contrast ☢☢☢ CT myelography cervical spine Usually Not Appropriate ☢☢☢☢ CTA neck with IV contrast Usually Not Appropriate ☢☢☢ Discography cervical spine Usually Not Appropriate ☢☢ Facet injection/medial branch block cervical Usually Not Appropriate spine ☢☢ MRA neck with IV contrast Usually Not Appropriate O MRA neck without IV contrast Usually Not Appropriate O MRI cervical spine with IV contrast Usually Not Appropriate O Bone scan whole body with SPECT or Usually Not Appropriate SPECT/CT neck ☢☢☢ X-ray myelography cervical spine Usually Not Appropriate ☢☢☢ ACR Appropriateness Criteria® 1 Cervical Neck Pain or Cervical Radiculopathy Variant 2: New or increasing nontraumatic cervical radiculopathy. No “red flags.” Initial imaging. Procedure Appropriateness Category Relative Radiation Level MRI cervical spine without IV contrast Usually Appropriate O CT cervical spine without IV contrast
    [Show full text]
  • Acute Calcific Discitis with Intravertebral Disc Herniation in the Dorsolumbar Spine
    Published online: 2021-08-02 MUSCULOSKELETAL Case report: Acute calcific discitis with intravertebral disc herniation in the dorsolumbar spine Puneet Mittal, Kavita Saggar, Parambir Sandhu, Kamini Gupta Department of Radiodiagnosis, Dayanand Medical College & Hospital, Ludhiana, Punjab, India Correspondence: Dr. Puneet Mittal, Department of Radiodiagnosis, Dayanand Medical College & Hospital, Tagore Nagar, Civil Lines, Ludhiana, Punjab - 141 001, India. E-mail: [email protected] Abstract Acute calcific discitis is a rare but well-known condition of unknown etiology. In symptomatic cases, the most common site is the cervical spine. We describe the CT scan and MRI findings in a symptomatic patient, with a lesion in the dorsolumbar spine. Key words: Acute; calcific; discitis; dorsolumbar; MR Introduction Acute calcifc discitis is a rare condition. When symptomatic, it can be mistaken for infection.[1] Most of the symptomatic cases present in the cervical spine.[1-3] We present the CT scan and MRI findings in a patient who had involvement of the dorsolumbar spine, with associated intravertebral disc herniation. Case Report A 10-year-old boy presented with a 2-week history of pain in the lower back following a yoga session in school. The pain had gradually worsened over the last 5 days. The patient was afebrile. The total white blood cell (WBC) count was normal. The erythrocyte sedimentation rate (ESR) was raised (52 mm/h). The Mantoux test was negative. A radiograph obtained elsewhere and repeated a day after the MRI [Figure 1], showed calcification of the D12-L1 intervertebral disc. MRI showed hypointense signal in the D12-L1 intervertebral disc on T1W [Figure 2A] and T2W [Figure 2B and C] images.
    [Show full text]
  • Cervical Spondylodiscitis in an Infant with Torticollis
    Cervical Spondylodiscitis in IMAGES IN CLINICAL an Infant with Torticollis RADIOLOGY BRECHT VAN BERKEL KRISTIN SUETENS LUC BREYSEM *Author affiliations can be found in the back matter of this article ABSTRACT CORRESPONDING AUTHOR: Brecht Van Berkel Teaching point: Narrowing of the intervertebral space and destruction of the adjacent UZ Leuven, BE vertebral end plates on conventional radiography or CT should raise suspicion for brecht.vanberkel@student. spondylodiscitis in symptomatic infants. kuleuven.be KEYWORDS: Spondylodiscitis; MRI; pediatric; torticollis; cervical; CT TO CITE THIS ARTICLE: Van Berkel B, Suetens K, Breysem L. Cervical Spondylodiscitis in an Infant with Torticollis. Journal of the Belgian Society of Radiology. 2021; 105(1): 35, 1–4. DOI: https://doi.org/10.5334/ jbsr.2454 Van Berkel et al. Journal of the Belgian Society of Radiology DOI: 10.5334/jbsr.2454 2 CASE REPORT disc space and loss of height of vertebral bodies C3 and C4 and irregular alignment of the end plates. On An eight-month-old infant presented at the emergency the sagittal T1-weighted Short-tau inversion-recovery department with a history of torticollis for six weeks. (STIR) images, the hyperintense signal in the vertebral Blood results showed no elevated inflammatory bodies of C3 and C4, as well as in the surrounding tissues parameters. Vertical lateral X-ray of the cervical spine (arrowheads) were compatible with a widespread area demonstrated a kyphotic angulation at the level of C3– of bone and soft tissue oedema (Figure 2). There were C4, narrowing of the intervertebral disc space, irregular no diffusion-restricted areas and no accompanying fluid end plates, and loss of height of the vertebral body of collections.
    [Show full text]
  • Cervical Radiculopathy Clinical Guidelines for Medical Necessity Review
    Cervical Radiculopathy Clinical Guidelines for Medical Necessity Review Version: 3.0 Effective Date: November 13, 2020 Cervical Radiculopathy (v3.0) © 2020 Cohere Health, Inc. All Rights Reserved. 2 Important Notices Notices & ​Disclaimers: GUIDELINES SOLELY FOR COHERE’S USE IN PERFORMING MEDICAL NECESSITY REVIEWS AND ARE NOT INTENDED TO INFORM OR ALTER CLINICAL DECISION MAKING OF END USERS. Cohere Health, Inc. (“​Cohere​”) has published these clinical guidelines to determine medical necessity of services (the “​Guidelines​”) for informational purposes only, and solely for use by Cohere’s authorized “​End Users​”. These Guidelines (and any attachments or linked third party content) are not intended to be a substitute for medical advice, diagnosis, or treatment directed by an appropriately licensed healthcare professional. These Guidelines are not in any way intended to support clinical decision making of any kind; their sole purpose and intended use is to summarize certain criteria Cohere may use when reviewing the medical necessity of any service requests submitted to Cohere by End Users. Always seek the advice of a qualified healthcare professional regarding any medical questions, treatment decisions, or other clinical guidance. ​The Guidelines, including any attachments or linked content, are subject to change at any time without notice. ©2020 Cohere Health, Inc. All Rights Reserved. Other ​Notices: CPT copyright 2019 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
    [Show full text]
  • Lumbar Spinal Stenosis Clinical Guidelines for Medical Necessity Review
    Lumbar Spinal Stenosis Clinical Guidelines for Medical Necessity Review Version: 4.0 Effective Date: November 13, 2020 Lumbar Spinal Stenosis (v4.0) © 2020 Cohere Health, Inc. All Rights Reserved. Important Notices Notices & ​Disclaimers: GUIDELINES SOLELY FOR COHERE’S USE IN PERFORMING MEDICAL NECESSITY REVIEWS AND ARE NOT INTENDED TO INFORM OR ALTER CLINICAL DECISION MAKING OF END USERS. Cohere Health, Inc. (“​Cohere​”) has published these clinical guidelines to determine medical necessity of services (the “​Guidelines​”) for informational purposes only, and solely for use by Cohere’s authorized “​End Users​”. These Guidelines (and any attachments or linked third party content) are not intended to be a substitute for medical advice, diagnosis, or treatment directed by an appropriately licensed healthcare professional. These Guidelines are not in any way intended to support clinical decision making of any kind; their sole purpose and intended use is to summarize certain criteria Cohere may use when reviewing the medical necessity of any service requests submitted to Cohere by End Users. Always seek the advice of a qualified healthcare professional regarding any medical questions, treatment decisions, or other clinical guidance. ​The Guidelines, including any attachments or linked content, are subject to change at any time without notice. ©2020 Cohere Health, Inc. All Rights Reserved. Other ​Notices: CPT copyright 2019 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Guideline ​Information​: Specialty Area:​ Diseases of the musculoskeletal system and connective tissue (M00-M99) CarePath Group:​ Spine CarePath Name: ​Lumbar Spinal Stenosis​ ​(M48) Physician author: ​Mandy Armitage, MD (Sports Medicine) Peer reviewed by: ​Adrian Thomas, MD (Orthopedic Spine Surgeon) Literature review current through​: ​June 22, 2020 Document last updated:​ ​November 13, 2020 Type:​ [​X​] Adult (18+ yo) | [_] Pediatric (0-17yo) Page 2 of 57 Lumbar Spinal Stenosis (v4.0) © 2020 Cohere Health, Inc.
    [Show full text]
  • Tuberculous Spondylodiscitis in A
    ISSN: 2474-3658 Mangouka et al. J Infect Dis Epidemiol 2019, 5:083 DOI: 10.23937/2474-3658/1510083 Volume 5 | Issue 4 Journal of Open Access Infectious Diseases and Epidemiology RESEARCH ARTICLE Tuberculous Spondylodiscitis in a Military Hospital in Gabon: Report of Eleven Patients Mangouka Guingali Laurette1, Iroungou Berthe A2, Bivigou-Mboumba Berthold3*, Oura Landry4, Mwanyombet Lucien4 and Nzenze Jean Raymond1 Check for 1Service de Médecine Interne, Hôpital d’Instruction des Armées Omar Bongo Ondimba (HIA OBO), Gabon updates 2École d’Application su Service de Santé Militaire de Libreville (EASSML), Gabon 3Unité mixte de Recherches sur le VIH et les Maladies Infectieuses Associées (UMR VIH-MIA), Centre Internationale de Recherche Médicale de Franceville (CIRMF), Gabon 4Service de Neurochirurgie, Hôpital d’Instruction des Armées Omar Bongo Ondimba (HIA OBO), Gabon *Corresponding authors: Dr. Bivigou-Mboumba Berthold, PhD, Unité mixte de Recherches sur le VIH et les Maladies Infectieuses Associées (UMR VIH-MIA), Centre Internationale de Recherche Médicale de Franceville (CIRMF), BP: 8507, Libreville, Gabon Abstract Background Background: Extrapulmonary forms of tuberculosis (TB) Tuberculosis (TB) is endemic in sub-Saharan Africa are on the rise in sub-Saharan Africa and pose a major and Asia [1]. It is caused by the Mycobacterium tuber- public health problem. The spine is the most frequent culosis and most commonly affects the lungs. However, location of musculoskeletal tuberculosis. Involvement of the spine causes severe back pain and weakness in the lower in TB endemic countries, extrapulmonary presentations extremities. We report 11 cases of TB spondylodiscitis, are reported frequently and include spinal tuberculo- commonly referred to as Pott's disease, who presented to sis, ganglionic tuberculosis, and urogenital involvement the internal medicine department at the Military Hospital of also known as Pott’s disease.
    [Show full text]
  • What Is Sciatica All About YPO
    WHAT IS SCIATICA ALL ABOUT ? Multimedia Health Education Disclaimer This movie is an educational resource only and should not be used to manage Sciatica. All decisions about the management of Sciatica must be made in conjunction with your Physician or a licensed healthcare provider. WHAT IS SCIATICA ALL ABOUT? Multimedia Health Education MULTIMEDIA HEALTH EDUCATION MANUAL TABLE OF CONTENTS SECTION CONTENT 1 . Introduction a. What is Sciatica? b. Normal Spine Anatomy c. Sciatic Nerve Anatomy 2 . Overview of Sciatica a. Risk Factors b. Causes of Sciatica c. Symptoms of Sciatica d. Diagnosing Sciatica 3 . Treatment Options a. Conservative Treatment b. Surgical Treatment c. Post Operative Care d. Risks and Complications WHAT IS SCIATICA ALL ABOUT? Multimedia Health Education INTRODUCTION What is Sciatica? Sciatica is a painful condition caused by the irritation of the sciatic nerve. The sciatic nerve is the longest nerve in our bodies. It begins in the lower back and extends through the buttocks down the back of each leg to the thighs and feet. Sciatica can be acute (short term) lasting a few weeks, or chronic (long term) persisting for more than 3 months. It is important to understand that most Sciatica will resolve itself within a few weeks or months and rarely causes permanent nerve damage. To learn more about Sciatica, it is important to first understand normal spine anatomy and function. WHAT IS SCIATICA ALL ABOUT? Multimedia Health Education Unit 1: Normal Spine Anatomy Normal Spine Anatomy The spine, also called the back bone, is designed to give us stability, smooth movement, as well as providing a corridor of protection for the delicate spinal cord.
    [Show full text]
  • Pathogenesis, Presentation, and Treatment of Lumbar Spinal Stenosis Associated with Coronal Or Sagittal Spinal Deformities
    Neurosurg Focus 14 (1):Article 6, 2003, Click here to return to Table of Contents Pathogenesis, presentation, and treatment of lumbar spinal stenosis associated with coronal or sagittal spinal deformities JUSTIN F. FRASER, B.A., RUSSEL C. HUANG, M.D., FEDERICO P. GIRARDI, M.D., AND FRANK P. CAMMISA, JR., M.D. Hospital for Special Surgery; Bronx Veterans Affairs Hospital; and the Weill Medical College of Cornell University, New York, New York Sagittal- or coronal-plane deformity considerably complicates the diagnosis and treatment of lumbar spinal steno- sis. Although decompressive laminectomy remains the standard operative treatment for uncomplicated lumbar spinal stenosis, the management of stenosis with concurrent deformity may require osteotomy, laminectomy, and spinal fusion with or without instrumentation. Broadly stated, the surgery-related goals in complex stenosis are neural decom- pression and a well-balanced sagittal and coronal fusion. Deformities that may present with concurrent stenosis are scoliosis, spondylolisthesis, and flatback deformity. The presentation and management of lumbar spinal stenosis asso- ciated with concurrent coronal or sagittal deformities depends on the type and extent of deformity as well as its impact on neural compression. Generally, clinical outcomes in complex stenosis are optimized by decompression combined with spinal fusion. The need for instrumentation is clear in cases of significant scoliosis or flatback deformity but is controversial in spondylolisthesis. With appropriate selection of technique for deformity correction, a surgeon may profoundly improve pain, quality of life, and functional capacity. The decision to undertake surgery entails weighing risk factors such as age, comorbidities, and preoperative functional status against potential benefits of improved neu- rological function, decreased pain, and reduced risk of disease progression.
    [Show full text]
  • Eikenella Corrodens (About the Left Side, with High Signal on T2/STIR Images and Low Sig- 10 Days After the Biopsy)
    237 CASE REPORT Postgrad Med J: first published as 10.1136/pmj.79.930.237 on 1 April 2003. Downloaded from Unusual cause of infective discitis in an adolescent M K Sayana, A J Chacko,RCMcGivney ............................................................................................................................. Postgrad Med J 2003;79:237–238 The first case of infective discitis caused by Eikenella corro- dens in an adolescent is presented. The need for anaero- bic cultures when dealing with infective pathology in the spine is stressed. A 14 year old boy presented with acute exacerbation of back pain, which showed characteristics of infective discitis after magnetic resonance imaging. Computed tomography guided biopsy grew E corrodens in anaerobic cultures that was sensitive to ampicillin, co- amoxiclav, cefadroxil, and cefotaxime. This patient responded well to co-amoxiclav and recovered without any surgical intervention. ikenella corrodens is a slow growing, non-motile, faculta- tive Gram negative bacillus, which is a commensal of the oral cavity, and intestinal and genital tracts. There are E Figure 1 Oblique view of lumbar spine. case reports of adult spine infections (vertebral osteomyelitis and discitis)12 caused by eikenella, but none of spinal infection in children and adolescents.3 We report here the first case of discitis secondary to this organism in an adolescent. The various clinical manifestations caused by this organism include head and neck, pulmonary, intra-abdominal, cutane- ous, and skeletal infections, endocarditis, and pelvic abscess.4 Rare and interesting presentations like osteomyelitis in a chronic nail biter,5 osteomyelitis due to toothpick injury,67and http://pmj.bmj.com/ vertebral osteomyelitis due to pharyngeal injury caused by a fish bone2 have been reported.
    [Show full text]
  • The Diagnosis and Management of Patients with Spinal Infections (Including Vertebral Osteomyelitis, Spondylodiscitis and Epidural Abscess)
    MOJ Orthopedics & Rheumatology The Diagnosis and Management of Patients with Spinal Infections (Including Vertebral Osteomyelitis, Spondylodiscitis and Epidural Abscess) Introduction Editorial - Volume 4 Issue 3 - 2016 Spinal infection is becoming an increasingly prevalent con dition. However it is still often overlooked in the Casualty / ER department. As with most conditions, if it considered during the Royal Free Hospitals NHS Trust, UK diagnostic process, it is usually correctly diagnosed. Therefore the Corresponding author: Bob Chatterjee, Royal Free Hospitals toawareness investigate of theand condition diagnose needsthe condition to be promoted. correctly. This is a useful NHS Trust, Manor Lodge, 50a Green Lane, Burnham, South short article covering the salient points of the condition, and how Buckinghamshire, SL1 8EB, UK, Tel: 07970 903 269; 01628 313331; Email: Received: January 17, 2016 | Published: February 02, 2016 Discitis is the inflammation of the intervertebral discs caused by an infection. In most cases, it is a single disc involved although the infection can spread to adjacent discs. The condition is rare inbut elderly occurs patients more frequently as the discs in become children small than and adults. less likely It is tomore be- common in children between the ages of 2 and 7. It is more rare- III. History, e.g. history of cancer come inflamed with age. The common cause of discitis is second IV. Constitutional symptoms, such as fever, chills or unexplained ary infection from a remote source and the spread is through the weight loss anblood invasive stream. procedure Rarely, it such can asbe ainfection lumbar puncture,from the boneepidural that injec goes- down to the adjacent discs.
    [Show full text]
  • Back Low Back Pain with Or Without Sciatica Pathway
    Low Back Pain With or Without Sciatica Referral and Management Pathway Patient presents with low backPatient pain, nerve Presentation root or mechanical back pain, with or without leg pain symptoms. Are there ?:‘Red flag’ signs: Primary Care •First acute onset age <20 or >55 Provide reassurance, keep on the move, stay at work if possible. Address any additional •Non-mechanical pain No Red yellow flag signs: •Thoracic pain Flag Signs •PH-carcinoma, steroids, HIV •Attitudes & beliefs about back pain •Unwell, weight loss •Behaviour •Widespread neurology – unilateral or bilateral lower limb weakness and/or numbness •Compensation issues extending over several dermatomes •Diagnosis & treatment •Structural deformity, Trauma •Emotions www.nzgg.org.nz/guidelines/0072/acc1038_col.pdf •Consider Malignant Spinal Cord Compression •Family (page 40 onwards) •Acute Cauda Equina Syndrome signs: •Work •Dysfunction of bladder, bowel or sexual function •Sensory changes in saddle or perianal area Issue advice sheet. Meds as appropriate. Symptomatic measures: local cold pack (early •Discitis/infection symptoms: post-onset – care that skin protected & short duration e.g. 5-10 mins with minimum 2 hr •Sudden onset of acute spinal pain or suspicious change in pattern, no history of break) or heat (ensure skin protection e.g. through towelling and skin regularly checked). trauma Other forms of manual therapy (e.g. chiropractics) may be beneficial, however, these are •Systemic signs, fever, high pulse currently unavailable on the NHS. •Night pain Encourage self management.
    [Show full text]