131 results on '"Cervical Vertebrae microbiology"'
Search Results
2. Management of an outbreak of invasive Kingella kingae skeletal infections in a day care center.
- Author
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Klein C, Peltier F, Pluquet E, Haraux E, Gouron R, and Joseph C
- Subjects
- Arthritis, Infectious diagnosis, Arthritis, Infectious therapy, Arthritis, Infectious transmission, Cervical Vertebrae microbiology, Child, Preschool, Combined Modality Therapy, Diagnosis, Differential, Discitis diagnosis, Discitis microbiology, Discitis therapy, Female, France epidemiology, Humans, Knee Joint microbiology, Male, Neisseriaceae Infections diagnosis, Neisseriaceae Infections therapy, Neisseriaceae Infections transmission, Retrospective Studies, Shoulder Joint microbiology, Wrist Joint microbiology, Arthritis, Infectious epidemiology, Child Day Care Centers, Discitis epidemiology, Disease Outbreaks prevention & control, Kingella kingae isolation & purification, Neisseriaceae Infections epidemiology
- Abstract
Background: Kingella kingae (Kk) is frequently responsible for invasive skeletal infections in children aged 3-36months. However, few outbreaks of invasive Kk infections in day care centers have been reported. The objective of the present study was to describe (a) the clinical and laboratory data recorded during an outbreak of invasive Kk skeletal infections, and (b) the management of the outbreak., Method: Four children from the same day care center were included in the study May and June 2019. We retrospectively analyzed the children's clinical presentation and their radiological and laboratory data. We also identified all the disease control measures taken in the day care center., Results: We observed cases of septic arthritis of the wrist (case #1), shoulder arthritis (case #2), knee arthritis (case #3) ans cervical spondylodiscitis (case #4). All cases presented with an oropharyngeal infection and concomitant fever prior to diagnosis of the skeletal infection. All cases were misdiagnosed at the initial presentation. The mean (range) age at diagnosis was 10.75months (9-12). The three patients with arthritis received surgical treatment. All patients received intravenous and then oral antibiotics. In cases 1 and 2, Kk was detected using real-time PCR and a ST25-rtxA1 clone was identified. The outcome was good in all four cases. Four other children in the day care center presented with scabies during this period and were treated with systemic ivermectin. The Regional Health Agency was informed, and all the parents of children attending the day care center received an information letter. The day care center was cleaned extensively., Conclusion: Our results highlight the variety of features of invasive skeletal Kk infections in children and (given the high risk of transmission in day care centers) the importance of diagnosing cases as soon as possible., (Copyright © 2020 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2021
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3. Bacillus Calmette-GuÉrin-Associated Cervical Spondylitis in a 3-Year-Old Immunocompetent Girl.
- Author
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Imakiire R, Nishikawa T, Tominaga H, Tawaratsumida H, Imuta N, Koriyama T, Nishi J, Taniguchi N, and Kawano Y
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- Abscess microbiology, Abscess surgery, Antitubercular Agents administration & dosage, Antitubercular Agents therapeutic use, BCG Vaccine administration & dosage, BCG Vaccine immunology, Cervical Vertebrae pathology, Child, Preschool, Female, Humans, Immunocompetence, Isoniazid administration & dosage, Isoniazid therapeutic use, Osteomyelitis pathology, Osteomyelitis therapy, Rifampin administration & dosage, Rifampin therapeutic use, Spondylitis pathology, Spondylitis therapy, Tuberculosis drug therapy, Tuberculosis prevention & control, Tuberculosis surgery, Cervical Vertebrae microbiology, Mycobacterium bovis, Osteomyelitis microbiology, Spondylitis microbiology, Tuberculosis pathology
- Abstract
Bacillus Calmette-Guérin (BCG)-associated osteomyelitis is a rare adverse event following BCG vaccination, and there have been no previous reports of BCG-associated cervical spondylitis. Here, we describe the case of a 3-year-old immunocompetent girl who developed BCG-associated cervical spondylitis and was successfully treated by prompt surgical drainage of the abscess and administration of isoniazid and rifampicin for 9 months without sequelae.
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- 2020
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4. Clinical Efficacy of Three Surgical Approaches for the Treatment of Cervicothoracic Tuberculosis: A Multicenter Retrospective Study.
- Author
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Wu WJ, Tang Y, Lyu JT, Yang S, Wang DG, Zhang Q, Liu X, Deng JZ, Luo F, Hou TY, Xu JZ, and Zhang ZH
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Female, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Young Adult, Cervical Vertebrae microbiology, Cervical Vertebrae surgery, Spinal Fusion methods, Thoracic Vertebrae microbiology, Thoracic Vertebrae surgery, Tuberculosis, Spinal surgery
- Abstract
Objective: To evaluate the efficacy of three surgical approaches for the treatment of cervicothoracic tuberculosis., Methods: This is a multicenter retrospective study. We analyzed 74 patients with cervicothoracic tuberculosis who were treated in six institutions between January 2000 and January 2015. There were 37 male and 37 female patients, with an average age of 24 years (range, 5-62 years). The operative method was selected according to the indications. A total of 33 patients underwent one-stage anterior surgery (group A); 16 underwent a combined anterior and posterior surgery (group B) and 25 underwent one-stage posterior surgery (group C). Clinical outcomes, laboratory indexes, and radiological results were analyzed., Results: All cases were followed up for approximately 36-96 months post-surgery (average, 39 months). At the last follow-up, patients in all three groups had achieved bone fusion, with pain relief and neurological recovery. No major vessel and nerve injuries were found during the operation. There were significant differences before and after treatment for visual analogue scale (VAS), neck disability index (NDI), and Japanese Orthopedic Association (JOA) score (P < 0.001). Three surgical strategies significantly improved kyphosis (P < 0.001)., Conclusion: The choice of operation for cervicothoracic tuberculosis should be selected based on the pathological changes, scope, and general physical condition of the patient. The indication for a posterior approach is narrow and it should be used selectively. The combined anterior and posterior approach involved a longer operating time, larger blood loss, and greater trauma, and also required a higher level of surgical skill. Therefore, the indications for this approach should be strictly controlled. Anterior approach surgery for the treatment of cervicothoracic tuberculosis showed excellent efficacy and fewer complications., (© 2019 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.)
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- 2020
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5. Cervical spine tuberculosis.
- Author
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Teka M, Ghozlen HB, Zaier AY, Hnia MB, Naouar N, and Abid F
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- Adult, Cervical Vertebrae microbiology, Cervical Vertebrae surgery, Drug Therapy, Combination, Humans, Magnetic Resonance Imaging, Male, Radiography, Tomography, X-Ray Computed, Tuberculosis, Spinal therapy, Antitubercular Agents administration & dosage, Arthrodesis methods, Tuberculosis, Spinal diagnosis
- Abstract
Tuberculosis of the cervical spine differs from other vertebral localizations by its extreme rarity, the clinical images are very diversified, the radiological measurements allow a good diagnostic orientation and specifically the MRI which allows a multi-planar study of the various lesions. Only bacteriological evidence can confirm the diagnosis. The treatment is based on a 12-month antituberculosis multidrug therapy and much debate upon the surgical indication. In our case, the patient presented with bilateral cervicobrachialgia with pain on examination at the mobilization of the cervical spine. A standard X-ray, a cervical CT scan, and a cervical MRI were performed, showing a C4 vertebral body compression of a probably infectious origin. The biopsy confirmed the diagnosis of a Cervical Pott's Disease that had been treated with anterior arthrodesis and TB treatment with rehabilitation, the patients' neurological symptoms improved, and he was doing well., Competing Interests: The authors declare no competing interests., (Copyright: Maher Teka et al.)
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- 2020
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6. Torticollis as a sign of spinal tuberculosis.
- Author
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Boussetta R, Zairi M, Sami SB, Lafrem R, Msakeni A, Saied W, and Nessib N
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- Antitubercular Agents administration & dosage, Biopsy, Cervical Vertebrae microbiology, Child, Female, Fever etiology, Humans, Neck Pain etiology, Torticollis microbiology, Tuberculosis, Spinal complications, Tuberculosis, Spinal drug therapy, Cervical Vertebrae pathology, Torticollis etiology, Tuberculosis, Spinal diagnosis
- Abstract
Bone localization of tuberculosis mainly affects the thoracolumbar spine. The cervical spine is rare. Its diagnosis is often late which exposes to great instability and potentially serious complications. We report the case of a 12-year old girl with no medical history, showing torticollis and high temperature without neurological complication. In the physical examination, he had torticollis and pain in the third, fourth and fifth cervical vertebra. When the biopsy was performed, we find an inter apophysis (between C7 and D1) collection. The histological examination confirmed the diagnosis of apophysis tuberculosis. The management based on tuberculosis chemotherapy and immobilization started as soon as possible., Competing Interests: The authors declare no competing interests., (Copyright: Rim Boussetta et al.)
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- 2020
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7. Disseminated cutaneous Mycobacterium avium complex infection invading the sternum and cervical vertebra.
- Author
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Sakakibara M, Takehana A, Nakashima C, Shimoyama H, Hirabayashi M, and Kuwano Y
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- Aged, 80 and over, Bone Diseases microbiology, Bone Diseases pathology, Cervical Vertebrae pathology, Female, Humans, Mycobacterium avium Complex, Mycobacterium avium-intracellulare Infection pathology, Sternum pathology, Bone Diseases diagnosis, Cervical Vertebrae microbiology, Mycobacterium avium-intracellulare Infection diagnosis, Sternum microbiology
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- 2020
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8. Late deep cervical infection after anterior cervical discectomy and fusion: a case report and literature review.
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Chen YC, Zhang L, Li EN, Ding LX, Zhang GA, Hou Y, and Yuan W
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- Abscess etiology, Anti-Bacterial Agents therapeutic use, Cervical Vertebrae microbiology, Debridement, Device Removal adverse effects, Drainage, Drug Therapy, Combination methods, Humans, Male, Middle Aged, Neck Dissection, Orthotic Devices, Prostheses and Implants adverse effects, Prosthesis-Related Infections etiology, Spinal Fusion instrumentation, Staphylococcus aureus isolation & purification, Time Factors, Titanium adverse effects, Treatment Outcome, Abscess therapy, Cervical Vertebrae surgery, Diskectomy adverse effects, Prosthesis-Related Infections therapy, Spinal Fusion adverse effects
- Abstract
Background: Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1-1.6% of early and late postoperative infection have been reported although the rate of late infection is very low., Case Presentation: Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient's deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame., Conclusions: This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.
- Published
- 2019
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9. Cervical anaerobic vertebral osteomyelitis following surgical tracheotomy: a case report.
- Author
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Larcher R, Maury C, Charbit J, Jean-Pierre H, Le Moing V, Klouche K, and Capdevila X
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- Adult, Bacteria, Anaerobic pathogenicity, Bacterial Infections microbiology, Brain Injuries, Traumatic surgery, Cervical Vertebrae diagnostic imaging, Cervical Vertebrae microbiology, Humans, Magnetic Resonance Imaging, Male, Osteomyelitis diagnosis, Osteomyelitis drug therapy, Anti-Bacterial Agents therapeutic use, Bacterial Infections drug therapy, Osteomyelitis microbiology, Tracheotomy adverse effects
- Abstract
Background: We report a rare case of anaerobic vertebral osteomyelitis associated with surgical tracheotomy which has never been reported to the best of our knowledge., Case Presentation: A healthy 39-year-old man was admitted to intensive care for a severe brain trauma injury where a surgical tracheotomy was performed. He was discharged to a rehabilitation centre after 54 days hospital stay. During rehabilitation, he developed progressive and febrile tetraplegia associated with cervical pain, requiring an intensive care readmission. A polymicrobial anaerobic bloodstream infection was revealed and magnetic resonance imaging diagnosed cervical vertebral osteomyelitis. Both the type of anaerobic micro-organisms found and the timing of the symptoms strongly suggest that the surgical tracheotomy was responsible for this rare case of cervical vertebral osteomyelitis. The patient was successfully treated by a prolonged antimicrobial therapy and by surgical laminectomy., Conclusions: Tracheotomy may generate anaerobic bacteraemia and related osteomyelitis in the specific setting of severe trauma patients. Clinicians should consider anaerobic vertebral osteomyelitis when they are confronted with a febrile tetraplegia after tracheotomy.
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- 2019
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10. Delayed diagnosis of odontoid peg osteomyelitis with bilateral X and XII cranial nerve palsies.
- Author
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Chaudhry FB, Raza S, and Ahmad U
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- Aged, Bacterial Infections therapy, Cervical Vertebrae microbiology, Cranial Nerve Diseases diagnostic imaging, Cranial Nerve Diseases therapy, Delayed Diagnosis, Female, Humans, Immobilization, Magnetic Resonance Imaging, Neck Pain, Odontoid Process diagnostic imaging, Odontoid Process microbiology, Osteomyelitis diagnostic imaging, Osteomyelitis therapy, Tomography, X-Ray Computed, Treatment Outcome, Voice Disorders, Anti-Bacterial Agents therapeutic use, Bacterial Infections pathology, Cervical Vertebrae pathology, Cranial Nerve Diseases pathology, Odontoid Process pathology, Osteomyelitis pathology
- Abstract
Upper cervical osteomyelitis is rare. Its presenting features are fever and neck pain, but rarely it can involve lower nerves. MRI is the main imaging modality, but it is difficult to interpret due to the unique anatomy of C1 and C2 vertebra and complex intervertebral joint. We describe a case of a 67-year-old woman, who presented with the complaint of loss of voice, neck pain and fever for 5 days. Despite repeated imaging of neck, the diagnosis was not reached. As the patient's condition continued to deteriorate, clinical signs of bilateral 10th and 12th cranial nerve paralysis appeared and lead to a focused workup for base of skull pathology. Discussion with the radiologist helped guide the imaging protocol, which leads to the correct diagnosis being made. Treatment was tailored by blood cultures and available images. Temporary immobilisation with a cervical collar and a total of 12 weeks of antibiotics lead to complete remission., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2019
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11. Tuberculosis of the cervical spine.
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Ben Hamida MK, Benmohamed O, Bekkay MA, Habboubi K, Bouhdiba S, Kherfani A, and Mestiri M
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- Antitubercular Agents therapeutic use, Cervical Vertebrae microbiology, Diagnosis, Differential, Female, Fracture Fixation, Fractures, Compression diagnosis, Fractures, Compression etiology, Fractures, Compression therapy, Humans, Immobilization, Middle Aged, Neck Pain diagnosis, Spinal Fractures diagnosis, Spinal Fractures etiology, Spinal Fractures therapy, Tuberculosis, Spinal complications, Tuberculosis, Spinal therapy, Cervical Vertebrae pathology, Tuberculosis, Spinal diagnosis
- Abstract
Tuberculosis of the cervical spine is a rare extra-pulmonary localization. We reported the case of a 59-year-old woman with no medical history. She consulted for a 9 weeks history of painful cervical stiffness. Neurological examination was normal. Plain radiography revealed an osteolytic lesion of the C3 body, with infiltration of adjacent soft tissues. MRI showed a compression fracture of the C3 body with a signal anomaly extending to the anterior epidural space and pre-vertebral soft tissues. First, tumoral extension assessment was done and was normal. BK's research into sputum was negative. Histological examination of a CT biopsy revealed typical granulomatous inflammation. The diagnosis of tuberculosis was retained and antituberculous treatment was started with immobilization for 12 months. The patient had a total functional recovery at 18 months follow-up, with complete radiographic bone reconstruction of C3 after 12 months.
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- 2019
12. Destructive Cutibacterium (formerly Propionibacterium) avidum cervical osteomyelitis.
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Rodrigues F, Simonneau A, Seznec A, Rogers A, Lassel L, Poignet B, Heym B, and Bachmeyer C
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- Aged, Humans, Male, Cervical Vertebrae microbiology, Osteomyelitis microbiology, Propionibacterium
- Published
- 2018
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13. Acute prevertebral abscess secondary to intradiscal oxygen-ozone chemonucleolysis for treatment of a cervical disc herniation.
- Author
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Yang CS, Zhang LJ, Sun ZH, Yang L, and Shi FD
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- Abscess diagnostic imaging, Abscess etiology, Abscess therapy, Aged, Anti-Bacterial Agents therapeutic use, Decompression, Surgical, Epidural Abscess diagnostic imaging, Epidural Abscess therapy, Female, Humans, Intervertebral Disc Chemolysis methods, Magnetic Resonance Imaging, Oxygen therapeutic use, Ozone therapeutic use, Spinal Diseases diagnostic imaging, Spinal Diseases etiology, Spinal Diseases therapy, Streptococcal Infections diagnostic imaging, Streptococcal Infections etiology, Streptococcal Infections therapy, Streptococcus intermedius isolation & purification, Therapeutic Irrigation, Cervical Vertebrae microbiology, Cervical Vertebrae surgery, Epidural Abscess etiology, Intervertebral Disc Chemolysis adverse effects, Intervertebral Disc Displacement surgery
- Abstract
Objective We herein present a case involving a prevertebral abscess complicated by a spinal epidural abscess (SEA) secondary to intradiscal oxygen-ozone chemonucleolysis for treatment of a cervical disc herniation. Methods A 67-year-old woman with a history of intradiscal oxygen-ozone chemonucleolysis developed numbness and weakness in her right upper and bilateral lower extremities followed by urinary retention. Her symptoms did not respond to intravenous antibiotics alone. Magnetic resonance imaging of the cervical region revealed an extensive SEA anterior to the spinal cord, spinal cord myelopathy due to anterior compression by the lesion, and a prevertebral abscess extending from C2 to T1. She underwent surgical drainage and irrigation. Results The patient was successfully treated with surgical drainage and systemic antibiotic therapy without kyphosis. Streptococcus intermedius was detected within the abscess. All clinical symptoms except for the sensory deficit in the left leg were relieved. Conclusions The safety of intradiscal oxygen-ozone therapy requires further assessment. High-dose intravenous antibiotics should be initiated empirically at the earliest possible stage of prevertebral and epidural abscesses. Surgical drainage may be a rational treatment choice for patients with a prevertebral abscess complicated by an SEA and spinal cord myelopathy.
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- 2018
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14. [Cervical lymphadenitis caused by no typhoid Salmonella in a diabetic patient].
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Velásquez MA, Ortiz J, Atehortúa S, and Agudelo CA
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- Aged, Cervical Vertebrae diagnostic imaging, Female, Humans, Lymphadenitis diagnostic imaging, Spinal Diseases diagnostic imaging, Spinal Diseases microbiology, Tomography, X-Ray Computed, Cervical Vertebrae microbiology, Diabetes Complications microbiology, Lymphadenitis microbiology, Salmonella isolation & purification
- Abstract
No Typhoid Salmonella infection is one of the most common and widely spread foodborne diseases worldwide. Although most cases are limited to the gastrointestinal tract, extraintestinal involvement is not uncommon. However, adenitis as an isolated manifestation, is an unusual form of the disease. We report a case of Salmonella no Typhoid cervical lymphadenitis in a 67-year-old female with a recent diagnosis of diabetes mellitus, who was treated with surgery and ciprofloxacin.
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- 2017
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15. Cervical facet joint septic arthritis: a real pain in the neck.
- Author
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Sethi S and Vithayathil MK
- Subjects
- Anti-Bacterial Agents therapeutic use, Arthritis, Infectious drug therapy, Arthritis, Infectious microbiology, Fever microbiology, Humans, Low Back Pain microbiology, Male, Middle Aged, Muscle Weakness microbiology, Arthritis, Infectious complications, Cervical Vertebrae microbiology, Neck Pain microbiology, Zygapophyseal Joint microbiology
- Abstract
A 64-year-old man with a complex medical history and previous cervical arthritis with discectomy presents with a 2-day history of neck and lower back pain and shortness of breath, associated with left-sided muscle weakness. He has a fever with severe sepsis causing acute renal failure. MRI spine shows evidence of left cervical facet joint septic arthritis at C6-T1. He required 6 weeks of intravenous antibiotics and intensive support with ventilation and haemofiltration. After completion of antibiotics, he made a full recovery and regained neurological function before discharge., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
- Published
- 2017
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16. Débridement and Reconstruction Improve Postoperative Sagittal Alignment in Kyphotic Cervical Spinal Tuberculosis.
- Author
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Pan Z, Luo J, Yu L, Chen Y, Zhong J, Li Z, Zeng Z, Duan P, Ha Y, and Cao K
- Subjects
- Adult, Bone Malalignment microbiology, Cervical Vertebrae microbiology, Cervical Vertebrae surgery, Decompression, Surgical methods, Female, Humans, Kyphosis microbiology, Male, Middle Aged, Postoperative Period, Retrospective Studies, Treatment Outcome, Tuberculosis, Spinal complications, Bone Malalignment surgery, Debridement methods, Kyphosis surgery, Plastic Surgery Procedures methods, Tuberculosis, Spinal surgery
- Abstract
Background: Cervical spinal tuberculosis is relatively common in some developing countries. It erodes vertebrae and discs, which sometimes results in cervical kyphosis and myelopathy. However, to our knowledge, no studies have evaluated improvements to patient-reported outcomes among patients who undergo surgical cervical sagittal realignment after kyphotic cervical spinal tuberculosis has been treated by débridement and reconstruction., Questions/purposes: (1) Can a spine with kyphotic cervical spinal tuberculosis be returned to normal alignment and fused successfully? (2) Will patient-reported outcomes be improved with this intervention? (3) Are patient-reported outcomes correlated with realignment?, Methods: Forty-six patients with kyphotic cervical spinal tuberculosis were evaluated in this retrospective study. We generally performed surgery on patients with this condition when patients with cervical spinal tuberculosis presented with cervical kyphosis with or without neurologic deficits. Patients who did not meet these criteria were treated with other surgical procedures during the study period. Study patients were evaluated with cervical imaging, patient-reported outcomes questionnaires (Neck Disability Index [NDI], and the Japanese Orthopaedic Association [JOA] score), and physical examinations. Scores were collected by fellows preoperatively and at followup. No patient died during the followup. The mean followup was 26.8 months (range, 20-35 months). Preoperative and 2-year followup radiologic parameters were measured, including C0-2 Cobb angle, C2-7 Cobb angle, C2-7 sagittal vertical axis, center of gravity (CG) to C7 sagittal vertical axis (CG-C7 sagittal vertical axis), thoracic inlet angle, T1 slope, and neck tilt. The correlations between cervical alignment and the NDI and JOA score were analyzed. Factors correlated with the NDI and JOA score improvements were identified by multiple stepwise regression analysis. CT was used to assess bone fusion after surgery., Results: All 46 patients showed bone fusion on CT scans. The preoperative C0-2 Cobb angle improved after surgery (mean difference, 5.0°; 95% CI, 2.3°-7.7°; p = 0.0068), as did C2-7 Cobb angle (mean difference, -33°; 95% CI, -35° to -31°; p = 0.0074), C2-7 sagittal vertical axis (mean difference, -28 mm; 95% CI, -30 mm to -26 mm; p = 0.0036), CG-7 sagittal vertical axis (mean difference, -26 mm; 95% CI, -28 mm to -24 mm; p = 0.0049), T1 slope (mean difference, 6.0°; 95% CI, 3.7°-8.3°; p = 0.0053) and the thoracic inlet angle (mean difference, 8.0°; 95% CI, 3.7°-12°; p = 0.0072). With the numbers available, the neck tilt angle did not improve (mean difference, -0.2°; 95% CI, -1.0° to 0.6°; p = 0.079). The preoperative NDI of 34 ± 5.1 decreased to 17 ± 4.6 (p = 0.0096) at followup. Improvements in NDI were correlated with the magnitude of correction of the cervical deformities, including C0-2 Cobb angle (r = -0.357, p = 0.007), C2-7 Cobb angle (r = 0.410, p = 0.002), T1 slope (r = -0.366, p = 0.006, thoracic inlet angle (r = -0.376, p = 0.005), C2-7 sagittal vertical axis (r = 0.450, p = 0.001), and CG-C7 sagittal vertical axis (r = 0.361, p = 0.007). The JOA score improved to 13 ± 2.6 from 7.2 ± 1.9, which did not correlate with postoperative cervical realignment. After controlling for potential confounding variables like Cobb angles and T1 slope, we found C2-7 sagittal vertical axis was the most influential factor correlated with NDI improvement (r = 0.450, p = 0.002)., Conclusion: When treating kyphotic cervical spinal tuberculosis by débridement, decompression, and reconstruction, more attention should be drawn to realigning the cervical spine, in particular to restoring the C2-7 sagittal vertical axis. However, how best to restore the C2-7 sagittal vertical axis and cervical alignment in a kyphotic cervical spine needs further study., Level of Evidence: Level III, therapeutic study.
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- 2017
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17. Serum procalcitonin measurement is not a useful biomarker in the detection of primary infectious spondylodiscitis.
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Dubost JJ, Lopez J, Pereira B, Couderc M, Tournadre A, and Soubrier M
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- Aged, Aged, 80 and over, Biomarkers blood, Cervical Vertebrae microbiology, Cervical Vertebrae physiopathology, Cohort Studies, Discitis diagnosis, Discitis drug therapy, Female, Humans, Lumbar Vertebrae microbiology, Lumbar Vertebrae physiopathology, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Assessment, Sensitivity and Specificity, Severity of Illness Index, Thoracic Vertebrae microbiology, Thoracic Vertebrae physiopathology, Discitis blood, Discitis microbiology, Procalcitonin blood
- Published
- 2017
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18. [Large cervicodorsal epidural abscess].
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Lafoeste H, Le Meur M, Mezhari I, Macovei G, and Thyrault M
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- Anti-Bacterial Agents therapeutic use, Cervical Vertebrae diagnostic imaging, Consciousness Disorders etiology, Epidural Abscess complications, Epidural Abscess diagnostic imaging, Epidural Abscess drug therapy, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Organ Failure etiology, Remission Induction, Staphylococcal Infections complications, Staphylococcal Infections diagnostic imaging, Staphylococcal Infections drug therapy, Thoracic Vertebrae diagnostic imaging, Cervical Vertebrae microbiology, Epidural Abscess diagnosis, Staphylococcal Infections diagnosis, Thoracic Vertebrae microbiology
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- 2017
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19. [Retropharyngeal abscess with cervical discitis and vertebral osteomyelitis caused by Escherichia coli in a patient with liver cirrhosis].
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Sakaguchi A, Ishimaru N, Ohnishi H, Kawamoto M, Takagi A, Yoshimura S, Kinami S, and Sakamoto S
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- Aged, Airway Obstruction etiology, Anti-Bacterial Agents therapeutic use, Bacteremia drug therapy, Bacteremia etiology, Cephalosporins therapeutic use, Discitis microbiology, Discitis surgery, Disease Susceptibility, Drainage, Drug Substitution, Escherichia coli Infections drug therapy, Escherichia coli Infections surgery, Humans, Magnetic Resonance Imaging, Male, Neck Pain etiology, Osteomyelitis drug therapy, Osteomyelitis microbiology, Osteomyelitis surgery, Oxygen Inhalation Therapy, Retropharyngeal Abscess diagnostic imaging, Retropharyngeal Abscess microbiology, Retropharyngeal Abscess surgery, Tomography, X-Ray Computed, Cervical Vertebrae microbiology, Discitis etiology, Escherichia coli Infections etiology, Liver Cirrhosis, Alcoholic complications, Retropharyngeal Abscess etiology
- Abstract
We describe the case of a 67-year-old male with liver cirrhosis who presented with fever and neck pain. Magnetic resonance imaging of the spine detected cervical vertebral osteomyelitis, and enhanced CT of the neck and spine revealed retropharyngeal abscess. The patient was treated with empirical antimicrobial therapy and surgical drainage due to significant airway involvement. Escherichia coli was cultured from the blood and pus in inferior cervical vertebrae which was a rare pathogen. Haematogenous spread may have resulted in cervical vertebral osteomyelitis and retropharyngeal abscess. With high mortality rates, early diagnosis of retropharyngeal abscess is required to avoid debilitating complications such as airway obstruction.
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- 2017
20. Spinal Infections Among Patients With Long-Term Central Venous Catheters for Home Parenteral Nutrition.
- Author
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Topan R, Ambrose T, Small M, Lightman E, Nightingale J, and Gabe SM
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- Aged, Anti-Infective Agents therapeutic use, Back Pain prevention & control, Bacteremia blood, Bacteremia drug therapy, Bacteremia microbiology, Bacteremia physiopathology, Catheter-Related Infections drug therapy, Catheter-Related Infections microbiology, Catheter-Related Infections physiopathology, Cervical Vertebrae diagnostic imaging, Cervical Vertebrae drug effects, Cervical Vertebrae microbiology, Cohort Studies, Female, Humans, London, Magnetic Resonance Imaging, Male, Middle Aged, Retrospective Studies, Spine diagnostic imaging, Spine microbiology, Spondylitis drug therapy, Spondylitis microbiology, Spondylitis physiopathology, Thoracic Vertebrae diagnostic imaging, Thoracic Vertebrae drug effects, Thoracic Vertebrae microbiology, Treatment Outcome, Back Pain etiology, Catheter-Related Infections diagnostic imaging, Catheterization, Central Venous adverse effects, Parenteral Nutrition, Home adverse effects, Spondylitis diagnostic imaging
- Abstract
Spinal infections are a rare yet serious metastatic complication of bacteremia among patients with long-term central venous catheters (CVCs) for which clinicians must remain vigilant. We performed a retrospective review of all cases of spinal infection occurring in the context of a CVC for long-term parenteral nutrition (PN) managed in our department between January 2010 and October 2013, a cohort of 310 patients over this time period. Six patients were identified (mean age, 65 years; 5 male). One hundred percent of patients presented with spinal pain (5/6 cervical, 1/6 thoracic). Organisms were cultured from the CVC in 5 of 6 patients. In all cases, the white blood cell count was normal, and in 5 of 6, C-reactive protein was normal. All diagnoses were confirmed on magnetic resonance imaging (MRI), and in 3 of 6 cases, an MRI was repeated (on the advice of neurosurgical colleagues) to confirm resolution of changes after a period of antimicrobial therapy. There was no clear correlation between duration of PN or number of days following CVC insertion and onset of infection. The CVC was replaced in 4 of 6 patients at the time of diagnosis, delayed removal in 1 of 6, and salvaged in the remaining case. Although rare, a high index of suspicion is needed in patients receiving long-term PN who present with spinal pain. Peripheral inflammatory markers may not be elevated. MRI should be performed and patients should be treated with antibiotics alongside involvement of local microbiology and neurosurgical teams. Multidisciplinary discussion on CVC salvage in these cases is important, especially in cases of challenging vascular anatomy.
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- 2017
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21. High cervical spine spondylodiscitis management and literature review.
- Author
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Sebben AL, Graells XS, Benato ML, Santoro PG, and Kulcheski ÁL
- Subjects
- Discitis complications, Discitis microbiology, Epidural Abscess etiology, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Spinal Cord Compression etiology, Spondylitis complications, Spondylitis microbiology, Staphylococcal Infections diagnosis, Tomography, X-Ray Computed, Cervical Vertebrae microbiology, Discitis diagnostic imaging, Spondylitis diagnostic imaging, Staphylococcal Infections complications, Staphylococcus aureus
- Abstract
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.
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- 2017
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22. Propionibacterium acnes, Coagulase-Negative Staphylococcus, and the "Biofilm-like" Intervertebral Disc.
- Author
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Coscia MF, Denys GA, and Wack MF
- Subjects
- Adolescent, Adult, Aged, Cervical Vertebrae microbiology, Cervical Vertebrae pathology, Coagulase metabolism, Female, Humans, Intervertebral Disc surgery, Intervertebral Disc Degeneration microbiology, Intervertebral Disc Degeneration surgery, Intervertebral Disc Displacement microbiology, Intervertebral Disc Displacement surgery, Low Back Pain complications, Lumbar Vertebrae surgery, Male, Middle Aged, Young Adult, Biofilms, Intervertebral Disc microbiology, Lumbar Vertebrae microbiology, Propionibacterium acnes isolation & purification
- Abstract
Study Design: Patients scheduled for spinal surgery were screened prospectively for a microbial presence associated with intervertebral disc specimens. Inclusion was limited to patients requiring surgery for any of five conditions: study patients with cervical spine intervertebral herniation (IVH), lumbar spine IVH, lumbar spine discogenic pain, and control patients with idiopathic scoliosis/Scheurermann's kyphosis or trauma/neuromuscular deformity. Exclusion criteria included ongoing systemic infection, abnormal pre-operative white cell counts, documented or suspected spinal infection, or previous surgery to the involved disc., Objective: The aim of this study was to test for an association between the presence of a bacterial entity in operated discs and a diagnosis of pathologic disc disease., Summary of Background Data: An association has been described between microbial colonization and progressive intervertebral disc degeneration in 36 herniation patients undergoing microdiscectomies. A total of 19 patients had positive cultures on long-term incubation, with Propionibacterium acnes present in 84% of discs., Materials and Methods: Discs were harvested during surgery, using strict sterile technique. Each disc was divided, with half the sample sealed in a sterile, commercially prepared anaerobic culture transport container, and half fixed in formalin. Live specimens were cultured for bacteria at a university-affiliated laboratory in a blinded fashion. Fixed pathologic specimens were gram-stained and read by a board-certified pathologist., Results: A total of 169 intervertebral discs from 87 patients were evaluated (46 males, 41 females). Positive cultures were noted in 76 of 169 discs (45%), with 34 discs positive for P. acnes and 30 discs positive for Staphylococcus. No pathologic evidence was seen of microorganisms, acute or chronic inflammation, or infection. Pooling the IVH and discogenic pain patients and contrasting them with control patients showed a significant association of IVH with positive bacterial cultures (χ = 15.37; P = 0.000088)., Conclusion: Endemic bacterial biofilms are significantly associated with IVH and discogenic pain., Level of Evidence: N/A., Competing Interests: The authors report no conflicts of interest.
- Published
- 2016
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23. Cervical Facet Joint Infection and Associated Epidural Abscess with Streptococcus intermedius from a Dental Infection Origin A Case Report and Review.
- Author
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Kaye ID and Protopsaltis TS
- Subjects
- Administration, Intravenous, Aged, Anti-Bacterial Agents administration & dosage, Cervical Vertebrae diagnostic imaging, Cervical Vertebrae physiopathology, Cervical Vertebrae surgery, Epidural Abscess diagnostic imaging, Epidural Abscess physiopathology, Epidural Abscess surgery, Foraminotomy, Humans, Laminectomy, Magnetic Resonance Imaging, Male, Recovery of Function, Streptococcal Infections diagnosis, Streptococcal Infections physiopathology, Streptococcal Infections surgery, Time Factors, Tomography, X-Ray Computed, Tooth Diseases diagnostic imaging, Tooth Diseases surgery, Tooth Extraction, Treatment Outcome, Zygapophyseal Joint diagnostic imaging, Zygapophyseal Joint physiopathology, Zygapophyseal Joint surgery, Cervical Vertebrae microbiology, Crowns, Dental Restoration Failure, Epidural Abscess microbiology, Streptococcal Infections microbiology, Streptococcus intermedius isolation & purification, Tooth Diseases microbiology, Zygapophyseal Joint microbiology
- Abstract
Pyogenic cervical facet joint infections are rare and such infections from a dental origin are even less common. Of these few cases, none have described infection with Streptococcus intermedius as the pathogen. A 65-year-old orthopaedic surgeon complained of fevers, right-sided radiating neck pain, stiffness, swelling, erythema, and right upper extremity weakness one month after he had broken a crown over his right mandibular premolar, a continued source of pain. Imaging of the cervical spine showed a right C4-C5 facet inflammatory arthropathy and a small epidural abscess that was cultured and initially treated with intravenous antibiotics. The oral maxillofacial surgery team performed an extraction of the infected, symptomatic tooth. For continued right upper extremity weakness, the patient underwent C4-C5 laminoforaminotomy and irrigation and debridement of the right C4-C5 facet joint. After 6 weeks of intravenous antibiotics, the patient's infectious and inflammatory markers had normalized. By 4 months, he had regained full strength at his upper extremity and a painless and full range of motion of his cervical spine.Pyogenic cervical facet joint infection is very rare and potentially dangerous. A high clinical suspicion and appropriate imaging, including magnetic resonance imaging, are important for correct diagnosis. Prompt medical and surgical treatment may avert complications, and although the patient presented made a complete recovery, patients may be left with neurological compromise.
- Published
- 2016
24. Cervical Spinal Epidural Abscess Due to Mycobacterium tuberculosis without Osseous Involvement: A Case Report.
- Author
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Esteves S, Catarino I, Robles D, Lopes D, Silva F, and de Sousa C
- Subjects
- Cervical Vertebrae microbiology, Cervical Vertebrae surgery, Decompression, Surgical, Epidural Abscess microbiology, Epidural Abscess surgery, Humans, Male, Middle Aged, Cervical Vertebrae diagnostic imaging, Epidural Abscess diagnostic imaging, Mycobacterium tuberculosis isolation & purification
- Abstract
Case: We present a rare case of cervical spinal epidural abscess due to Mycobacterium tuberculosis without osseous involvement that was treated with decompression and arthrodesis in a 2-stage procedure., Conclusion: Spinal epidural abscess due to Mycobacterium tuberculosis is the least common of the various forms of spinal tuberculosis. This abscess represents a severe infection of the epidural space that can compromise neural elements and can require urgent surgical intervention to avoid permanent neurological deficits. Early diagnosis and early decompression remain the 2 most important predictors of a successful neurological outcome.
- Published
- 2016
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25. Anterior Cervical Retropharyngeal Debridement Combined With Occipital Cervical Fusion to Upper Cervical Tuberculosis.
- Author
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Xing S, Gao Y, Gao K, Zhang G, and Yu Z
- Subjects
- Adult, Antitubercular Agents therapeutic use, Biomechanical Phenomena, Cervical Vertebrae diagnostic imaging, Cervical Vertebrae microbiology, Cervical Vertebrae physiopathology, Debridement adverse effects, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Occipital Bone diagnostic imaging, Occipital Bone microbiology, Retrospective Studies, Spinal Fusion adverse effects, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Tuberculosis, Spinal diagnosis, Tuberculosis, Spinal microbiology, Cervical Vertebrae surgery, Debridement methods, Occipital Bone surgery, Spinal Fusion methods, Tuberculosis, Spinal surgery
- Abstract
Study Design: A retrospective analysis of 11 cases., Objective: The aim of the study was to evaluate the effectiveness of anterior cervical and retropharyngeal debridement combined with posterior occipital-cervical fusion in treatment of upper cervical spinal tuberculosis., Summary of Background Data: The anterior approach simply could not provide strong fixation whereas the posterior treatment could not clear up the lesions completely. The method combining anterior and posterior approaches to treat the upper cervical tuberculosis is advisable., Methods: The clinical data of 11 patients with upper cervical tuberculosis who underwent an upper cervical operation in our hospital were retrospectively analyzed. All 11 patients underwent the surgery of anterior cervical and retropharyngeal approaches to debridement, and then, according to the different degrees of patient pedicle destruction and deformity, different occipitocervical approaches were used (either through pedicle screw or laminar screw fixation). After surgery, antituberculosis drugs were administered for 18 months. During the follow-up, neurological function, clinical symptoms, fusion, reducible degree, and complications were all evaluated and documented., Results: Surgeries for 11 patients were performed successfully; anatomical reduction was achieved in nine cases, bony fusion was achieved in all 11 patients, and all cases with tuberculosis were clinically cured in the 18 months after the operation. The Japanese Orthopaedic Association score increased from 8.4 ± 1.3 preoperative to 15.0 ± 1.3 in the last follow-up (P < 0.05). The occipitocervical visual analog scale decreased from 6.7 ± 0.6 preoperative to 0.6 ± 0.6 at the last follow-up (P < 0.05). No serious complications were documented during follow-up., Conclusion: The approach of anterior cervical and retropharyngeal debridement combined with posterior occipitocervical fusion has been proved to be an effective treatment of upper cervical tuberculosis, which plays an important role in removing the lesions, restoring stability, and anatomical reduction., Level of Evidence: 4.
- Published
- 2016
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26. Spinal infections caused by Parvimonas micra.
- Author
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Gahier M, Cozic C, Bourdon S, Guimard T, and Cormier G
- Subjects
- Abscess etiology, Abscess microbiology, Aged, 80 and over, Anti-Bacterial Agents therapeutic use, Discitis complications, Discitis drug therapy, Female, Fractures, Spontaneous etiology, Gram-Positive Bacterial Infections complications, Gram-Positive Bacterial Infections drug therapy, Granuloma etiology, Granuloma microbiology, Humans, Low Back Pain etiology, Middle Aged, Neck Pain etiology, Osteomyelitis complications, Osteomyelitis drug therapy, Spinal Cord Compression etiology, Spondylitis complications, Spondylitis drug therapy, Cervical Vertebrae microbiology, Discitis microbiology, Firmicutes isolation & purification, Gram-Positive Bacterial Infections microbiology, Lumbar Vertebrae microbiology, Osteomyelitis microbiology, Spondylitis microbiology, Thoracic Vertebrae microbiology
- Published
- 2015
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27. Lemierre's syndrome: An unusual presentation.
- Author
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Medina F, Tatay M, Smati M, Aoun O, Tankovic J, Bouchaud O, and Méchaï F
- Subjects
- Amoxicillin-Potassium Clavulanate Combination therapeutic use, Anti-Bacterial Agents therapeutic use, Clindamycin therapeutic use, Drug Therapy, Combination, Embolism diagnostic imaging, Embolism etiology, Female, Gram-Positive Bacterial Infections drug therapy, Gram-Positive Bacterial Infections microbiology, Headache etiology, Humans, Lemierre Syndrome complications, Lemierre Syndrome microbiology, Myalgia etiology, Retropharyngeal Abscess etiology, Rifampin therapeutic use, Spondylitis diagnostic imaging, Spondylitis drug therapy, Tomography, X-Ray Computed, Young Adult, Cervical Vertebrae microbiology, Gram-Positive Bacterial Infections complications, Lemierre Syndrome diagnosis, Peptostreptococcus isolation & purification, Spondylitis etiology
- Published
- 2015
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28. [A woman in her fifties with neck pain and increased sedimentation rate].
- Author
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Stenklev NC, Rusten H, Müller K, Hennig R, Eggen T, and Wikran G
- Subjects
- Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents therapeutic use, Blood Sedimentation, Cervical Vertebrae microbiology, Discitis drug therapy, Discitis microbiology, Female, Humans, Methicillin-Resistant Staphylococcus aureus isolation & purification, Middle Aged, Osteomyelitis drug therapy, Osteomyelitis microbiology, Staphylococcal Infections drug therapy, Staphylococcal Infections microbiology, Discitis diagnosis, Neck Pain microbiology, Osteomyelitis diagnosis, Staphylococcal Infections diagnosis
- Abstract
Background: Spondylitis in the upper cervical spine can have an insidious onset, with symptoms mimicking low-grade infections or common musculoskeletal disorders. Some patients have neurological symptoms, and if untreated, the outcome may be fatal., Case Presentation: A woman in her fifties had general malaise, weight loss and neck pain over 6-8 weeks. Her sedimentation rate was elevated, and she developed bulbar symptoms. Biopsy and culture samples were harvested endoscopically from the prevertebral area in the C1-C2 region, and confirmed our preliminary diagnosis of localised infection. She was treated with high-dose antibiotics and rigid collar immobilisation until stability of the cervical spine was ascertained., Interpretation: It is difficult to make a differential diagnosis between spondylitis, rheumatoid inflammation and malignancy in the upper cervical spine. Adequate histologic and bacterial culture samples must if possible be obtained from the prevertebral area. This is best achieved transnasally or transorally, under endoscopic and radiological guidance. The neck must be stabilised and patients must have long-term antibiotic treatment followed by permanent neck fixation if indicated.
- Published
- 2015
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29. Intramedullary cervical abscess in the setting of aortic valve endocarditis.
- Author
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Arnáiz-García ME, González-Santos JM, López-Rodriguez J, Dalmau-Sorli MJ, Bueno-Codoñer M, and Arévalo-Abascal A
- Subjects
- Abscess diagnosis, Abscess drug therapy, Adult, Anti-Bacterial Agents therapeutic use, Aortic Valve diagnostic imaging, Aortic Valve drug effects, Aortic Valve surgery, Cervical Vertebrae drug effects, Cervical Vertebrae pathology, Echocardiography, Doppler, Color, Echocardiography, Transesophageal, Endocarditis, Bacterial complications, Endocarditis, Bacterial diagnosis, Endocarditis, Bacterial therapy, Heart Valve Prosthesis Implantation, Humans, Magnetic Resonance Imaging, Male, Methicillin-Resistant Staphylococcus aureus drug effects, Spinal Cord Diseases diagnosis, Spinal Cord Diseases drug therapy, Streptococcal Infections complications, Streptococcal Infections diagnosis, Streptococcal Infections therapy, Treatment Outcome, Abscess microbiology, Aortic Valve microbiology, Cervical Vertebrae microbiology, Endocarditis, Bacterial microbiology, Methicillin-Resistant Staphylococcus aureus isolation & purification, Spinal Cord Diseases microbiology, Streptococcal Infections microbiology
- Abstract
Spinal cord tissue has a remarkable resistance to infection. An intramedullary abscess is an exceptional complication of infective endocarditis in the post-antibiotic era. We describe the case of a 42-year-old man who presented with fever and cephalea. Two days later, left-side numbness, lack of sphincter control, and a new aortic murmur were noticed. Magnetic resonance imaging demonstrated an 8 ×15-mm intramedullary cervical abscess. Transesophageal echocardiography revealed an aortic valve perforation as a result of infective endocarditis. Conservative management was decided for the intramedullary abscess., (© The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)
- Published
- 2015
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30. Cervical spinal tuberculosis: a preliminary study of clinical diagnosis and management.
- Author
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Bunmaprasert T and Dongsang K
- Subjects
- Adult, Aged, Antitubercular Agents therapeutic use, Cervical Vertebrae surgery, Debridement, Female, Humans, Male, Middle Aged, Neck Pain etiology, Retrospective Studies, Spinal Fusion, Cervical Vertebrae microbiology, Tuberculosis, Spinal diagnosis, Tuberculosis, Spinal therapy
- Abstract
Background: Cervical involvement in spinal tuberculosis is rare; however delayed diagnosis and treatment may result in massive, irreversible neurological deterioration. The purpose of this study is to report on a strategy for clinical diagnosis and management of cervical spinal tuberculosis., Material and Method: Eighteen patients (13 males and 5 females) during 1998-2013 were retrospectively reviewed at Chiang Mai University Hospital. The patients had a mean age of 51.4 years (range 37-68 years). History, examination, radiographs, MRI and tissue sampling were used in diagnosis. Most of the patients were given antituberculous therapy (ATT) and underwent surgical management. The mean follow-up period was 12.8 months., Results: Axial neckpain, quadriparesis, spastic gait and hand clumsiness were the predominant symptoms. Disc narrowing, endplate destruction andparaspinal soft tissue swelling were the prominent radiographic findings. MRI found Gadolinium enhancement of prevertebral soft tissue, T2 hypersignal of the intervertebral discs, intraosseous T2 hypersignal at the vertebral body, and disc fragmentation. Thirteen patients underwent single-stage anterior debridement with fusion. Three patients underwent posterior fusion alone. Axial neck pain improved in all patients. Nurick's disability index and fusion rate improved in 70% of the patients after conservative and surgical treatment., Conclusion: Cervical spinal tuberculosis should be suspected in endemic patients with severe neck pain and progressive neurological deficit. Histopathology is the gold standard of tuberculosis diagnosis. Anti-tuberculosis drugs should be continued for at least 12 months. Radical anterior debridement and instrumented fusion has demonstrated favorable results. The posterior approach is an alternative treatment in patients when the anterior approach cannot be performed or as part of second-stage surgery.
- Published
- 2015
31. Helicobacter cinaedi-associated Vertebral Osteomyelitis in an Immunocompetent Patient.
- Author
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Murata S, Suzuki H, Sakamoto S, Miki T, Rimbara E, Shibayama K, Koyama S, Tamai K, Yaguchi Y, and Tada M
- Subjects
- C-Reactive Protein analysis, Ceftriaxone therapeutic use, Diagnosis, Differential, Helicobacter genetics, Helicobacter Infections genetics, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Osteomyelitis drug therapy, RNA, Ribosomal, 16S genetics, Tomography, X-Ray Computed, Cervical Vertebrae microbiology, Helicobacter Infections drug therapy, Immunocompromised Host, Osteomyelitis microbiology
- Abstract
A 56-year-old previously healthy man was hospitalized due to a 10-day history of neck pain and an elevated C-reactive protein level. Gram-negative spiral bacilli were isolated from his blood, and Helicobacter cinaedi was confirmed using 16S rRNA sequencing. The infectious focus was not identified by initial cervical magnetic resonance imaging (MRI); however, repeated MRI demonstrated prominent high signal intensity in the entire region of the C6-C7 vertebrae and C6/C7 disc space. Furthermore, fluorodeoxyglucose-positron emission tomography/computed tomography showed no significant uptake, other than in the C6-C7 region. The patient was successfully treated with ceftriaxone for six weeks without sequelae.
- Published
- 2015
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32. Teaching NeuroImages: spherules in spine: vertebral coccidioidomycosis.
- Author
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Dubey D, Narayan RN, Motiwala A, and Gupta P
- Subjects
- Adult, Cervical Vertebrae microbiology, Coccidioidomycosis diagnosis, Coccidioidomycosis therapy, Diagnosis, Differential, Humans, Magnetic Resonance Imaging, Male, Osteomyelitis diagnosis, Osteomyelitis therapy, Cervical Vertebrae pathology, Coccidioidomycosis pathology, Osteomyelitis microbiology, Osteomyelitis pathology
- Published
- 2014
- Full Text
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33. Disseminated coccidioidomycosis of the spine in an immunocompetent patient.
- Author
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Elgafy H, Miller J, Meyers S, and Assaly R
- Subjects
- Adult, Cervical Vertebrae injuries, Cervical Vertebrae microbiology, Cervical Vertebrae surgery, Coccidioidomycosis complications, Coccidioidomycosis drug therapy, Humans, Male, Osteomyelitis etiology, Osteomyelitis microbiology, Spinal Fractures etiology, Spinal Fractures microbiology, Treatment Outcome, Amphotericin B therapeutic use, Antifungal Agents therapeutic use, Coccidioidomycosis surgery, Fluconazole therapeutic use, Osteomyelitis surgery, Spinal Fractures surgery, Spinal Fusion
- Abstract
Coccidioidomycosis infections result from inhalation of the dimorphic fungus Coccidiodes immitis. Coccidioidomycosis typically is benign, but its extremely rare disseminated form can result in significant morbidity and mortality. Dissemination of the fungus to the spine is difficult to control and usually requires an aggressive combination approach (surgical/medical). In this article, we report the case of a 27-year-old Indonesian man with vertebral osteomyelitis caused by disseminated coccidioidomycosis. We outline the case management (includes 30-month follow-up) and review the treatment recommendations. The patient presented with an unstable C5 pathologic fracture caused by C immitis. After corpectomy and stabilization of the cervical spine along with antifungal therapy with amphotericin B and oral fluconazole, he developed multiple complications. This case illustrates some of the potential pitfalls in managing spinal osteomyelitis caused by C immitis and the need for continuous medical therapy after surgical treatment.
- Published
- 2014
34. Cervical and thoracic actinomycosis on (18)F-FDG PET/CT.
- Author
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Singla S, Singh H, Mukherjee A, Karunanithi S, Bal C, and Kumar R
- Subjects
- Adolescent, Humans, Male, Multimodal Imaging, Thorax microbiology, Actinomycosis diagnostic imaging, Cervical Vertebrae diagnostic imaging, Cervical Vertebrae microbiology, Fluorodeoxyglucose F18, Positron-Emission Tomography, Thorax diagnostic imaging, Tomography, X-Ray Computed
- Abstract
Actinomycosis is a rare chronic granulomatous disease that runs an indolent course, predominantly seen in Asian countries. The present case highlights the findings of F-FDG PET/CT in cervicothoracic actinomycosis imitating lymphoma.
- Published
- 2014
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35. [Cardiobacterium hominis septic arthritis].
- Author
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Ducoulombier V, Budzik JF, Dehecq E, Baclet N, and Houvenagel E
- Subjects
- Amoxicillin therapeutic use, Anti-Bacterial Agents therapeutic use, Arthritis, Infectious diagnosis, Arthritis, Infectious drug therapy, Arthritis, Infectious etiology, Bacteremia drug therapy, Bacteremia etiology, Bacteremia microbiology, Dental Care, Diagnosis, Differential, Endocarditis, Bacterial diagnosis, Gentamicins therapeutic use, Gram-Negative Bacterial Infections drug therapy, Gram-Negative Bacterial Infections etiology, Humans, Male, Middle Aged, Mouth microbiology, Spondylitis diagnosis, Spondylitis drug therapy, Spondylitis etiology, Systemic Inflammatory Response Syndrome etiology, Arthritis, Infectious microbiology, Cardiobacterium isolation & purification, Cervical Vertebrae microbiology, Gram-Negative Bacterial Infections microbiology, Neck Pain etiology, Spondylitis microbiology
- Published
- 2014
- Full Text
- View/download PDF
36. Cervical spondylitis and spinal abscess due to Actinomyces meyeri.
- Author
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Duvignaud A, Ribeiro E, Moynet D, Longy-Boursier M, and Malvy D
- Subjects
- Abscess diagnosis, Actinomyces genetics, DNA, Bacterial genetics, Humans, Immunocompetence, Male, Middle Aged, Polymerase Chain Reaction, RNA, Ribosomal, 16S genetics, Spinal Diseases diagnosis, Spondylitis diagnosis, Abscess microbiology, Actinomyces isolation & purification, Actinomycosis diagnosis, Cervical Vertebrae microbiology, Spinal Diseases microbiology, Spondylitis microbiology
- Abstract
Human actinomycosis with involvement of the spine is a rare condition although it has been first described a long time ago. It is probably underrecognized since its clinical presentation is often misleading and accurate bacteriological diagnosis is challenging. We herein report a rare case of cervical actinomycosis with paravertebral abscess and spondylitis imputed to an infection by Actinomyces meyeri in a 52-year-old immunocompetent Caucasian man. A. meyeri should be considered as a potential cause for subacute or chronic spondylitis, even in immunocompetent subjects. Modern diagnostic tools such as Matrix-Assisted Laser Desorption-Ionization Time of Flight mass spectrometry and 16S rRNA sequencing are efficient for accurate microbiological identification., (Copyright © 2013 Elsevier Editora Ltda. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF
37. Fatal case of retropharyngeal abscess associated with Pott's disease.
- Author
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Hugar BS, Chandra YP, Babu PR, Jayanth SH, and Vinay J
- Subjects
- Adolescent, Airway Obstruction etiology, Cervical Vertebrae pathology, Female, Forensic Pathology, Humans, Lung pathology, Necrosis, Osteomyelitis microbiology, Osteomyelitis pathology, Poverty, Asphyxia etiology, Cervical Vertebrae microbiology, Retropharyngeal Abscess microbiology, Retropharyngeal Abscess pathology, Tuberculosis, Spinal complications
- Abstract
Retropharyngeal abscess is a rare, deep seated infection of the neck that usually affects young children. Chronic retropharyngeal abscess is rare and results from tuberculosis of the spine. Such swelling in the neck gradually increases in size and is detected during the routine radiological screening for symptoms like pain, dysphagia, fever, dyspnoea, progressive inspiratory stridor (from laryngeal obstruction), neck hyperextension etc, but rarely leads to sudden death due to airway obstruction. Thus the forensic pathologist rarely comes across such type of cases. Present case concerns obstruction of upper airway by a large retropharyngeal cold abscess leading to death in a 13-year-old female child from a lower socio-economic family. The possible explanation for the progression and fatal outcome of such abscesses associated with the Pott's disease is being discussed in the light of available literature., (Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)
- Published
- 2013
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38. Salmonella spinal infection: a rare case in a patient with advanced AIDS.
- Author
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Berngard SC and Miller M
- Subjects
- AIDS-Related Opportunistic Infections drug therapy, Anti-Bacterial Agents therapeutic use, Humans, Male, Middle Aged, Ofloxacin therapeutic use, Osteomyelitis drug therapy, Salmonella Infections drug therapy, Salmonella enterica isolation & purification, AIDS-Related Opportunistic Infections microbiology, Cervical Vertebrae microbiology, Osteomyelitis microbiology, Salmonella Infections diagnosis, Thoracic Vertebrae microbiology
- Abstract
We present an unusual case of nontyphoidal Salmonella causing an epidural abscess and vertebral osteomyelitis in a severely immunocompromised patient with AIDS as well as a review of the literature. Salmonella vertebral osteomyelitis is exceptionally rare, and this is the first case report in a patient with AIDS.
- Published
- 2013
- Full Text
- View/download PDF
39. [Cervical spondylodiscitis inoculation revealed by abdominal infection].
- Author
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Labbé F, Frénoy E, and Bousta M
- Subjects
- Adult, Alcoholism complications, Bacteremia microbiology, Diabetes Complications diagnosis, Humans, Male, Meningitis, Bacterial diagnosis, Neck Pain microbiology, Peritonitis microbiology, Psoas Abscess microbiology, Pulmonary Atelectasis microbiology, Smoking, Spondylosis microbiology, Cervical Vertebrae microbiology, Discitis microbiology, Staphylococcal Infections diagnosis
- Abstract
We report a patient who presented successively peritonis concomitant bacteriema with Staphylococcus aureus then meningitis and finally a bone and joint infection. All the infections are associated with the same germ. This patient of 40 years suffers of diabet mellitus and has history of neck pain and cervical spondylosis. For this, he received corticosteroid injection locally one year before his hospitalization.
- Published
- 2013
- Full Text
- View/download PDF
40. Cervical spondylodiscitis due to Staphylococcus equorum.
- Author
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Doualla Bija M, Namme Luma H, Abena Mbida P, Tchaleu Nguenkam C, and Okalla Ebongue C
- Subjects
- Abscess complications, Abscess diagnostic imaging, Abscess drug therapy, Abscess microbiology, Adrenal Cortex Hormones therapeutic use, Analgesics therapeutic use, Anti-Bacterial Agents therapeutic use, Bacteremia complications, Bacteremia drug therapy, Bacteremia microbiology, Braces, Cervical Vertebrae diagnostic imaging, Combined Modality Therapy, Discitis diagnostic imaging, Discitis drug therapy, Humans, Immobilization, Lung Abscess complications, Lung Abscess drug therapy, Lung Abscess microbiology, Male, Middle Aged, Neck Pain drug therapy, Neck Pain etiology, Neck Pain therapy, Spinal Cord Compression diagnostic imaging, Spinal Cord Compression etiology, Staphylococcal Infections diagnostic imaging, Staphylococcal Infections drug therapy, Staphylococcus classification, Tomography, X-Ray Computed, Cervical Vertebrae microbiology, Discitis microbiology, Staphylococcal Infections microbiology, Staphylococcus isolation & purification
- Published
- 2013
- Full Text
- View/download PDF
41. A staged treatment algorithm for spinal infections.
- Author
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Stüer C, Stoffel M, Hecker J, Ringel F, and Meyer B
- Subjects
- Adult, Aged, Aged, 80 and over, Cervical Vertebrae microbiology, Cervical Vertebrae surgery, Disease Management, Female, Follow-Up Studies, Humans, Lumbar Vertebrae microbiology, Lumbar Vertebrae surgery, Male, Middle Aged, Retrospective Studies, Thoracic Vertebrae microbiology, Thoracic Vertebrae surgery, Treatment Outcome, Algorithms, Neurosurgical Procedures methods, Spinal Diseases microbiology, Spinal Diseases surgery
- Abstract
Background and Study Aim: Spinal pyogenic infections occur frequently in today's neurosurgical routine. Conservative therapy often proves to be insufficient against an aggressive disease that affects patients who tend to be elderly and debilitated with complex comorbidity. Treatment, or lack of treatment, carries risks of persistent disability, sepsis, and death. In this study, we propose a tailored and staged algorithm for treating such spinal infections and present results of this approach., Patients and Methods: We retrospectively analyzed 52 patients (33 male, 19 female; median age: 68 years) who had undergone cervical, thoracic, or lumbar surgery for spinal infections according to the proposed staged treatment algorithm., Results: Most of the 52 patients were severely disabled (35% with quadri- or paraparesis, 31% with sepsis and catecholamine dependency, 17% with a single motor deficit, and 10% with meningitis). We surgically treated multilevel and multisegmental spinal infections via 23 nonstabilizing and 57 stabilizing ventral or dorsal approaches to the cervical, thoracic, or lumbar spine. The mean follow-up time was 24 months. Overall mortality was 19%. Surgery-related complications occurred in 11.5% of patients; recurrence of infection occurred in 3.8%. Motor function improved in 61.7%; bladder and sphincter dysfunction remitted completely in 50.0%., Conclusions: Depending on the patient's health status and neurological condition, surgery in complex spinal infections provides a good outcome in most cases. Nevertheless, indication must be individualized; for this, the proposed algorithm seems to be an excellent tool. We find that surgery should be discussed as a treatment of first choice for today's often complex spinal infections., (Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2013
- Full Text
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42. Cervical spondylitis due to Phaeoacremonium venezuelense in an immunocompetent patient. A first case report.
- Author
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Mostofi K, Jeanbourquin D, and Charles JI
- Subjects
- Amphotericin B adverse effects, Amphotericin B therapeutic use, Antifungal Agents adverse effects, Antifungal Agents therapeutic use, Cervical Vertebrae diagnostic imaging, Epidural Abscess diagnostic imaging, Epidural Abscess drug therapy, Humans, Immunocompetence, Kidney Diseases chemically induced, Magnetic Resonance Imaging, Male, Middle Aged, Mycoses diagnostic imaging, Mycoses drug therapy, Pyrimidines therapeutic use, Species Specificity, Spondylitis diagnostic imaging, Spondylitis drug therapy, Tomography, X-Ray Computed, Triazoles therapeutic use, Voriconazole, Ascomycota isolation & purification, Cervical Vertebrae microbiology, Epidural Abscess microbiology, Mycoses microbiology, Spondylitis microbiology
- Abstract
In this paper, we present a case of cervical spondylitis due to Phaeoacremonium venezuelense, in a fifty-two-year-old male who complained about neck pain and tingles in his right arm. Fungal cervical spondylitis is extremely rare in immunocompetent patients. This case is the first case of spondylitis due to P. venezuelense., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)
- Published
- 2012
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43. Severe spinal angulation.
- Author
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Koubâa M, Marrakchi C, Maâloul I, Hammami B, Lahiani D, Mnif Z, and Ben Jemâa M
- Subjects
- Cervical Vertebrae pathology, Female, Humans, Young Adult, Cervical Vertebrae microbiology, Thoracic Vertebrae microbiology, Thoracic Vertebrae pathology, Tuberculosis, Spinal pathology
- Published
- 2012
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- View/download PDF
44. Pleural involvement in spinal tuberculosis.
- Author
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Malhotra HS, Garg RK, and Raut TP
- Subjects
- Abscess complications, Abscess diagnostic imaging, Abscess microbiology, Adult, Cervical Vertebrae diagnostic imaging, Cervical Vertebrae microbiology, Female, Humans, Male, Pleura diagnostic imaging, Pleura microbiology, Radiography, Tuberculosis, Spinal complications, Tuberculosis, Spinal diagnostic imaging, Tuberculosis, Spinal microbiology, Abscess pathology, Cervical Vertebrae pathology, Mycobacterium tuberculosis pathogenicity, Pleura pathology, Tuberculosis, Spinal pathology
- Abstract
Spinal tuberculosis or Pott's disease of the spine associated with pleural involvement has long intrigued researchers regarding the nature and pathogenesis of their occurrence. We describe two interesting patients of spinal tuberculosis, one with cervical and another with thoracic spine disease, with pleural involvement, which developed after lateral extension of cold abscess involving the parietal pleura, and without any evidence of pulmonary disease.
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- 2012
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45. Management of infectious discitis. Outcome in one hundred and eight patients in a university hospital.
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Cebrián Parra JL, Saez-Arenillas Martín A, Urda Martínez-Aedo AL, Soler Ivañez I, Agreda E, and Lopez-Duran Stern L
- Subjects
- Aged, Aged, 80 and over, Comorbidity, Cross-Sectional Studies, Diabetes Mellitus epidemiology, Discitis diagnosis, Discitis epidemiology, Female, Hospitals, University, Humans, Incidence, Magnetic Resonance Imaging, Male, Middle Aged, Retrospective Studies, Spain epidemiology, Treatment Outcome, Cervical Vertebrae microbiology, Discitis drug therapy, Discitis surgery, Lumbar Vertebrae microbiology, Thoracic Vertebrae microbiology
- Abstract
Purpose: The optimal management of pyogenic discitis is not agreed on. We conducted a retrospective, cross-sectional, observational study in which all patients with discitis who attended Hospital San Carlos Madrid from January 1999 to January 2009 were included., Methods: We identified 108 consecutive adult patients with infectious discitis. There were 49 men and 59 women with an average age of 67,5 (+/- 16,89) years in the study group. Mean follow-up interval was 6,06 (12,5-2) years. 78 patients had spontaneous discitis and 30 patients had postoperative discitis. Inclusion criteria for the review were illness compatible with vertebral infection and / or evidence of spinal involvement on magnetic resonance imaging (MRI)., Results: In 56 percutaneous discal biopsy (52% patients) were positive in 28 cases. A single disc was infected in 100 patients. The segments involved were the cervical spine in four, the thoracic spine in 38 and the lumbar spine in 66. One or more comorbid diseases were present in 73 (68%) of 108 patients. Diabetes mellitus was the most common disease. Comorbid disease was rapidly fatal in four patients, ultimately fatal in seven patients, and nonfatal or not present in 97 patients (90 %)., Conclusion: Early diagnosis is a major challenge. Heightened awareness and the prompt use of MRI are necessary to avoid diagnostic delay. Prolonged antimicrobial therapy and the judicious application of timely surgical intervention are essential for an optimal outcome.
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- 2012
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46. Pseudomonas aeruginosa osteomyelitis of the cervical spine.
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Alshaya WA and Alkhani AM
- Subjects
- Cervical Vertebrae diagnostic imaging, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Osteomyelitis diagnostic imaging, Penicillanic Acid analogs & derivatives, Penicillanic Acid pharmacology, Piperacillin pharmacology, Piperacillin, Tazobactam Drug Combination, Pseudomonas aeruginosa drug effects, Radiography, Smoking adverse effects, Cervical Vertebrae microbiology, Osteomyelitis microbiology, Pseudomonas Infections complications, Pseudomonas Infections diagnosis, Pseudomonas aeruginosa isolation & purification
- Published
- 2012
47. Clinical features of cervical pyogenic spondylitis and intraspinal abscess.
- Author
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Miyazaki M, Yoshiiwa T, Kodera R, and Tsumura H
- Subjects
- Abscess microbiology, Abscess pathology, Aged, Aged, 80 and over, Cervical Vertebrae pathology, Female, Fever of Unknown Origin diagnosis, Fever of Unknown Origin microbiology, Fever of Unknown Origin pathology, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Muscle Weakness diagnosis, Muscle Weakness microbiology, Muscle Weakness pathology, Neck Pain diagnosis, Neck Pain microbiology, Neck Pain pathology, Spondylitis microbiology, Spondylitis pathology, Staphylococcal Infections pathology, Abscess diagnosis, Cervical Vertebrae microbiology, Spondylitis diagnosis, Staphylococcal Infections diagnosis
- Abstract
Study Design: Retrospective study., Objectives: The purpose of the present study was to elucidate the clinical features of cervical pyogenic spondylitis and intraspinal abscess and to use this knowledge for early diagnosis and treatment., Summary of Background Data: Cervical pyogenic spondylitis and intraspinal abscess are relatively rare diseases in which accurate diagnosis is difficult at early stage. However, because both diseases can cause severe paralysis and vital crisis at advanced stages, early diagnosis and treatment are very important., Methods: Fourteen patients (men: 9, women: 5; average age at treatment: 65.4 y; age range: 49-89 y) with cervical pyogenic spondylitis and/or intraspinal abscess were treated in our hospital. We analyzed their initial symptoms, initial diagnosis, duration between the appearance of initial symptoms and final diagnosis, symptoms at final diagnosis, level of the affected cervical spine, predisposing factors, organisms, and treatments., Results: Initial symptoms included neck pain with fever (n=7), neck pain without fever (n=3), pharyngeal pain with fever (n=1), muscle weakness in both the upper and lower extremities (n=1), gait disturbance (n=1), and numbness of the lower extremities (n=1). Patients were initially diagnosed with meningitis (n=4), fever of unknown origin (n=2), cervical spondylosis (n=2), polymyalgia rheumatica (n=1), upper respiratory tract inflammation (n=1), metastatic spinal tumor (n=1), cervical spondylotic myelopathy (n=1), and cervical disc herniation (n=1). Of the 14 patients, 1 was correctly diagnosed with cervical pyogenic spondylitis., Conclusions: The initial symptoms of cervical pyogenic spondylitis and intraspinal abscess varied and neck pain with fever was not essential. Therefore, doctors should consider the possibility of cervical pyogenic spondylitis and repeat the assessments of the clinical examination for early diagnosis of this disease.
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- 2011
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48. Group A streptococcal vertebral osteomyelitis presenting with acute quadriplegia.
- Author
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Furitsch M, Träger K, van der Linden M, and Spellerberg B
- Subjects
- Aged, Anti-Bacterial Agents therapeutic use, Cervical Vertebrae diagnostic imaging, Cervical Vertebrae pathology, Clindamycin therapeutic use, Fatal Outcome, Germany, Humans, Magnetic Resonance Imaging, Male, Meropenem, Osteomyelitis cerebrospinal fluid, Osteomyelitis microbiology, Osteomyelitis therapy, Quadriplegia cerebrospinal fluid, Quadriplegia diagnosis, Quadriplegia microbiology, Radiography, Spinal Cord Diseases cerebrospinal fluid, Spinal Cord Diseases diagnosis, Spinal Cord Diseases microbiology, Spinal Cord Diseases therapy, Streptococcal Infections cerebrospinal fluid, Streptococcal Infections microbiology, Streptococcal Infections therapy, Streptococcus agalactiae drug effects, Thienamycins therapeutic use, Cervical Vertebrae microbiology, Osteomyelitis diagnosis, Quadriplegia therapy, Streptococcal Infections diagnosis, Streptococcus agalactiae isolation & purification
- Published
- 2011
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49. [A conus medullaris tuberculoma: a case report and literature review].
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Agossou M, Gargouri I, Holveck A, Dimitriu CP, Fraisse P, and Quoix E
- Subjects
- Adrenal Cortex Hormones therapeutic use, Aged, Antitubercular Agents therapeutic use, Brain microbiology, Drug Therapy, Combination, Humans, Inappropriate ADH Syndrome etiology, Magnetic Resonance Imaging, Male, Radiography, Remission Induction, Tuberculoma drug therapy, Tuberculosis, Central Nervous System complications, Tuberculosis, Meningeal drug therapy, Tuberculosis, Meningeal etiology, Tuberculosis, Miliary diagnostic imaging, Tuberculosis, Miliary drug therapy, Tuberculosis, Pulmonary complications, Tuberculosis, Pulmonary diagnostic imaging, Tuberculosis, Spinal drug therapy, Cervical Vertebrae microbiology, Lumbar Vertebrae microbiology, Spinal Cord Compression etiology, Tuberculoma complications, Tuberculosis, Spinal complications
- Abstract
Background: Tuberculosis affecting the central nervous system is well recognized, but only rarely localizes to the medullary conus., Observation: We report the case of a 69 year old man who was admitted to our unit with cauda equina syndrome. The MRI demonstrated ring-enhanced necrotizing lesions involving the medullary conus, the cervical cord and the brain. His chest CT scan showed a miliary infiltrate. The clinical presentation was associated with an inappropriate secretion of antidiuretic hormone. Quadruple antituberculous therapy was initiated, with corticosteroids in the initial phase of the treatment. Evolution was favorable, and follow-up MRI imaging demonstrated complete resolution of the cervical cord and brain lesions., (Copyright © 2011. Published by Elsevier Masson SAS.)
- Published
- 2011
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50. Septic elbow in the setting of neuropathic joint as the initial presentation of a cervical syrinx.
- Author
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Strike SA, Johnston JC, and Farjoodi P
- Subjects
- Anti-Bacterial Agents therapeutic use, Arthritis, Infectious microbiology, Arthritis, Infectious surgery, Arthropathy, Neurogenic microbiology, Arthropathy, Neurogenic surgery, Cefepime, Cephalosporins therapeutic use, Cervical Vertebrae microbiology, Cervical Vertebrae pathology, Cervical Vertebrae surgery, Elbow Joint microbiology, Humans, Magnetic Resonance Imaging, Male, Methicillin-Resistant Staphylococcus aureus isolation & purification, Methicillin-Resistant Staphylococcus aureus physiology, Middle Aged, Staphylococcal Infections microbiology, Staphylococcal Infections pathology, Staphylococcal Infections surgery, Syringomyelia microbiology, Syringomyelia surgery, Treatment Refusal, Vancomycin therapeutic use, Arthritis, Infectious pathology, Arthropathy, Neurogenic pathology, Elbow Joint pathology, Syringomyelia pathology
- Abstract
Neuropathic arthropathy, or Charcot's joint, is a degenerative disorder resulting from abnormal sensory innervation that is associated with diabetes mellitus, tabes dorsalis, and syringomyelia. Patients may present with a painless instability of the affected joint, although a range of symptoms are seen. This article presents a case of a patient who presented with a swollen elbow, consistent with septic arthritis, and bilateral lower extremity weakness. Joint fluid cultures were positive for methicillin-resistant Staphylococcus aureus. Extensive joint destruction on radiographic imaging and a thorough neurologic examination revealing generalized weakness and upper motor neuron signs prompted magnetic resonance imaging (MRI) of the spine which revealed a cervical syrinx. Our patient was diagnosed with syringomyelia-associated neuropathic arthropathy that initially presented as a septic joint. In the setting of septic arthritis, substantial joint destruction (particularly in a patient with neurologic deficits) should prompt additional investigation, including MRI of the spine, for neurologic causes. Although surgery is generally not recommended for neuropathic arthropathy because of poor healing and high rates of complication, neuropathic arthropathy in the setting of a septic joint requires operative irrigation and debridement., (Copyright 2011, SLACK Incorporated.)
- Published
- 2011
- Full Text
- View/download PDF
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