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Patient demographic and clinical characteristics may be factors associated with the success of conservative treatment for pyogenic spondylitis. The ability of imaging findings at initial diagnosis to predict patient outcomes remains unclear. The aim of this study was to investigate the risk factors associated with conversion surgery after conservative treatment for pyogenic spondylitis, with a special focus on the initial computed tomography (CT) findings. This study enrolled 35 patients with pyogenic spondylitis who underwent CT and magnetic resonance imaging (MRI) at diagnosis and were followed-up for more than 6 months. Patients were diagnosed by MRI, and the degree of bone destruction was assessed on CT cross-sectional images. Vertebral body destruction was classified as grades 0 (almost normal), 1 (endplate irregularity), 2 (vertebral body destruction not involving the posterior wall), and 3 (destruction involving the posterior wall). Patients were divided into four groups based on grade of bone destruction and their clinical characteristics were compared. 1, 11, 11, and 12 patients were classified as grades 0, 1, 2, and 3, respectively. Univariate analysis showed no significant differences in the demographic and clinical characteristics of the four groups. Eighteen (51.4 %) patients had been treated surgically, with the rate of surgical treatment being significantly higher in patients with grade 3 (83.3 %) than in those with grades 0 + 1 (25 %) and grade 2 (45.5 %) (P < 0.05). Multivariate analysis showed that epidural abscess on MRI (odds ratio [OR] 10.8, 95 % confidence interval [CI] 1.68–69.7), grade 3 bone destruction on CT (OR 3.97, 95 % CI 1.21–13.0), and C-reactive protein (CRP) improvement rate after 1 week of treatment (OR 0.95, 95 % CI 0.91–0.99) were risk factors for surgery. Early surgical treatment should be considered for patients with pyogenic spondylitis who present with an epidural abscess on MRI and bone destruction extending to the posterior wall on CT at the time of diagnosis. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the clinical management and effectiveness of metagenomic next-generation sequencing (mNGS) in patients with pyogenic spinal infections. Methods: We conducted a retrospective review of 17 patients diagnosed with pyogenic spinal infections and treated at our institution between October 2022 and February 2024. The cohort included 8 males and 9 females, with a mean age of 63.59 ± 10.18 years (range: 41–71 years). The infections comprised 9 epidural abscesses, 6 intervertebral space infections, and 2 deep abscesses. All patients underwent open surgical procedures and mNGS-based bacterial identification using intraoperative pus or tissue specimens, in addition to conventional blood bacterial cultures. Clinical outcomes were assessed using CRP, PCT, WBC inflammatory markers, and VAS scores postoperatively. Results: All 17 patients with pyogenic spinal infections underwent open surgery and mNGS bacterial detection at our institution. Among the 17 patients, mNGS yielded positive results in 14 cases (82.4%), significantly higher than the 5.9% positivity rate of conventional bacterial cultures (p < 0.001). The mNGS test time was notably shorter than conventional cultures (1.0 vs. 5.88 days, p < 0.001). Postoperative antibiotic therapy was adjusted based on mNGS findings. There were significant reductions in postoperative VAS, WBC, PCT, and CRP values compared to preoperative levels (p < 0.01). Conclusion: Metagenomic next-generation sequencing is effective in managing pyogenic spinal infections by facilitating rapid and sensitive detection of pathogens. This technique improves the timeliness and accuracy of diagnosis, highlighting its potential for broader clinical use. [ABSTRACT FROM AUTHOR]

Rationale and objective: To investigate the MR characteristics of phlegmonous stage and abscess stage primary spinal epidural abscess. Materials and methods: This study retrospectively analyzed the clinical and imaging characteristics of 27 cases of pathologically confirmed primary spinal epidural abscess. Predisposing conditions of all patients were collected. All patients underwent conventional magnetic resonance imaging, while fifteen patients also underwent post-contrast magnetic resonance imaging. Results: The initial symptoms included back pain in 25 patients, fever in 18, motor deficit in five, and sensory changes in 13. Underlying diseases included distant site of infection in seven, injection therapy in five, neoplasm in five, chronic inflammatory disease in five, diabetes mellitus in four, alcoholism in three, metabolic disorder in three, hepatopathy in three, and obesity in two. Abscess location was ventral epidural space in 15 patients (55.6%) and dorsal epidural space in 12 (44.4%). On T1-weighted image, the abscess was hypointense to the spinal cord in 23 patients (85%) and isointense in four (15%). All abscesses were hyperintense to the spinal cord on T2-weighted image. Among the 15 patients who underwent contrast-enhanced imaging, ring enhancement was present in 13 and homogeneous enhancement in two. Adjacent vertebrae body edema was present in four patients. The abscess was purely intraspinal in 25 patients (92.6%). Paraspinal extension was present in two (7.4%). Conclusion: Primary spinal epidural abscess patients have one or more predisposing conditions. Phlegmonous stage primary spinal epidural abscess appears isointense on T1WI and hyperintense on T2WI and enhancement is homogeneous. Abscess stage primary spinal epidural abscess hyperintense on T2WI and hypointense on T1WI and ring enhancement. Presence of vertebral body edema is an important sign to help diagnose primary spinal epidural abscess. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective cohort study. Objective. To externally validate the Spinal Orthopaedic Research Group (SORG) index for predicting 90-day mortality from spinal epidural abscess and compare its utility to the 11-item modified frailty index (mFI-11) and Charlson comorbidity index (CCI).Summary of Background Data. Providing a mortality estimate may guide informed patient and clinician decision-making. A number of prognostic tools and calculators are available to help predict the risk of mortality from spinal epidural abscess, including the SORG index, which estimates 90-day postdischarge mortality. External validation is essential before wider use of any clinical prediction tool. Materials and Methods. Patients were identified using hospital coding. Medical and radiologic records were used to confirm the diagnosis. Mortality data and data to calculate the SORG index, mFI-11, and CCI were collected. Area under the curve and calibration plots were used to analyze. Results. One hundred and fifty patients were included: 58 were female (39%), with a median age of 63 years. Fifteen deaths (10%) at 90 days postdischarge and 20 (13%) at one year. The mean SORG index was 13.6%, the mean CCI 2.75, and the mean mFI-11 was 1.34. The SORG index (P= 0.0006) and mFI-11 (P< 0.0001) were associated with 90-day mortality. Area under the curve for SORG, mFI-11, and CCI were 0.81, 0.84, and 0.49, respectively. The calibration slope for the SORG index showed slight overestimation in the middle ranges of the predicted probability, more so than mFI-11, and was not well-calibrated over the higher ranges of predicted probability. Conclusions. This study externally validated the SORG index, demonstrating its utility in our population at predicting 90-day mortality; however, it was less well calibrated than the mFI-11. Variations in algorithm performance may be a result of differences in socioethnic composition and health resources between development and validation centres. Continued multicenter data input may help improve such algorithms and their generalisability. [ABSTRACT FROM AUTHOR]

Background The incidence of spine infections has increased due to the surge in injection drug use driven by the opioid epidemic. Few recent studies have evaluated the microbiology of spinal epidural infections among people who inject drugs compared to the microbiology of such infections among the general population. Methods We performed a retrospective chart review to identify patients with a spinal epidural abscess or phlegmon unrelated to recent spine surgery between 2015 and 2023. Results Of 346 initial records, 277 met inclusion criteria for demographic analyses. Of the 229 patients with microbiologic results, details regarding possible drug use were available in 227 patients. Patients with no documented history of drug use were categorized as non-PWUD, while patients who use drugs (PWUD) were separated based on whether drug use was active or not. Patients with prior histories of injection or noninjection drug use were categorized as nonactive PWUD, while those with injection or snorting drug use reported in the past 3 months were categorized as active PWUD. Thirty-nine percent of patients with spinal epidural infection had substance use disorder. Most patients with monomicrobial cultures were infected with gram-positive, aerobic bacteria (86%). Active PWUD were more likely to have methicillin-resistant Staphylococcus aureus compared to non-PWUD (36% vs 13%, respectively, P =.002). Nonactive PWUD were more likely to have non– Escherichia coli gram-negative bacterial infections than non-PWUD (18% and 4.4%, respectively, P =.01). Conclusions More than 1 in 3 patients with a spinal epidural infection unrelated to recent surgery had substance use disorder. These patients are more likely to have infections due to MRSA and gram-negative bacteria other than E coli such as Serratia marcescens. [ABSTRACT FROM AUTHOR]

Cervical septic arthritis can lead to complications such as epidural abscess, which may result in respiratory failure. We present a case of a 78‑year‑old male with cervical septic arthritis complicated by epidural abscess, leading to severe diaphragm dysfunction. Ultrasound evaluation revealed dysfunction of the left hemidiaphragm and compensatory activation of accessory respiratory muscles. Treatment included antibiotic therapy and corticosteroids, alongside respiratory support. After 21 days, improvements were observed in diaphragmatic function and respiratory muscle activation. Our findings highlight the importance of assessing both diaphragm and accessory respiratory muscles in cases of cervical septic arthritis with respiratory complications. [ABSTRACT FROM AUTHOR]

Background: The incidence of metastatic complications in Gram-negative bloodstream infection (GN-BSI) remains undefined. This retrospective cohort study examines the incidence and predictors of complications within 90 days of GN-BSI. Methods: Patients with GN-BSIs hospitalized at two Prisma Health-Midlands hospitals in Columbia, South Carolina, USA from 1 January 2012 through 30 June 2015 were included. Complications of GN-BSI included endocarditis, septic arthritis, osteomyelitis, spinal infections, deep-seated abscesses, and recurrent GN-BSI. Kaplan–Meier analysis and multivariate Cox proportional hazards regression were used to examine incidence and risk factors of complications, respectively. Results: Among 752 patients with GN-BSI, median age was 66 years and 380 (50.5%) were women. The urinary tract was the most common source of GN-BSI (378; 50.3%) and Escherichia coli was the most common bacteria (375; 49.9%). Overall, 13.9% of patients developed complications within 90 days of GN-BSI. The median time to identification of these complications was 5.2 days from initial GN-BSI. Independent risk factors for complications were presence of indwelling prosthetic material (hazards ratio [HR] 1.73, 95% confidence intervals [CI] 1.08–2.78), injection drug use (HR 6.84, 95% CI 1.63–28.74), non-urinary source (HR 1.98, 95% CI 1.18–3.23), BSI due to S. marcescens, P. mirabilis or P. aeruginosa (HR 1.78, 95% CI 1.05–3.03), early clinical failure criteria (HR 1.19 per point, 95% CI 1.03–1.36), and persistent GN-BSI (HR 2.97, 95% CI 1.26–6.99). Conclusions: Complications of GN-BSI are relatively common and may be predicted based on initial clinical response to antimicrobial therapy, follow-up blood culture results, and other host and microbiological factors. [ABSTRACT FROM AUTHOR]

Extensive spinal epidural abscess (ESEA) is a rare clinical entity subject to delayed diagnosis, which can be explained by the extension of the epidural collection, thereby delaying the mass effect responsible for its clinical manifestations. We report a rare case of an extensive C7–T10 epidural abscess in a 54-year-old man treated with antibiotics, laminectomy, and abscess drainage. In addition, we conducted a systematic literature search according to the "Preferred Reporting Items for Systematic Reviews" guidelines. Relevant studies (1980–2023) reporting patients with ESEA were identified from PubMed databases. A total of 48 studies reporting 55 patients were included in this study with a mean age of 55.7 ± 14.6 years with a male predominance of 61.8% (n = 34). The median duration of follow-up was 38 months (21.5–64.3). The mortality rate of ESEA was 1.8% for a 21.8% morbidity rate with 76.4% (n = 42) reported to have been improved after surgery. Both single and multilevel laminectomy with abscess drainage for ESEA leads to patient recovery from this devastating condition. Evaluation of the outcome with data on time-to-Nadir and Nadir-to-surgery is needed to codify ESEA management. [ABSTRACT FROM AUTHOR]

Guangming Yang,1,&ast; Jian Zhang,2,&ast; Qian Liu,2 Erqing Chai2 1The First Clinical School of Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu Province, 730000, People’s Republic of China; 2Gansu Provincial Hospital, Lanzhou, Gansu Province, 730000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Erqing Chai, Email 18809407241@163.comAbstract: Inflammation of the frontal sinus is a relatively common clinical condition among paranasal sinusitis and is curable through anti-infection treatments, with a rare progression to frontal sinus abscess. An even rarer complication is the development of intracranial epidural empyema secondary to frontal sinus abscess. In this report, we describe a case of a 14-year-old male with a frontal sinus abscess that led to intracranial infection and was complicated by an epidural abscess misdiagnosed as an epidural hematoma. The primary symptoms were headache, dizziness, and fever. Following combined antibiotic therapy and surgical intervention, including maxillary and frontal sinus window drainage, the patient was cured. A follow-up period of three months showed no recurrence, indicating a favorable outcome.Keywords: sinusitis, frontal sinus abscess, intracranial infection, epidural abscess

Abstract Background An upper cervical spine epidural abscess (UCEA) is an epidural abscess that develops in the area between the occiput and the second cervical spine (axis). It is a rare diagnosis that carries the risk of instability of the atlantoaxial joint, and its management is not well-defined. It is known that the skin is the most common source of infection, and that diabetes mellitus (DM) is the most frequently reported risk factor. In this case, we present a patient diagnosed with UCEA, who achieved full neurological recovery postoperatively despite having neurological deficits for over five days prior to surgery. Case presentation We report the case of a 56-year-old male patient with no history of any prior medical conditions, who presented with headache, neck pain, and weakness of the left side. The weakness started approximately three days prior to his presentation. His initial work up revealed hyperglycemia and elevated HbA1c of 86 mmol/mol (10%). Magnetic resonance imaging (MRI) of the cervical spine revealed spondylitis of the C2 spine with an abscess at the craniocervical junction. He underwent a two-staged surgical approach: decompression and stabilisation. The patient achieved full motor recovery approximately three months postoperatively. Conclusions We recommend screening for DM when a spinal epidural abscess (SEA) is diagnosed without readily identifiable risk factors. The optimal management in most SEA cases is surgical, which is particularly true for UCEA because of the risk of atlantoaxial joint instability. Full neurological recovery is possible even when the patient has been having deficits for more than five days.

Spinal involvement of infantile hemangiomas is rare with the predilection to involve the epidural space. A proper diagnosis might be challenging due to the atypical location and variable/inconsistent use of the International Society for the Study of Vascular Anomalies (ISSVA) classification by radiologists, pathologists, and clinicians. A proper diagnosis of epidural infantile hemangioma is key due to the different aggressiveness of the treatment options with inconstant literature regarding the best available treatment. Herein, we present a case of a massive epidural infantile hemangioma successfully treated with only beta-blocker. We discuss the clinical, MRI, CT, ultrasound, and histological features of this lesion as we review the literature with the objective of addressing some of the confusion surrounding the subject. [ABSTRACT FROM AUTHOR]

Abstract Background Spondylodiscitis is an infection of the vertebral body extending to the intervertebral disc, and possibly the surrounding paraspinal structures. Objectives To evaluate the clinical results of posterior long segment transpedicular screws fixation and decompression of the infected area for management of idiopathic pyogenic spondylodiscitis of the thoracic and lumbar spine. Methods This retrospective study included 14 patients with idiopathic active pyogenic spondylodiscitis of the lumber and thoracic spine between January 2017 and December 2021, with follow-up continuing until December 2022. All patients had posterior long-segment rigid fixation with infection decompression. Results All patients after 6-month follow-up had achieved complete fusion. There was no evidence of postoperative wound infection, and no patient had a recurrence of infection at the lesion site during follow-up. Prior to surgery, the mean VAS score for back pain was 7.6 (range 6–9), however, after surgery, it fell to 1.3 (0–3), a statistically significant improvement (P

Abstract Background The incidence of cervical spinal brucellosis is low, only a few case reports have been published, and case series are not widely reported in the medical literature. Therefore, clinical features, management, and outcomes of cervical spinal brucellosis are relatively unknown. In this series, the authors report 15 cases of patients with cervical spinal brucellosis, including clinical characteristic, imaging findings, management plans, the institution’s experience, and outcomes at 1 year postoperatively. Methods The study reviewed the clinical and radiographic records of 15 patients who received antimicrobial pharmacotherapy, and anterior cervical debridement and fusion for cervical spinal brucellosis. The data collected included patient demographic characteristics, spinal level affected, abscess, neurology, pathological reports, duration and type of antimicrobial regimens, details of orthopedic management, and complications incurred during the procedure. Results Neck pain (100%) and limb paralysis (86.7%) were the most common clinical presentations, and the disease had a rapid progression. The C6-7 segment was the most commonly affected segment, followed by C4-5 and C5-6. Imaging commonly revealed epidural or paravertebral abscesses (80%). There was a significant improvement in the VAS, JOA, and NDI scores three months after surgery, and the scores continued to improve until the final follow-up. There was a statistically significant difference between the pre- and postoperative scores (P

Background: Spondylodiscitis is an infection of the vertebral body extending to the intervertebral disc, and possibly the surrounding paraspinal structures. Objectives: To evaluate the clinical results of posterior long segment transpedicular screws fixation and decompression of the infected area for management of idiopathic pyogenic spondylodiscitis of the thoracic and lumbar spine. Methods: This retrospective study included 14 patients with idiopathic active pyogenic spondylodiscitis of the lumber and thoracic spine between January 2017 and December 2021, with follow-up continuing until December 2022. All patients had posterior long-segment rigid fixation with infection decompression. Results: All patients after 6-month follow-up had achieved complete fusion. There was no evidence of postoperative wound infection, and no patient had a recurrence of infection at the lesion site during follow-up. Prior to surgery, the mean VAS score for back pain was 7.6 (range 6–9), however, after surgery, it fell to 1.3 (0–3), a statistically significant improvement (P < 0.001) during the last follow-up. According to the Kirkaldy-Willis criteria, the functional prognosis was excellent in 11 individuals, good in two, and fair in one. Conclusions: Posterior long-segment fixation in conjunction with decompression of the affected area effectively resolved bacterial spinal infection and restored neurological impairment. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Facet joint septic arthritis (SAFJ) is a rare clinical entity that is extremely challenging to diagnose, often presenting unilaterally and with nonspecific clinical symptoms. However, SAFJ has significant morbidity and mortality, especially with delayed diagnosis. It becomes all the more important for the clinician to recognize that SAFJ can present bilaterally and be associated with direct inoculation, such as in acupuncture. Case Report: A 53-year-old woman with chronic alcoholism and well-controlled type 2 diabetes mellitus was initially admitted for progressively worsening atraumatic lower back pain. Initial non-contrast magnetic resonance imaging (MRI) of the lumbar spine revealed bilateral L4-L5 and L5-S1 nonspecific facet joint effusions. Clinical examination was unremarkable. Biochemically, the patient had mildly elevated inflammatory markers. She was treated conservatively with close outpatient follow-up. However, her back pain progressively worsened, with new-onset lower limb weakness and numbness. Repeat MRI showed L4-L5 bilateral facet joint fluid collection with adjacent bony destruction, as well as posterior paraspinal and epidural fluid collections compatible with L4-L5 bilateral SAFJ with paraspinal and epidural abscesses. Urgent surgical drainage and bilateral lateral facet decompression was performed. Intraoperative cultures revealed methicillin-sensitive Staphylococcus aureus as the causative organism. Postoperatively, 6 weeks of intravenous and oral antibiotics were given with good recovery. Conclusions: We describe a case of bilateral SAFJ following acupuncture that was initially missed. With the increasing prevalence of acupuncture treatment for lower back pain, bilateral SAFJ should be a diagnostic consideration. Detailed clinical history is key; this, as well as a high index of suspicion, early evaluation and treatment, are essential to obtain a favorable outcome. [ABSTRACT FROM AUTHOR]

There is limited consensus regarding management of spinal epidural abscesses (SEAs), particularly in patients without neurologic deficits. Several models have been created to predict failure of medical management in patients with SEA. We evaluate the external validity of 5 predictive models in an independent cohort of patients with SEA. One hundred seventy-six patients with SEA between 2010 and 2019 at our institution were identified, and variables relevant to each predictive model were collected. Published prediction models were used to assign probability of medical management failure to each patient. Predicted probabilities of medical failure and actual patient outcomes were used to create receiver operating characteristic (ROC) curves, with the area under the receiver operating characteristic curve used to quantify a model's discriminative ability. Calibration curves were plotted using predicted probabilities and actual outcomes. The Spiegelhalter z-test was used to determine adequate model calibration. One model (Kim et al) demonstrated good discriminative ability and adequate model calibration in our cohort (ROC = 0.831, P value = 0.83). Parameters included in the model were age >65, diabetes, methicillin-resistant Staphylococcus aureus infection, and neurologic impairment. Four additional models did not perform well for discrimination or calibration metrics (Patel et al, ROC = 0.580, P ≤ 0.0001; Shah et al, ROC = 0.653, P ≤ 0.0001; Baum et al, ROC = 0.498, P ≤ 0.0001; Page et al, ROC = 0.534, P ≤ 0.0001). Only 1 published predictive model demonstrated acceptable discrimination and calibration in our cohort, suggesting limited generalizability of the evaluated models. Multi-institutional data may facilitate the development of widely applicable models to predict medical management failure in patients with SEA. [ABSTRACT FROM AUTHOR]

Purpose: Mebos, a traditional South Africa confection consisting of dried, pulped, and sugared apricots, is rich in fibre and vitamins, but also contains salicylic acid, flavonoids, and citric acid. We report a case of postoperative surgical site bleeding in a healthy patient who consumed approximately 2 kg of mebos per day prior to his elective spinal surgery. Methods: The clinical course of a previously healthy 54-year-old male patient with cauda equina syndrome secondary to lumbar spinal stenosis who underwent surgical intervention with subsequent bleeding into the surgical site is discussed. The cause was investigated through biochemical analysis, thromboelastometry (ROTEM®) and mass and absorption spectrometry were applied to assess flavonoid, citric acid, and salicylic acid content. Results: ROTEM® revealed an abnormal clotting profile with an increased clot forming time, suggesting intrinsic coagulopathy. Mass and absorption spectrometry revealed a high total flavonoid content as well as citric acid concentration in the mebos. Salicylic acid was at detection limits of the instrument. Conclusion: Results highlighted the effect of flavonoids and citric acid and therefore explain the abnormal clotting profile in this patient. Inhibition of coagulation prior to elective surgery is a known contraindication and may pose great risks in spinal surgery. In the present report, we demonstrated an association between inhibition of coagulation and an excess of the flavonoids content and citric acid concentration in mebos consumed in the days prior to elective spinal surgery. [ABSTRACT FROM AUTHOR]

Background: Angioleiomyomas are benign mesenchymal tumors usually located in the limbs, with anecdotal reports in the spine. We present an atypical case of an epidural spine angioleiomyoma presenting with compressive myelopathy symptoms. The diagnosis was suggested based on MRI findings, and subsequently confirmed histopathologically. Results: This is the first known occurrence of pure spinal epidural angioleiomyoma as a source of compressive myelopathy. The imaging presentation, especially the 'dark reticular sign' on MRI, was crucial in suggesting the diagnosis despite the atypical location Conclusion: This report serves to raise awareness among clinicians and radiologists about including angioleiomyoma in differential diagnoses for spinal epidural lesions with indicative MRI features. The favorable outcome after surgical intervention underscores the necessity of swift and accurate diagnosis followed by appropriate treatment for such uncommon spinal tumors. [ABSTRACT FROM AUTHOR]

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Purpose: Spontaneous spinal epidural hematoma (SSEH) is a rare pathology characterized by a hemorrhage in the spinal epidural space without prior surgical or interventional procedure. Recent literature reported contradictory findings regarding the clinical, radiological and surgical factors determining the outcome, hence the objective of this retrospective analysis was to re-assess these outcome-determining factors. Methods: Patients surgically treated for SSEH at our institution from 2010 – 2022 were screened and retrospectively assessed regarding management including the time-to-treatment, the pre-and post-treatment clinical status, the radiological findings as well as other patient-specific parameters. The outcome was assessed using the modified McCormick Scale. Statistical analyses included binary logistic regression and Fisher's exact test. Results: In total, 26 patients (17 men [65%], 9 women [35%], median age 70 years [interquartile range 26.5]) were included for analysis. The SSEHs were located cervically in 31%, cervicothoracically in 42% and thoracically in 27%. Twenty-four patients (92%) improved after surgery. Fifteen patients (58%) had a postoperative modified McCormick Scale grade of I (no residual symptoms) and 8 patients (31%) had a grade of II (mild symptoms). Only 3 (12%) patients remained with a modified McCormick Scale grade of IV or V (severe motor deficits / paraplegic). Neither time-to-treatment, craniocaudal hematoma expansion, axial hematoma occupation of the spinal canal, anticoagulation or antiplatelet drugs, nor the preoperative clinical status were significantly associated with the patients' outcomes. Conclusion: Early surgical evacuation of SSEH generally leads to favorable clinical outcomes. Surgical hematoma evacuation should be indicated in all patients with symptomatic SSEH. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Intracranial epidural abscesses require swift diagnosis and treatment. While magnetic resonance imaging (MRI) is preferred for its detailed visualisation, it is costly and time‐consuming. Transcranial sonography offers a rapid, portable and cost‐effective alternative for assessing brain lesions.We present a case study involving the diagnosis and management of an intracranial epidural abscess in a 25‐year‐old man with a traumatic brain injury who underwent a craniectomy and later developed fever and drowsiness in the intensive care unit.Using transcranial point‐of‐care ultrasound, a hypoechoic collection was identified at the surgical site, prompting further imaging with computed tomography (CT) and MRI, which confirmed the diagnosis of an epidural abscess. Prompt surgical intervention led to the resolution of symptoms and a favourable clinical outcome.This case highlights the potential utility of brain sonography as an efficient and cost‐effective initial diagnostic tool for detecting intracranial complications, particularly in postoperative patients with altered sensorium and fever, where timely intervention is crucial. [ABSTRACT FROM AUTHOR]

Introduction: Intracranial empyema is a rare but serious and life-threatening infection. It is an accumulation of purulent material in the subdural or extradural space leading to development of subdural empyema or intracranial epidural abscess, respectively. The incidence of morbidity and mortality is high because the diagnosis is often unsuspected. Infections of dental origin could be responsible for such condition. Case reports: A 22-year-old female and 30-year-old male patients, both with no significant medical history, presented with subdural empyema and intracranial epidural abscess, respectively, both complicating pan-sinusitis of dental origin. Successful outcomes were achieved with surgical drainage of the lesions, antibiotic therapy, and extraction of affected teeth. Female patient underwent further management for neurological sequelae, while male patient was discharged without neurological complications. Discussion: Intracranial suppuration of odontogenic origin is an uncommon but extremely serious complication. The most common dental origins are caries with periapical involvement and periodontitis. Wisdom tooth extraction is the most common preceding dental procedure for this infection. A multidisciplinary approach is essential for the identification and treatment of suspected oral sources. Antibiotic therapy with surgical approach is the gold standard treatment. Conclusion: This sequel to odontogenic infection is quite rare, but it can be prevented by a good oral hygiene and removal of abscessed teeth. [ABSTRACT FROM AUTHOR]

Objective: Thoracic spinal epidural abscess (SEA) is a rare but dangerous condition, and traditional surgical methods are accompanied by extensive trauma and approach‐related complications. Here we introduce the technique of full‐endoscopic transforaminal debridement and decompression and evaluate its feasibility for treating brucellar thoracic SEA. Methods: We performed thoracic full‐endoscopic transforaminal decompression and debridement on two patients with neurological deficits caused by brucellar SEA, which is mainly composed of granulation tissue rather than pus. Postoperative MRI was conducted to confirm the presence of any residual abscess compressing the nerves. Frankel grading was employed to assess the recovery of neurological function, and complications were documented. Results: There were no occurrences of dural tear, postoperative hematoma, or pulmonary complications. Their neurological function had significantly improved after surgery, and postoperative MRI confirmed no residual abscess compressing the spinal cord. During the 2‐year follow‐up, one patient achieved complete recovery (from Frankel‐C to Frankel‐E), while another patient improved from Frankel‐A to Frankel‐D. Neither patient experienced infection recurrence, instability, nor kyphotic deformity. Conclusion: We described the novel application of transforaminal endoscopic surgery in brucellar thoracic granulomatous SEA and preliminarily indicated the feasibility of this technique as a minimally invasive alternative to open surgery. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare and analyze differences in clinical and magnetic resonance imaging (MRI) findings between tuberculous spondylodiscitis (TbS) and pyogenic spondylodiscitis (PyS), and to develop and validate a simplified multiparameter MRI-based scoring system for differentiating TbS from PyS. Methods: We compared predisposing factors in 190 patients: 123 with TbS and 67 with PyS, confirmed by laboratory tests, culture, or pathology. Data encompassing patient demographics, clinical characteristics, laboratory results, and MRI findings were collected between 2015 and 2020. Data were analyzed using logistic regression methods, and selected coefficients were transformed into an MRI-based scoring system. Internal validation was performed using bootstrapping method. Results: Univariate analysis revealed that the significant risk factors associated with TbS included thoracic lesions, vertebral destruction > 50%, intraosseous abscess, thin-walled abscess, well-defined paravertebral abscess, subligamentous spreading, and epidural abscess. Multivariate analysis revealed that only thoracic lesions, absence of epidural phlegmon, subligamentous spreading, intraosseous abscesses, well-defined paravertebral abscesses, epidural abscesses, and absence of facet joint arthritis were independent predictive factors for TbS (all p < 0.05). These potential predictors were used to derive an MRI scoring system. Total scores ≥ 14/29 points significantly predicted the probability of TbS, with a sensitivity of 97.58%, specificity of 92.54%, and an area under the curve of 0.96 (95% confidence interval, 125.40–3,257.95). Conclusion: This simplified MRI-based scoring system for differentiating TbS from PyS helps guide appropriate treatment when the causative organism is not identified. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Spinal deformity as a sequela of nontuberculous spondylodiscitis is a rarely discussed clinical entity. Sagittal plane deformity, segmental instability, and persistently active infection overlap in these patients resulting in severe restriction in activity and quality of life. The presence of multiple medical co-morbidities restricts surgical options but nonoperative care may be ineffective and result in persistent, refractory discitis for years. We describe our experience with vertebrectomy and long-segment fixation for patients with postinfectious thoracic or lumbar deformity. Methods: A retrospective chart review of 23 consecutive patients who underwent vertebrectomy and long-segment fixation for thoracic or lumbar deformity secondary to nontuberculous bacterial spondylodiscitis was performed. Pre, peri- and postoperative data is compiled and analyzed with a focus on the perioperative management algorithm to safely perform an extensive reconstruction in this very sick patient population. Results: Extremely low preoperative quality of life was evident with 87% (20/23) of patients bedridden primarily due to pain despite 70% (16/23) of patients being strong enough to ambulate (Frankel D or E). Most patients (87%) already had an identified infection under adequate treatment either through blood cultures, prior biopsy or decompressive surgery. A single-stage posterior-only was the primary surgical approach utilized in the majority (83%) of cases. Complications were present in 100% of patients, most commonly perioperative anemia and hypotension requiring vasopressor support and aggressive blood product replacement. One in-hospital mortality occurred secondarily to pulmonary embolism. Mean preoperative segmental angle was 18±10 degrees of kyphosis which was corrected to 1±9 degrees of lordosis (p=.001). The mean correction of the segmental angle was 19 degrees (standard deviation 23 degrees). Visual analogue scale scores improved from a preoperative value of 8.8±0.9 to a postoperative value of 2.5±1.4 (p

To avoid inhalational anesthetics, total intravenous anesthesia (TIVA) is required in patients with a predisposition to malignant hyperthermia (MH). However, propofol, which is frequently used, may be avoided in patients with egg allergies because of the contraindications in the drug information. Furthermore, some patients may not consent to the use of propofol. We report a case of TIVA using midazolam and dexmedetomidine as substitutes for propofol in a pediatric patient with egg allergy and a predisposition to MH. A 10‑year‑old boy was scheduled to undergo perforated drainage of an epidural abscess. He had egg allergy, and his uncle had been diagnosed with MH. He also developed a generalized drug eruption caused by antibiotics. Concerned about allergic reactions, he and his parents did not consent to administrating propofol. The patient’s perioperative course was uneventful. The combination of midazolam and dexmedetomidine may be a useful option as substitutes for propofol. [ABSTRACT FROM AUTHOR]

This document discusses a case study of a 14-year-old patient who presented with painful bluish lesions on his back that caused diaphragmatic spasms. The patient had previously been diagnosed with glomangioma, a condition characterized by the proliferation of glomus cells with a vascular component. The spasms were debilitating and had a significant impact on the patient's daily life. The authors highlight the unique presentation of glomangioma in this case and emphasize the need for further research and understanding of this condition. [Extracted from the article]

Aim and background: Spinal epidural abscess (SEA) is the collection of pus mostly affecting the epidural space of the spine. Tubercular and fungal etiologies are more commonly accountable for SEA in developing countries and in immunocompromised populations. Case description: The patient presented to us with complaints of fever, bilateral lower limb weakness, and urinary retention of 2 weeks' duration. After contrast-enhanced magnetic resonance imaging (CEMRI) revealed a posterior epidural collection in the dorsal spine, he was empirically started on antibiotics, antitubercular drugs, and steroids. Following an urgent neurosurgical consultation, he underwent a two-level dorsal (D6-D7) laminectomy with evacuation. The drained pus sample revealed Candida albicans growth, which was sensitive to fluconazole. He was started on intravenous (IV) fluconazole followed by echinocandins. Amphotericin, which remains the drug of choice for invasive Candida of the nervous system, could not be initiated in our patient despite the identification of the species, in view of rapidly progressive renal failure. Unfortunately, despite all measures, his condition continued to deteriorate, and he finally succumbed to acute renal failure and sepsis. Conclusion: Spinal epidural abscess is a rare but potentially fatal disease that is often missed or misdiagnosed. Appropriate and timely treatment can help reduce the rate of mortality and morbidity from this fulminant disease. Clinical significance: Fungal SEA is a rare entity and often goes undiagnosed, leading to its mismanagement and subsequent high morbidity and mortality. [ABSTRACT FROM AUTHOR]

Spinal epidural abscess (SEA) is a rare and life-threatening infection within the epidural space with significant functional impairment and morbidity. Active debate remains over whether to operate for SEAs, with limited existing data comparing the long-term survivability after surgical versus nonsurgical management. This study aims to determine the long-term survival of patients who underwent surgical and nonsurgical management for SEA. Retrospective cohort study. A total of 250 consecutive SEA patients. Survival and mortality rates, complications. All patients treated at a tertiary medical center for a primary SEA from January 2000 to June 2020 are identified. Data collection is by retrospective chart review. Cox proportional hazards regression models are used for all survival analyses while controlling for potential confounding variables and with multiple testing corrections. A total of 35 out of 250 patients died with an overall all-cause mortality of 14%. More than half of all deaths occurred within 90 days after treatment. The 90-day, 3-year, and 5-year survival rates are 92.8%, 89.2%, and 86.4%, respectively. Among surgery patients, the all-cause mortality was 13.07%, compared to 16.22% for medically-managed patients. Surgical treatment (decompression, fusion, debridement) significantly reduced the risk of death by 62.4% compared to medical therapy (p=.03), but surgery patients experienced a significantly longer mean length of stay (p=.01). Risk factors of short-term mortality included hypoalbuminemia (<3.5 g/dL), American Society of Anesthesiologists (ASA) 4+, and cardiac arrest. Risk factors of long-term mortality were immunocompromised state, elevated WBC count >12,000, sepsis, septic shock, ASA 4+, and cardiac arrest (p<.05). In terms of complications, surgically-managed patients experienced a higher proportion of deep vein thrombosis (p<.05). The overall long-term survivability of SEA treatment is relatively high at (86% at 5-year) in this study. The following SEA mortality risk factors were identified: hypoalbuminemia (short-term), immunocompromised state (long-term), leukocytosis (long-term), sepsis and septic shock (long-term), ASA 4+ and cardiac arrest (overall). For primary SEA patients, surgical management may reduce mortality risk compared to nonsurgical management. [ABSTRACT FROM AUTHOR]

In recent years, the incidence of spinal epidural abscesses (SEA) has tripled in number and nonoperative management has risen in popularity. While there has been a shift towards reserving surgical intervention for patients with focal neurologic deficits, a third of patients will still fail medical management and require surgical intervention. Failure to understand long-term quality of life and functional outcomes hinders effective decision making and prognostication. To describe patterns and associated factors impacting long-term quality of life following treatment of spinal epidural abscess. Multicenter cohort study at two urban academic tertiary referral centers and two community centers. Adult patients treated for a spinal epidural abscess. EuroQoL 5-Dimension 5L (EQ5D), Neuro-Quality of Life Lower Extremity – Mobility (Short Form; NeuroQoL-LE), Patient-Reported Outcomes Measurement Information System Physical Function (short form 4a; PROMIS PF), and PROMIS Global Mental Health score (PROMIS Mental). Eligible patients were enrolled and administered questionnaires. Multivariable analysis assessed the influence of ambulatory status on HRQL, adjusting for covariates including age, biologic sex, Charlson comorbidity index, intravenous drug use, management approach, and ASIA grade on presentation. Sixty-one patients were enrolled (mean age 60.5 years, 46% male). Thirty-four patients (58%) underwent operative management. Mean standard deviation (SD) results for HRQL measures were: EQ5D 0.51 (0.37), EQ5D visual analogue scale 60.34 (25.11), NeuroQoL Lower extremity 41.47 (10.64), PROMIS physical function 39.49 (10.07), and PROMIS Global Mental Health 44.23 (10.36). Adjusted analysis demonstrated ambulatory status at presentation, and at 1 year, to be important drivers of HRQL, irrespective of other factors including IVDU and ASIA grade. Patients with independent ambulatory function at 1 year had mean EQ5D utility of 0.65 (95% CI 0.55, 0.75), whereas those requiring assistive devices saw a 49% decrease with mean EQ5D utility of 0.32 (0.14, 0.51). Ambulatory status was associated with global and physical function but did not impact overall health self-assessment or mental health scores. We found that ambulatory status was the most important factor associated with long-term HRQL regardless of other factors such as ASIA grade or IVDU. Given prior literature demonstrating the protective effect of operative intervention on ambulatory function, this highlights ambulatory dysfunction as a potential indication for surgery and a marker of poor long-term prognosis, even in the absence of focal neurologic deficits. Our work also highlights the importance of optimized long-term rehabilitation strategies aimed to preserve ambulatory function in this high-risk population. Level III, cohort study [ABSTRACT FROM AUTHOR]

Study Design: Retrospective Cohort Study. Objective: To assess the predictive value of early C-reactive protein (CRP) trends following diagnosis of spinal epidural abscess (SEA). Non-operative management with intravenous antibiotics has not demonstrated equivalent outcomes with regard to mortality and morbidity. Knowledge of specific patient and disease factors associated with worse outcomes may predict treatment failure. Methods: All patients treated for spontaneous SEA in a tertiary centre in New Zealand over a 10-year period were followed for at least 2 years. CRP at diagnosis and day 4-5 following treatment initiation was analyzed to determine predictors of CRP reduction of at least 50%. Proportional Cox hazards regression investigated mortality over 2 years. Results: 94 patients met inclusion criteria and with CRP values available for analysis. Median age was 62 years (+/− 17.7) and 59 (63%) were treated operatively. Kaplan-Meier analysis estimate of 2-year survival was.81 (95% CI.72-.88). CRP reduction by 50% was seen in 34 patients. Patients who did not experience a 50% reduction were more likely to have thoracic infection (27 vs 8, P =.02) or multifocal sepsis (41 vs 13, P =.002). Failure to achieve a 50% reduction by day 4-5 was associated with worse post-treatment Karnofsky scores (70 vs 90, P =.03) and longer hospital stay (25 days vs 17.5 days, P =.04). Cox regression model showed mortality predicted by Charlson Comorbidity Index, thoracic location of infection, pre-treatment Karnofsky score, and failure to achieve a 50% CRP reduction by day 4-5. Conclusions: Patients who fail to reduce CRP values by 50% at day 4-5 following treatment initiation are more likely to experience prolonged hospital stay, have poorer functional outcome and have greater mortality risk at 2 years. This group has severe illness regardless of treatment type. Failure to achieve a biochemical response to treatment should prompt reassessment. [ABSTRACT FROM AUTHOR]

Emphysematous osteomyelitis (EO) is an uncommon fatal condition with high morbidity and mortality. Simultaneous involvement of the axial and appendicular skeleton with multifocal disease is even rarer, with only a few cases being reported in the literature. We present a case of multifocal emphysematous osteomyelitis in a 56-year-old woman with concurrent emphysematous pyelonephritis complicated by psoas and epidural abscesses. The causative organism in our patient was Escherichia coli. Emergency radiologists should be aware of this condition and differentiate it from other benign entities that can present with intraosseous gas. Prompt diagnosis is important given the high morbidity and mortality with this condition. This case report emphasizes the specific pattern of intraosseous gas seen with EO, which can help diagnose EO with confidence. [ABSTRACT FROM AUTHOR]

Background Dalbavancin has been used off-label to treat invasive bacterial infections in vulnerable populations like people who use drugs (PWUD) because of its broad gram-positive coverage and unique pharmacological properties. This retrospective, multisite study examined clinical outcomes at 90 days in PWUD versus non-PWUD after secondary treatment with dalbavancin for bacteremia, endocarditis, osteomyelitis, septic arthritis, and epidural abscesses. Methods Patients at 3 teaching hospitals who received dalbavancin for an invasive infection between March 2016 and May 2022 were included. Characteristics of PWUD and non-PWUD, infection highlights, hospital stay and treatment, and outcomes were compared using χ2 for categorical variables, t test for continuous variables, and nonparametric tests where appropriate. Results There were a total of 176 patients; 78 were PWUD and 98 were non-PWUD. PWUD were more likely to have a patient-directed discharge (26.9% vs 3.1%; P <.001) and be lost to follow-up (20.5% vs 7.14%; P <.01). Assuming loss to follow-up did not achieve clinical cure, 73.1% of PWUD and 74.5% of non-PWUD achieved clinical cure at 90 days (P =.08). Conclusions Dalbavancin was an effective treatment option for invasive gram-positive infections in our patient population. Despite higher rates of patient-directed discharge and loss to follow-up, PWUD had similar rates of clinical cure at 90 days compared to non-PWUD. [ABSTRACT FROM AUTHOR]

Total laryngectomy is an operation mainly employed in recurrent laryngeal and hypopharyngeal carcinoma after previous radiotherapy. The most feared complication after this procedure is a pharyngocutaneous fistula. An extremely rare complication is the development of osteomyelitis of the cervical spine, which is associated with high rates of neurological impairment and epidural empyema, often requiring surgical treatment. This report describes the case of a patient with neck and shoulder pain and progressive motor weakness of the left deltoid and biceps muscle, caused by a pharyngo-cervicospinal fistula with spinal empyema. This condition resulted in destructive osteomyelitis of the cervical spine. A successful reconstruction of the cervical spine and neopharynx was performed using a free vascularized fibula bone and skin graft in a complex area because of previous treatments. It appears that no similar case has been described previously. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer is one of the most frequently diagnosed forms of cancer, and it is associated with several common symptoms and signs such as rectal bleeding, altered bowel habits, abdominal pain, anemia, and unintentional weight loss. Sciatica, a debilitating condition in which the patient experiences paresthesia and pain in the dermatome of associated lumbosacral nerve roots or sciatic nerve distribution, is not considered one of these. Here we present a case of colorectal cancer manifesting symptoms of sciatica alone. Case presentation: A 68-year-old male presented with progressive lower back pain radiating to his left thigh and calf over L5/S1 dermatome. Sciatica was suspected and initially underwent conservative treatment with analgesics. However, the symptoms progressed and MRI revealed an epidural abscess surprisingly. Surgical debridement was performed and pus culture isolated Streptococcus gallolyticus. Based on the strong association of S. gallolyticus with colorectal cancer, the presence of this pathogen prompted further tumor evaluation, even in the absence of the typical symptoms and signs. This investigation ultimately leads to the diagnosis of sigmoid adenocarcinoma. Conclusions: Although rare, sciatica caused by S. gallolyticus infection of the spinal epidural space may serve as the initial presentation of colorectal cancer. Physicians should be aware of the strong association between S. gallolyticus and colorectal cancer. Based on what we currently know about the condition; a thorough systematic assessment of occult neoplasia for patients with S. gallolyticus infection is recommended. [ABSTRACT FROM AUTHOR]

Brucellar cervical epidural abscess (CEA) is a rare condition with potentially permanent neurological damage if left untreated. This study aims to define the clinical presentation of brucellar CEA and evaluate the outcome of surgical treatment, specifically decompression and fusion surgery. The findings will contribute to understanding whether all patients with brucellar CEA could benefit from this surgical intervention. A retrospective study on brucellar spondylitis was conducted at the First Hospital of Jilin University from August 2018 to August 2022. During this period, a total of 37 patients were diagnosed with brucellar spondylitis at the hospital. Out of the 37 cases, six patients (16.2%) were confirmed to have CEA through cervical magnetic resonance imaging examination and serology test results.. Six patients were diagnosed with brucellar CEA (16.2%), of whom 5 successfully underwent anterior cervical decompression and fusion surgery. One patient had a large prevertebral abscess that could only be drained. In combination with effective antibiotic therapy, the clinical performance of the 5 patients who underwent surgery improved after the surgery. The remaining one patient required delayed surgery due to instability of the cervical spine. The follow-up period of all the 6 patients was 6 months. Brucellosis should be considered as a potential cause of CEA, especially in endemic areas. Timely detection and effective management of this condition are crucial in order to minimize the associated morbidity and mortality. For patients with detectable brucellar CEA, we recommend decompression and fusion surgery. [ABSTRACT FROM AUTHOR]

(1) Background: Vertebral osteomyelitis is an infection affecting the vertebrae, with a potentially devastating impact, which requires a prompt diagnosis established as quickly as possible to avoid complications such as neurological impairment, fractures, and chronic pain; (2) Methods: We reported a case of a 47-year-old male patient with multiple risk factors (high blood pressure, smoking, dyslipidemia, type II diabetes) and a history of right hemiplegia post a thalamomesencephalic hemorrhage, admitted to the Neuromuscular Clinic Division of The Teaching Emergency Hospital "Bagdasar-Arseni" (TEHBA) Bucharest, for complete paraplegia following a surgically treated vertebral osteomyelitis at T4-T5 level with spinal epidural abscess; (3) Results: The patient had an oscillating and long evolution, due to long-term antibiotherapy and the imperative of minimal mobilization periods, which eventually led to favorable results, with the recovery of motor function and the ability to perform his previous daily activities; (4) Conclusions: Proper management in vertebral osteomyelitis cases has a great impact on the evolution of the patient, increasing the quality of life, and preventing future complications. A multidisciplinary approach is essential for this type of complex case in order to achieve significant improvements. [ABSTRACT FROM AUTHOR]

Background Septic arthritis of the spinal facet joints is increasingly recognized in the era of magnetic resonance imaging, but its epidemiology, clinical features, management, and prognosis are ill-defined. Methods We review 101 previously published cases and report 16 cases occurring at our institutions between 2006 and 2018. Results Most patients presented with fever (60%) and back or neck pain (86%). Radiation into the hip, buttock, or limb was present in 34%. The lumbosacral vertebral segments were involved in 78% of cases. Most cases (64%) were due to Staphylococcus aureus. Bacteremia was present in 66% and paraspinal muscle abscesses in 54%. While epidural abscesses were present in 56%, neurologic complications were seen in only 9%, likely because most abscesses arose below the conus medullaris. Neurologic complications were more common with cervical or thoracic involvement than lumbosacral (32% vs 2%, P <.0001). Extraspinal infection, such as endocarditis, was identified in only 22% of cases. An overall 98% of patients survived, with only 5% having neurologic sequelae. Conclusions Septic arthritis of the facet joint is a distinct clinical syndrome typically involving the lumbar spine and is frequently associated with bacteremia, posterior epidural abscesses, and paraspinal pyomyositis. Neurologic outcomes are usually good with medical management alone. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus is found in the normal skin and mucosa of approximately 30% of healthy populations and is the most common pathogen in human disease associated with bacteria. They are divided into methicillin-sensitive S. aureus (MSSA) and methicillinresistant S. aureus (MRSA). The S. aureus strains carrying the Panton-Valentine leukocidin genes (SA-PVL) were initially believed to belong to the MRSA group; however, recent reports showed they also belonged to the MSSA group (MSSA-PVL). SA-PVL is common in skin and soft-tissue infections but rare in musculoskeletal infections, especially in spondylodiscitis. We are reporting a case suffering from cervical spondylodiscitis and epidural abscess associated with MSSA carrying the Panton-Valentine leukocidin genes. [ABSTRACT FROM AUTHOR]

Infective spondylodiscitis (ISD), the infection of vertebral bodies and surrounding tissues, is a rare complication with major impact on the long-term survival of hemodialysis (HD) patients. Although the most frequent etiology is staphylococcal, identifying these pathogens in blood cultures and biopsy cultures is often difficult. This paper aims to present suitable antibiotic combinations for the treatment of these patients, which is usually challenging in the case of an unidentified pathogen. We presented the therapies applied for 13 HD patients and 19 patients without chronic kidney disease (CKD), diagnosed with ISD between 2013 and 2023 in Bihor County. The percentage of positive blood cultures was low in both groups (30.78% HD vs. 15.78% non-HD). The average length of antibiotic therapy was 5.15 weeks in HD patients and 6.29 weeks in non-HD patients. The use of Carbapenem alone (e.g., Meropenem) for an average of 19.6 days for patients in HD when the pathogen was not identified has proven to be efficient in most cases, similarly to using Vancomycin and Fluoroquinolone/Cephalosporines in combination. Regarding the non-CKD patients, the use of Clindamycin in various combinations for an average of 30.3 days has proven to be efficient in more than 90% of cases of ISD with a nonidentified pathogen. Within 2 years after ISD was diagnosed, 12 of the 13 HD patients passed away, mainly due to cardiovascular causes. Unfortunately, there are no guidelines in the literature concerning the empiric treatment of ISD in the particular case of HD patients. Upon checking the literature on PubMed and Google Scholar, only 10 studies provided relevant data regarding ISD treatment for HD patients. More data about the treatment and evolution of these patients is needed in order to elaborate a truly relevant metanalysis. [ABSTRACT FROM AUTHOR]

The article in Acta Paediatrica discusses the unusual presentations of acute mastoiditis in children, emphasizing the importance of considering neurological symptoms in diagnosis. A retrospective study of 110 children with acute mastoiditis revealed that 5.5% had atypical clinical manifestations, leading to worse outcomes, including intracranial complications. While the study had limitations, it highlights the need to include unusual presentations in differential diagnoses for young children with neurological symptoms to prevent poor outcomes. [Extracted from the article]

ObjectiveCervical spondylodiscitis is a rare pathology, with an incidence of 0.5–2.5 per 100,000 population, posing significant potential risks. This type of infection can lead to neurological impairment in up to 29% of patients. Radical surgical debridement of the infected segment, fusion, and an intravenous antibiotic regimen remains the gold standard in most spine centers. This study aimed to analyze the surgical outcome in a tertiary spine center based on disease severity.MethodsIn this study, we retrospectively included all patients diagnosed with cervical spondylodiscitis and treated at the University Hospital Augsburg between January 2017 and May 2022. We collected and analyzed baseline parameters on clinical presentation with symptoms, laboratory parameters, radiological appearance, and surgical parameters such as type of approach and implant, as well as neurological and radiological outcomes. Descriptive statistics were performed using SPSS, and relevant correlations were examined using the t-test for independent samples and the chi-square test.ResultsTwenty-four patients (9%) with cervical spondylodiscitis were identified. Twenty-two (92%) surgically treated patients were subdivided into the complicated discitis group (n = 14, 64%) and the uncomplicated discitis group (n = 8, 36%). Seventeen patients (71%) presented with sepsis on admission, 17 patients (71%) were diagnosed with epidural abscess on primary imaging, and 5 patients (21%) had more than one discitis lesion at a distant spinal segment. The presence of epidural abscess was significantly associated with systemic sepsis (OR = 6.2; p = 0.03) and myelopathy symptoms (OR = 14.4; p = 0.00). The most frequently detected specimen was a multisensitive Staphylococcus aureus (10 patients, 42%). Six patients (25%) died after a median of 20 days despite antibiogram-accurate therapy, five of whom were diagnosed with a complicated type of discitis. The follow-up data of 15 patients (63%) revealed permanent neurological damage in 9 patients (38%). Notably, the surgical approach was a significant factor for revision surgery (p = 0.008), as three out of five (60%) ventrodorsal cases with complicated discitis were revised.ConclusionCervical spondylodiscitis represents a severe infectious disease that is often associated with permanent neurological damage or a fatal outcome, despite adequate surgical and antibiotic treatments. Complicated types of discitis may require a more challenging surgical and clinical course.

Mycobacterium abscessus (M. abscessus) infections primarily affect immunocompromised patients who commonly present with non-orthopedic infections. We present a case of a 63-year-old female presented with persistent back pain and radicular pain. Computed tomography and magnetic resonance imaging showed a large multiloculated anterior epidural abscess. We show here the unique occurrence of lumbar M. abscessus vertebral osteomyelitis, which was treated with L2 and L3 corpectomies, anterior lumbar interbody fusion, and posterior instrumentation via an anterolateral thoracoabdominal (TA) incision. Vascular surgery provided L1–L4 spine exposure via a left anterolateral TA incision, whereas orthopedic surgery performed L2 and L3 corpectomies with lumbar cage placement and posterior instrumentation in two separate procedures. The patient was discharged to a skilled nursing facility, retaining all neurological function, and is progressing well on follow-up. [ABSTRACT FROM AUTHOR]

This article discusses a case of Lemierre's syndrome, a rare and severe condition characterized by bacterial oropharyngeal infection with septic thrombophlebitis of the jugular vein. The patient in this case study presented with symptoms of fever, sore throat, and sputum production, and was later diagnosed with Lemierre's syndrome along with a rare complication of cervical epidural abscess. The article provides details of the patient's treatment, including antibiotic therapy, and highlights the importance of prompt and adequate management for this condition. The article also mentions the potential association of Epstein-Barr virus infection with the pathogenesis of Lemierre's syndrome. [Extracted from the article]