1/6. Pyogenic spondylitis in an S1-S2 immobile segment.STUDY DESIGN: A case of pyogenic spondylitis in S1-S2 is presented. OBJECTIVE: To describe the diagnosis and management of this rare spondylitis. SUMMARY OF BACKGROUND DATA: The segment including the first and second sacral vertebrae is not mobile. Therefore, discitis of S1-S2 and adjacent spondylitis is very rare. To the authors' knowledge, this is the first reported case of infectious spondylitis in an immobile segment: S1-S2. methods: In addition to radiography and bone scintigraphy, magnetic resonance imaging was used to confirm the diagnosis. Changes consistent with infectious spondylitis were shown, including an epidural abscess. RESULTS: The patient was treated with laparoscopic drainage and biopsy. staphylococcus aureus was cultured, and adequate antibiotics were administered. Repeat magnetic resonance imaging at approximately 4 months demonstrated normal signal intensity and disappearance of the abscess. CONCLUSION: Findings from this study show that pyogenic spondylitis can occur in immobile S1-S2.- - - - - - - - - - ranking = 1keywords = spondylitis (Clic here for more details about this article) |
2/6. Halo pin intracranial penetration and epidural abscess in a patient with a previous cranioplasty: case report and review of the literature.STUDY DESIGN: Report of a patient with an epidural abscess after halo pin intracranial penetration at the site of a previous cranioplasty. OBJECTIVES: To report a rare case of intracranial penetration at the site of a previous cranioplasty associated with epidural abscess, and to discuss the diagnostic and therapeutic approach to its management. SUMMARY OF BACKGROUND DATA: The most serious complications associated with use of halo device occur when pins penetrate the inner table of the skull, resulting in cerebrospinal fluid leak and rarely in an intracranial abscess. However, no mention of intracranial halo pin penetration at the site of a previous cranioplasty was found in the literature. methods: A 64-year-old man with ankylosing spondylitis had a halo vest placed for management of a fracture dislocation through the C5-C6 intervertebral disc space associated with left C6 radiculopathy. One week later, the patient experienced fever and headache associated with pain, redness, and drainage at the site of the insertion of the left posterior pin. Computed tomography of the brain showed a 1.5-cm intracranial penetration of the halo pin through a previous cranioplasty of the temporal bone, associated with epidural abscess and cerebral edema in the left temporoparietal lobe. The pins and the halo vest were removed, the pin site was cleaned, and a philadelphia cervical collar was applied. staphylococcus epidermidis grew on the culture of drainage from the pin site. The patient started immediate intravenous antibiotic treatment for 2 weeks, followed by oral antibiotics for 2 additional weeks. RESULTS: The patient had gradual improvement of his symptoms within the first 48 hours. At the latest follow-up visit, he had fully recovered and his fracture had healed. CONCLUSIONS: The halo device should not be used for patients with a previous cranioplasty, especially if the pins cannot be inserted at other safe areas of the skull. A thorough medical history and physical examination of the skull are important before the application of a halo device. Computed tomography of the skull may be necessary before elective halo application for patients with concomitant head trauma, confusion, or intoxication and for patients with a previous cranioplasty to ascertain the safest pin sites.- - - - - - - - - - ranking = 0.1keywords = spondylitis (Clic here for more details about this article) |
3/6. Multilevel epidural abscess formation with paraplegia in a healthy 33-year-old man caused by staphylococcus aureus (MSSA).We report an unusual case of a devastating multilevel pyogenic spondylitis with paraplegia and soft tissue abscess formation in a previously healthy young man. methicillin susceptible staphylococcus aureus (MSSA) was identified as causal pathogen. The infection could only be managed after surgical debridement of all spinal manifestations and a prolonged course of antibiotic therapy. It is possible that delayed surgical debridement of all infection sites fostered the course of the disease.- - - - - - - - - - ranking = 0.1keywords = spondylitis (Clic here for more details about this article) |
4/6. Diagnostic value of 99mTc-HMDP bone scan in atypical osseous tuberculosis mimicking multiple secondary metastases.STUDY DESIGN: A case of atypical osseous tuberculosis (TB) mimicking multiple secondary metastases on radiologic and nuclear imaging is presented. OBJECTIVES: To emphasize the contribution of nuclear bone scanning for the assessment of osseous tuberculosis in typical and atypical presentations. SUMMARY AND BACKGROUND DATA: Skeletal locations of TB mostly involve the dorsolumbar spine and diagnosis is often delayed. The presence of multiple TB sites can mimic secondary metastases and biopsy remains the mainstay for final diagnosis. methods: Clinical symptoms, lab tests, and imaging data are presented. Possible diagnoses are discussed. A review of imaging characteristics in cases of typical and atypical presentations of osseous TB is proposed. RESULTS: A dorsal spine spondylitis was first diagnosed on a 56-year-old patient presenting neurologic deficit of the left arm. Fine needle aspiration identified bacterial infection but was negative for mycobacterium tuberculosis. Whole-body bone scan allowed the identification of an asymptomatic sacroiliac lesion, which was accessible to biopsy and gave a final diagnosis. CONCLUSION: Nuclear bone scanning should be kept in mind when assessing spinal pain in patients at high risk of TB infection or reactivation.- - - - - - - - - - ranking = 0.1keywords = spondylitis (Clic here for more details about this article) |
5/6. Bilateral extraordinary huge, multi-compartmental tuberculous abscesses: a case report.OBJECTIVE: To illustrate computerized tomography (CT) and magnetic resonance imaging (MRI) findings of tuberculous spondylitis with extensive abscess collections. METHOD: A review of one patient with tuberculous spondylitis and extensive paraspinal, subligamentous, retroperitoneal, and subcutaneous abscesses including pertinent history, important physical examination, CT and MR imaging findings was performed. RESULT AND CONCLUSION: This case demonstrates multiple patterns of tuberculous abscess formation secondary to spinal tuberculosis; included are paraspinal, subligamentous, retroperitoneal, and subcutaneous locations. The extension of the abscess should be kept in mind when treating a patient with tuberculous spondylitis. MR imaging is a modality of choice to illustrate full extension of the disease process, which is necessary for therapeutic decision making and planning.- - - - - - - - - - ranking = 0.3keywords = spondylitis (Clic here for more details about this article) |
6/6. Pyogenic cervical spondylitis with quadriplegia as a complication of severe burns: Report of a case.We report a case of cervical pyogenic spondylitis complicated by epidural abscess with quadriplegia during treatment of severe burns. The patient was a 49-year-old man with 3rd-degree burns to 20% of his body, involving the lower extremities. We performed escharectomy of the 3rd-degree necrosis on days 7 and 16, followed by the first skin graft on day 23. pseudomonas aeruginosa was detected in the postoperative graft wound culture. On day 23 after the skin graft, he became febrile and began to experience cervical pain and muscle weakness of the extremities. By day 24, quadriplegia had developed. A cervical vertebral magnetic resonance imaging (MRI) scan showed pyogenic spondylitis with an epidural abscess, which was causing the quadriplegia. We treated the patient by performing curettage of the pyogenic lesion and anterior fixation of the cervical vertebral bodies. The fact that P. aeruginosa was detected in the pyogenic focus culture indicated that burn wound sepsis was responsible for the infection. This case reinforces that acting on a strong suspicion helps to establish a diagnosis and initiate appropriate treatment early.- - - - - - - - - - ranking = 0.6keywords = spondylitis (Clic here for more details about this article) |