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Tuberculous radiculomyelitis as a complication of spondilodiscitis: MR demonstration.
We present the MRI features and follow-up results in a case of acute tuberculous (TB) radiculomyelitis adjacent to spondilodiscitis in the thoracic spine. Medullary involvement by tuberculosis originating by different mechanisms have been demonstrated in the recent literature. However, this rare complication accompanying TB spondilodiscitis has not been reported.
Interventional radiological treatments tested.
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[Lumbar interapophyseal septic arthritis. Apropos of 3 cases].
Septic arthritis of spinal apophyseal joint, seldom described, mainly concern the lumbar spine. We report three cases. Inflammatory lesions of the paravertebral soft tissues were associated in each case; an epidural abscess was present twice. Our three cases were due to Staphylococcus aureus. The initial clinical features were consistent with a spondylodiscitis. Imaging led to the correct diagnosis in all cases. According to our observations and several others of the literature: facet joint lesions are visible too late on plain films. Bone scintigraphy is sensitive, but not specific. CT scan and MRI are the most contributive investigations. A pathologic aspect of the paravertebral soft tissues is visible less than one week after the beginning of the symptoms on CT scan and MRI. Lesions of the facet joint are detectable as soon as the first week on MRI, and after 15 days of clinical course on CT scan. Epidural abscess, when present, is best shown by MRI as early as the first week. CT scan can guide percutaneous needle biopsies of the paravertebral abscesses or of the concerned facet joint.
[Therapy-resistant lumbago].
The 71-year-old female patient was hospitalized owing to a therapy-resistant lumbo-spondylogenic syndrome. Radiology with increased infection parameters gave rise to the suspicion of a bacterial spondylodiscitis L1/L2. Puncture of the vertebral body as well as blood cultures established proof of yersinia enterocolitica. In spite of immediate adequate antibiosis, by means of "Ciprofloxacin" i.v. spondylodesis of the lumbar spine had to be carried out in order meet the threat of instability. Spondylodiscitis is an extremely rare manifestation of a yersinia infection, only few cases have been described so far in medical literature.
Spinal tuberculosis in an unusual location.
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[Spondylodiscitis caused by Streptococcus agalactiae].
Two previously healthy adults, a man aged 69 and a woman aged 51 years, presented with spondylitis caused by Streptococcus agalactiae. One patient had fever and acute pain in the neck, the other progressive pain in the lower back. From cultures of blood and bone respectively. S. agalactiae was isolated. Both patients recovered after treatment with benzylpenicillin. S. agalactiae (group B streptococcus) is a wellknown cause of invasive infections in neonates and pregnant adults. Infections in nonpregnant adults are increasingly reported. Chronic conditions such as diabetes mellitus are strongly associated with disease caused by S. agalactiae.
Paravertebral inflammation mistaken for neoplasm or abscess by MRI.
Magnetic resonance imaging (MRI) is a useful procedure for the evaluation of spinal pathology in children. The high sensitivity of soft tissue changes may lead to misinterpretation of paravertebral swelling caused by inflammation. We present a report of three patients with paravertebral soft tissue swelling caused by disk space infection or intervertebral disk space calcification. The findings shown by MRI were initially interpreted as neoplasm or abscess, which led to surgical procedures either planned or done. Surgeons need to exercise extreme care when interpreting soft tissue changes shown by MRI.
Treatment of coccidioidal spinal infection: experience in 16 cases.
Sixteen patients with spinal infection from Coccidioides immitis were treated. Lesion location was cervical in two, thoracic in four, lumbar in six, sacroiliac joint in one, and disseminated spinal in three. The neurological status was intact in 11 patients. One patient had incomplete quadriplegia, three patients had incomplete paraplegia, and a fifth patient had a lumbar root lesion. Treatment was medical only in 4 patients (one of whom required surgery 2 years later) and combined medical and surgical in 13 patients. All patients received amphotericin B intravenously. Follow-up averaged 24 months in 15 patients (range, 12-42 months). The outcome in four patients treated medically alone was one death, one remission, one relapse with disease progression, and one without follow-up. The outcome in the combined medical and surgical group was nine fusions, one pseudarthrosis, and three lesional excisions, all with remission. Successful treatment outcome is disease arrest, as opposed to "cure."
[Cellulitis caused by Streptococcus pneumoniae associated with spondylodiscitis after suppurative otitis media].
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Evaluation of infections of the locomotor system with indium-111-labeled human IgG scintigraphy.
UNLABELLED: Indium-111-labeled human nonspecific immunoglobin G (111In-IgG) is one of the newer agents suggested for scintigraphic evaluation of infection and inflammation. In this study, the utility of this agent was studied in routine clinical practice. METHODS: A dose of 75 MBq 111In labeled to 2 mg IgG (MacroScint) was administered intravenously in 226 patients with 232 possible foci of infection or inflammation. Imaging was performed 4, 24 and 48 hr postinjection. The results were verified by culture, obtained either surgically (42%) or via puncture (19%) and long-term clinical and roentgenological follow-up (39%). Follow-up data were used in patients of whom the vast majority had a negative work-up, including negative 111In-IgG scintigraphy. RESULTS: All infected total hip (THA) and total knee arthroplasties, focal osteomyelitis, diabetic foot infections, septic arthritis and soft-tissue infections were detected (61 foci). Only one patient with early, low-grade spondylodiscitis was false negative with 111In-IgG. Since 111In-IgG scintigraphy does not discriminate between infectious and sterile inflammation, careful interpretation is necessary in cementless THA up to 1 yr after insertion, uptake only around the neck of the femoral component of a THA, recent fractures and pseudarthrosis, in which uptake may be caused by sterile inflammation and not by infection (specificity for inflammation 100%, specificity for infection of 77%). CONCLUSION: Indium-111-IgG scintigraphy is a very sensitive tool for detection of infectious bone and joint disease. Moreover, when uptake patterns of 111In-IgG, which are characteristic for sterile inflammation, are excluded, infection can be ruled out with a high degree of certainty.
Multifocal Aspergillus terreus discospondylitis in two German shepherd dogs.
Multifocal fungal (Aspergillus terreus) discospondylitis was diagnosed in 2 German shepherd dogs. In one dog, the aetiology was established by means of fluoroscopic-guided disc aspiration, cytology and culture of disc material and urine. Disseminated aspergillosis was confirmed at necropsy and A. terreus cultured from numerous organs in this dog. The aetiology in the other dog was not established until therapeutic failure forced surgical curettage of disc material from which the fungus was cultured. Ketoconazole therapy failed to effect an improvement, and at necropsy, disease was localised to the spinal column, with A. terreus cultured from the affected discs and associated vertebrae. Immunodeficiency was suspected in both cases. In the case of disseminated disease a reduced lymphocyte blastogenic response was demonstrated. Reduced IgA was shown in both cases. The German shepherd breed seems to be predisposed to Aspergillus infections and IgA deficiency.
Epidural involvement in nontuberculous disk space infections. Incidence by magnetic resonance imaging, impact and prognosis.
Eleven of 25 patients admitted for nontuberculous disk space infections had magnetic resonance imaging evidence of epidural infection. No differences were found between the 11 patients with and the 14 patients without epidural infection regarding time to diagnosis, height of fever, presence of nerve root pain, presence of prespinal and/or paraspinal abscesses and proportion of cases due to Staphylococcus aureus. Antimicrobial therapy alone ensured a full recovery with no neurological sequelae in most cases, suggesting that presence of epidural sepsis does not affect the prognosis of nontuberculous disk space infections.
Paravertebral inflammation mistaken for neoplasm or abscess by MRI.
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Spondylodiscitis: clinical and MRI findings.
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[Clinical picture, diagnosis and treatment of intervertebral osteochondritis].
25 patients with intervertebral osteochondritis (11-cervical, 5-thoracic, 9-lumbar) at the age of 30-70 years are analysed. Clinical features of osteochondritis locafed in different segments of the spine, are described. The fact that at the early stages of it's development, the disease is "X-ray negative", is stressed. The radioisotopic examination of the spine is highly effective in diagnosis of early stages of infective-inflammatory process of the intervertebral disks. The roentgenological characteristics of different stages of the disease are provided. Conservative methods, including antibiotics, bedding, orthopaedic methods are most important in the treatment of intervertebral osteochondritis. Surgical treatment is indicated in case of spine compression and instability of a damaged segment of the spine. In case of a proper diagnosis and adequate treatment the outcome is favorable.
The effectiveness of gallium citrate Ga 67 radionuclide imaging in vertebral osteomyelitis revisited.
We investigated the role of gallium citrate Ga 67 scanning in diagnosing spondylodiscitis. Scans of 41 patients with suspected spondylodiscitis showed increased radionuclide uptake in 39 patients; these findings correlated with those of magnetic resonance imaging and were proved by biopsy. Two patients with negative findings on gallium scans had been strongly suspected of having spondylodiscitis; biopsy findings in these patients showed degenerative changes. Thirteen patients had negative cultures, while 22 had polygenic infections and 4 had granulomatous infections. Gallium scanning proved to be 100% sensitive, specific, and accurate. The interrater accuracy was excellent. Follow-up scans were used to track therapeutic progress. We recommend complementary bone and gallium scans in cases of suspected spinal infections. If the scan is positive, a biopsy should be done. If the scans are negative, no further investigation is needed.
Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis.
Spondylodiscitis normally heals itself, but it can cause bone destruction leading to deformity and often pain. Debridement of these infections by percutaneous transpedicular discectomy with access from adjacent caudal pedicles can accelerate natural healing and prevent progression to bone destruction and deformity. We outline this technique and discuss a series of 28 patients treated using a percutaneous transpedicular approach to obtain culture and histopathology specimens, permit drainage and antibiotic irrigation, and provide a channel for granulation tissue to invade the infected space. This procedure is safe and effective, but it is contraindicated for epidural abscess or granulation tissue-induced neurocompression and it is ineffective against extensive bone destruction.