Pyogenic Spondylitis: Case Report on Cervical Pyogenic Spondylitis

Pyogenic spondylitis involves a broad spectrum of structures around the spine including the vertebra (vertebral osteomyelitis), discs (septic discitis) and epidural abscess. Symptoms may include fever, pain, sensory-motor deficits, and obtundation. Fever is a symptom, however, may not be common as it occurs in less than of patients. It may affect any aspect of the spine, with the cervical spine been the least affected. Magnetic resonance imaging (MRI) is critical for early diagnosis and extensively used for diagnosis. Our case presents a lady who was referred for an MRI of the neck following neck pain for over 3 months.

Debridement and corpectomy via single posterior approach to treat pyogenic spondylitis after vertebral augmentation

Background Infection after vertebral augmentation (VA) often limits the daily activities of patients and even threatens their life. The operation may be one of the effective treatments if the patient suffers from intolerable severe pain, neurological deficits, and damage to spinal stability. This study aimed to investigate the clinical efficacy of the treatment of pyogenic spondylitis after vertebral augmentation (PSVA) with Single posterior debridement, vertebral body resection, and intervertebral bone graft fusion and internal fixation (sPVRIF). Methods The study was performed on 19 patients with PSVA who underwent VA at 4 hospitals in the region between January 2010 and July 2020. Nineteen patients were included. Among them, 16 patients underwent sPVRIF to treat the PSVA. Results A total of 2267 patients underwent VA at 4 hospitals in the region. Of the 19 patients with postoperative PSVA, suppurative spondylitis was misdiagnosed as an osteoporotic vertebral fracture(OVF) in 4 patients and they underwent VA. Besides osteoporosis, 18 patients had other comorbidities. The average interval between the first surgery and the diagnosis of PSVA was 96.4 days. Of the 19 patients, 16 received surgical treatment. The surgical time was 175.0±16.8 min, and the intraoperative blood loss was 465.6±166.0 mL. Pathogenic microorganisms were cultured in 12 patients. Conclusion PSVA is a severe complication that can even threaten the life of the patients. sPVRIF may be one of the effective treatments if the patient suffers from intolerable severe pain, neurological deficits, and damage to spinal stability.

A case of septic shock which postmortem pathological autopsy revealed bacterial myocardial abscess

Background and purpose: The myocardial abscess is a scarce condition, but it is significant due to its high mortality. We aimed to seek insight into myocardial abscess by presenting a case report. Methods: A 73 years old male was emergently transferred to our hospital with disorientation and hypotension. He had a past medical history of diabetes mellitus, hypertension, myocardial infarction, atrial fibrillation, and calculous cholecystitis. He had complained of lumbago since 1 week before arrival at our hospital. We diagnosed him with septic shock due to pyogenic spondylitis and psoas abscess by the laboratory and imaging findings. We could not find abnormality in his cardiac status of echocardiography. Despite the treatment, his condition worsened rapidly, and he died after 24 hours of arrival. We performed a postmortem pathological autopsy, which revealed the condition of myocardial abscesses. We examined medical literature about a myocardial abscess. Results: According to a previous treatise, pyogenic spondylitis was reported as a causative disease of the myocardial abscess to the same extent as infective endocarditis. Bacterial myocarditis may lead to decreased cardiac function and arrhythmias. Our case did not show cardiac asynergy, decreased cardiac function, and sudden fatal arrhythmias during the course. We thought that the myocardial abscess was due to a hematogenous metastasis from the pyogenic spondylitis. And we thought the direct cause of death was septic shock, not the myocardial abscess. Conclusions: We experienced a fatal septic shock case that revealed myocardial abscess by the postmortem pathological autopsy. It is possible that we cannot notice the existence of myocardial abscess without a pathological autopsy.

Involvement of L5-S1 level as an independent risk factor for adverse outcomes after surgical treatment of lumbar pyogenic spondylitis: A multivariate analysis

Purpose: To identify the independent risk factors for adverse outcomes and determine the effect of L5-S1 involvement on the outcome of surgical treatment of lumbar pyogenic spondylitis (PS). Methods: A retrospective analysis was performed for all consecutive patients who underwent surgery for lumbar PS between November 2004 and June 2020 at a single institution. The patients were divided into two groups based on the outcomes: good and adverse (treatment failure, relapse, or death). Treatment failure was defined as persistent or worsening pain with C-reactive protein (CRP) reduction less than 25% from preoperative measurement or requiring additional debridement. Relapse was defined as the reappearance of symptoms and signs with an elevated white blood cell count, erythrocyte sedimentation rate, and CRP after the first period of treatment. Binary logistic regression analyses were performed to identify the independent risk factors for adverse outcomes. Results: Twenty-four (21.2%) of the 113 patients were classified as having adverse outcomes: treatment failure, relapse, and death occurred in 15, 7, and 2 patients, respectively. The involvement of L5-S1 (adjusted odds ratio [aOR] = 6.561, P = 0.004), Methicillin-resistant Staphylococcus aureus (MRSA) infection (aOR = 6.870, P = 0.008), polymicrobial infection (aOR = 12.210, P = 0.022), and Charlson comorbidity index (CCI; P = 0.005) were identified as significant risk factors for adverse outcomes. Conclusion: Involvement of L5-S1, MRSA, polymicrobial infection, and CCI were identified as independent risk factors for adverse outcomes after surgical treatment of lumbar PS. Because L5-S1 is anatomically demanding to access anteriorly, judicious access and thorough debridement are recommended in patients requiring anterior debridement of L5-S1.

An infected aneurysm of the vertebral artery following cervical pyogenic spondylitis: a case report and literature review

Background An important complication of pyogenic spondylitis is aneurysms in the adjacent arteries. There are reports of abdominal aortic or iliac aneurysms, but there are few reports describing infected aneurysms of the vertebral artery. Furthermore, there are no reports describing infected aneurysms of the vertebral arteries following cervical pyogenic spondylitis. We report a rare case of an infected aneurysm of the vertebral artery as a complication of cervical pyogenic spondylitis, which was successfully treated by endovascular treatment. Case presentation Cervical magnetic resonance imaging (MRI) of a 59-year-old man who complained of severe neck pain showed pyogenic spondylitis. Although he was treated extensively by antibiotic therapy, his neck pain did not improve. Follow-up MRI showed the presence of a cyst, which was initially considered an abscess, and therefore, treatment initially included guided tapping and suction under ultrasonography. However, under ultrasonographic examination an aneurysm was detected. The contrast-enhanced computed tomography (CT) scan showed an aneurysm of the vertebral artery. Following endovascular treatment (parent artery occlusion: PAO), the patient’s neck pain disappeared completely. Conclusion Although there are several reports of infected aneurysms of the vertebral arteries, this is the first report describing an infected aneurysm of the vertebral artery as a result of cervical pyogenic spondylitis. Whenever a paraspinal cyst exist at the site of infection, we recommend that clinicians use not only X-ray, conventional CT, and MRI to examine the cyst, but ultrasonography and contrast-enhanced CT as well because of the possibility of an aneurysms in neighboring blood vessels. It is necessary to evaluate the morphology of the aneurysm to determine the treatment required.