Cervical spinal epidural abscess following acupuncture and wet-cupping therapy: A case report

Neurological Complications of Cupping Therapy: A Comprehensive Review

BACKGROUND

Cupping therapy, a traditional treatment method, has been shown to be effective in various studies. However, there have been reports of significant neurological complications following cupping therapy. This comprehensive review aimed to investigate the important and potentially severe neurological complications documented in the literature.

SUMMARY

The review analyzed case reports and case studies published in three major databases (PubMed, Google Scholar, and Cochrane) up to June 2024. The search strategy involved a three-step process, where two traditional medicine experts independently searched for case reports and published case series, and then a 3-person committee consisting of two traditional medicine experts and a neurologist reviewed the selected articles. Out of 280 case reports and case series, 12 studies were included in the review, reporting 14 patients with neurological complications. The majority of cases (7/14) involved interventions combining cupping with other traditional medicine manual therapies. Complications reported included vascular and infectious complications, with subdural hemorrhage being the most common (4/14). Most patients (11/14) were free of underlying diseases, and all but 3 patients recovered from their complications with surgical and medical treatments.

KEY MESSAGES

The study concludes that although rare, neurological complications of cupping therapy can be severe and potentially life-threatening. Therefore, it is essential for traditional medicine practitioners to be aware of these risks and take necessary precautions to prevent them. Adopting proper techniques and adhering to health guidelines can help mitigate the likelihood of complications. The creation of an international system to record and report the side effects of cupping therapy is also recommended.

Identification of pathogen composition in a Chinese population with iatrogenic and native vertebral osteomyelitis by using mNGS

BACKGROUND

Early antimicrobial therapy is crucial regarding the prognosis of vertebral osteomyelitis, but early pathogen diagnosis remains challenging.

OBJECTIVE

In this study, we aimed to differentiate the types of pathogens in iatrogenic vertebral osteomyelitis (IVO) and native vertebral osteomyelitis (NVO) to guide early antibiotic treatment.

METHODS

A total of 145 patients, who had confirmed spinal infection and underwent metagenomic next-generation sequencing (mNGS) testing, were included, with 114 in the NVO group and 31 in the IVO group. Using mNGS, we detected and classified 53 pathogens in the 31 patients in the IVO group and 169 pathogens in the 114 patients in the NVO group. To further distinguish IVO from NVO, we employed machine learning algorithms to select serum biomarkers and developed a nomogram model.

RESULTS

The results revealed that the proportion of the Actinobacteria phylum in the NVO group was approximately 28.40%, which was significantly higher than the 15.09% in the IVO group. Conversely, the proportion of the Firmicutes phylum (39.62%) in the IVO group was markedly increased compared to the 21.30% in the NVO group. Further genus-level classification demonstrated that Staphylococcus was the most common pathogen in the IVO group, whereas Mycobacterium was predominant in the NVO group. Through LASSO regression and random forest algorithms, we identified 5 serum biomarkers including percentage of basophils (BASO%), percentage of monocytes (Mono%), platelet volume (PCT), globulin (G), activated partial thromboplastin time (APTT) for distinguishing IVO from NVO. Based on these biomarkers, we established a nomogram model capable of accurately discriminating between the two conditions.

CONCLUSION

The results of this study hold promise in providing valuable guidance to clinical practitioners for the differential diagnosis and early antimicrobial treatment of vertebral osteomyelitis.

Disseminated Staphylococcus aureus infection after scarification wet cupping therapy: a case report and literature review

BACKGROUND

Cupping therapy is a complementary and alternative medical therapy used especially in pain management. It is generally considered a safe procedure, but complications, including life-threatening infection, may still occur. Understanding these complications is essential to safe and evidence-based use of cupping in practice.

CASE PRESENTATION

Here we report a rare case of disseminated Staphylococcus aureus infection after cupping therapy. After wet cupping, a 33-year-old immunocompetent woman developed fever, myalgia, and a productive cough accompanied by acute liver and kidney injury, iliopsoas abscess, and gastrointestinal bleeding. The patient was treated successfully with cefmetazole plus levofloxacin after microbiological and antimicrobial sensitivity testing.

CONCLUSIONS

Though rarely reported, clinicians, practitioners of cupping therapy, and patients should be aware of the risk of infection after cupping therapy. High hygiene standards are recommended for cupping therapy, even in immunocompetent individuals.

Surgery combined with antibiotics for thoracic vertebral Escherichia coli infection after acupuncture: A case report

BACKGROUND

Acupuncture is relatively popular worldwide, but an unregulated operation can easily lead to infections. The purpose of this report was to analyze a clinical case of surgery combined with the use of antibiotics for the treatment of thoracic vertebral infection by Escherichia coli (E. coli) after acupuncture.

CASE SUMMARY

A 63-year-old male was diagnosed with E. coli infection in the thoracic vertebra after acupuncture. His fever and pain did not improve after treatment with broad-spectrum antibiotics for 10 d. Thus, debridement of the infected area and biopsy were decided. The final pathology confirmed the diagnosis of vertebral infection by E. coli. The patient underwent anterior and posterior thoracic vertebral debridement and internal fixation surgery combined with the use of sensitive antibiotics. He had no fever or backache 3 mo postoperatively.

CONCLUSION

In this report, we first considered antibiotic treatment for the patient with septic spinal infection, but the effect was not obvious. Interventional surgery was combined with the use of sensitive antibiotics to relieve backache, and good clinical results were achieved. Furthermore, acupuncture practitioners should pay attention to hygienic measures.

Update on spinal epidural abscess

PURPOSE OF REVIEW

Spinal epidural abscess (SEA) is still a rare but potentially very morbid infection of the spine. In recent years, the incidence has risen sharply but the condition remains a medical conundrum wrought with unacceptably long diagnostic delays. The outcome depends on timely diagnosis and missed opportunities can be associated with catastrophic consequences. Management and outcomes have improved over the past decade. This review focuses on risk factors and markers that can aid in establishing the diagnosis, the radiological characteristics of SEA on MRI and their clinical implications, as well as the importance of establishing clear indications for surgical decompression.

RECENT FINDINGS

This once exclusively surgically managed entity is increasingly treated conservatively with antimicrobial therapy. Patients diagnosed in a timely fashion, prior to cord involvement and the onset of neurologic deficits can safely be managed without decompressive surgery with targeted antimicrobial therapy. Patients with acute cord compression and gross neurologic deficits promptly undergo decompression. The greatest therapeutic dilemma remains the group with mild neurological deficits. As failure rates of delayed surgery approach 40%, recent research is focused on predictive models for failure of conservative SEA management. In addition, protocols are being implemented with some success, to shorten the diagnostic delay of SEA on initial presentation.

SUMMARY

SEA is a potentially devastating condition that is frequently missed. Protocols are put in place to facilitate early evaluation of back pain in patients with red flags with appropriate cross-sectional imaging, namely contrast-enhanced MRI. Efforts for establishing clear-cut indications for surgical decompression of SEA are underway.

Cervical spinal epidural abscess following needle-knife acupotomy, with an initial presentation that mimicked an acute stroke: A case report

Introduction: A spinal epidural abscess is difficult to diagnose and it can sometimes mimic an acute ischemic stroke.Case presentation: We report a 69-year-old woman attended our emergency department because of gross hematuria for 1 week, with fever and bilateral flank pain. Two weeks earlier, she had received needle-knife acupotomy (a more invasive procedure than the traditional acupuncture) for chronic neck pain. Acute pyelonephritis was diagnosed; however, 4 h later, she developed weakness of both right limbs. Acute lacunar infarction was tentatively diagnosed. After admission, weakness of the left limbs developed, with a feeling of fullness and discomfort around the entire T6 dermatome with urinary retention. Neck magnetic resonance imaging showed extensive cervical epidural abscesses from C3 to T1. After an operation, her neck pain and the weakness of the four limbs gradually improved.Discussion: Spinal epidural abscess is a rare complication, and which should be considered for patients who have undergone invasive cervical procedures. Needle-knife acupotomy is a more invasive procedure than the traditional acupuncture. Conclusion: Although it is considered safe and effective for cervical spondylosis, it can be complicated by spinal infection. Careful disinfection should therefore be performed, and disposable needleknives should be used.

Acupuncture-Induced Cranial Epidural Abscess: Case Report and Review of the Literature

BACKGROUND

Acupuncture is a common form of alternative medicine that is used for pain control among other modalities of treatment. It is a relatively safe procedure, but complications, including those of infectious etiology, may still occur.

CASE DESCRIPTION

A 47-year-old immunosuppressed woman presented with fever, altered level of consciousness, dysphasia, and a left occipital subgaleal fluctuant mass after acupuncture for headaches in the same area. Imaging demonstrated subgaleal and epidural collection localized in the left occipital region. She underwent urgent surgical evacuation of both collections. Cultures from intraoperative specimens grew Streptococcus anginosus. The patient started targeted antibiotic treatment leading to complete recovery.

CONCLUSIONS

To our knowledge, this is the first report of intracranial abscess after acupuncture. Given the worldwide application of this alternative treatment, physicians, acupuncturists, and the general public should be aware of the possibility of this rare but serious complication.

Community acquired Stenotrophomonas maltophilia discitis: Diagnosis aided by shotgun metagenomic sequencing

We report a rare case of culture negative L4-L5 discitis and epidural abscess in an immunocompetent child who had dry cupping therapy performed to treat low back strain. The causative pathogen was identified as Stenotrophomonas maltophilia by shotgun metagenomic sequencing of spinal cord aspirate after more than one month of unsuccessful empirical treatment with 6 different antibiotics. The patient was successfully treated with Sulfamethoxazole-trimethoprim and minocycline. Cupping therapy is a very popular medical procedure widely used in China, but the potential risk for severe infections such as discitis and epidural abscess described in this case should be recognized.

Thoracic Spondylodiscitis Epidural Abscess in an Afebrile Navy Veteran: A Case Report

Objective

The purpose of this case study was to describe the differential diagnosis of a thoracic epidural abscess in a Navy veteran who presented to a chiropractic clinic for evaluation and management with acupuncture within a Veterans Affairs Medical Center.

Clinical Features

An afebrile 59-year-old man with acute thoracic spine pain and chronic low back pain presented to the chiropractic clinic at a Veterans Affairs Medical Center for consideration for acupuncture treatment.

Intervention and Outcome

The veteran elected to trial acupuncture once per week for 4 weeks. A routine thoracic magnetic resonance imaging scan without gadolinium detected a space-occupying lesion after the patient failed to attain 50% reduction of pain within 2 weeks with conservative care. The patient was diagnosed with a multilevel thoracic spondylodiscitis epidural abscess and was treated same day with emergency debridement and laminectomy of T7-8 with a T6-9 fusion. The patient had complete recovery without neurological compromise and completed an antibiotic regimen for 6 weeks.

Conclusion

A Navy veteran with acute thoracic spine and chronic low back pain appeared to respond initially but failed to achieve clinically meaningful outcomes. Follow-up advanced imaging detected a thoracic spondylodiscitis epidural abscess. Early diagnosis and immediate intervention are important to preserving neurological function and limiting morbidity in cases of spondylodiscitis epidural abscess.

An Acute Cervical Subdural Hematoma as the Complication of Acupuncture: Case Report and Literature Review

BACKGROUND

Several injuries in the cervical region as complications of acupuncture have been previously reported in the literature, including cord and medulla oblongata injuries, subdural empyema, and cervical hematoma. Spinal cord subdural hematoma is a rare condition mainly associated with coagulopathy, trauma, and iatrogenic procedures. We herein report an acute cervical subdural hematoma after cervical acupuncture for neck and shoulder pain.

CASE DESCRIPTION

A 74-year-old woman presented with progressive quadriparesis and sensory deficit after receiving acupuncture in the neck and shoulder. Magnetic resonance imaging of the cervical spine showed a subdural lesion that was a hyperintense mass in the T1-weighted and hypointense in T2-weighted images at the C4-C6 level, which proved to be an early subacute subdural hematoma. After surgical evacuation of the hematoma, the patient had significant neurologic improvement.

CONCLUSIONS

Although rare, cervical spinal cord hematomas are disastrous complications of cervical acupuncture. These procedures should be performed under direct observation of trained physicians with appropriate knowledge of cervical anatomy to avoid these complications.