Fluoroscopy-guided percutaneous needle aspiration of posterior epidural abscesses: a report of two cases

Bacteroides fragilis vertebral osteomyelitis: A rare clinical entity

Acute pyogenic vertebral osteomyelitis is mainly attributed to haematogenous spread of aerobic bacteria, while anaerobic osteomyelitis results from contiguous spread of polymicrobial infections through breaks in the gut mucosal barrier and involves the vertebral bodies in only about 2%-5%. Herein, we report two cases of vertebral osteomyelitis due to Bacteroides fragilis. It is noteworthy that cases of vertebral osteomyelitis due to Bacteroides fragilis have been attributed to the extension of intra-abdominal or pelvic floor infections. However, in the two cases described, there was no history of a previous medical intervention nor an intestinal or pelvic floor infection. Early recognition of the aetiological agent that causes vertebral osteomyelitis may lead to the timely treatment and therefore, may deter any neurosurgical/orthopaedic interventions.

Cervical, Thoracic, and Lumbar Spine Epidural Abscess: Case Report and Literature Review

We report a case of a spinal epidural abscess (SEA) in a patient without significant risk factors. The patient was treated in an outpatient setting for one week for worsening back pain and subsequently admitted to the hospital for the treatment of sepsis and suspected SEA. An MRI obtained on admission showed an epidural abscess extending from the lower cervical to the upper lumbar region and accompanying paraspinal cervical and psoas abscesses. The patient was successfully treated with antibiotics based on the sensitivity of the surgical cultures received from a needle aspiration of the abscess. SEA has a low incidence; however, the number of cases is consistently rising over the last two decades. The outcome of SEA treatment is related to the duration of the process prior to intuition of the treatment. Patients with no neurological symptoms, or with symptoms lasting less than 36 h, have the best recovery rate. As the typical symptoms of SEA are seen in only 13% of cases, physicians should have a low threshold to order MRI in patients with back pain that is new or changed from the baseline. With the help of CT-guided aspiration for culture analysis, patients can be successfully treated conservatively using antibiotics in cases where neurological signs are absent.