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Beyer RS, Franklin AJ, Hatter MJ, Nguyen A, Brown NJ, Camino-Willhuber G, Davies NR, Hashmi S, Oh M, Bhatia N, Lee YP. Surgical treatment in primary spinal infections in a pediatric population: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22204. [PMID: 36046267 PMCID: PMC9329860 DOI: 10.3171/case22204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Primary spinal infections (PSIs) are a group of uncommon but serious infectious diseases that are characterized by inflammation of the endplate-disc unit. Pediatric spinal infection is rare and challenging to diagnose due to vague presenting symptoms. Most cases are conservatively managed with surgery rarely indicated. The authors performed a systematic review to study the baseline characteristics, clinical presentation, and outcomes of pediatric patients with PSIs who underwent surgical treatment. OBSERVATIONS PSI in pediatric patients might behave differently in terms of epidemiology, clinical presentation, and outcomes when compared with nonpediatric patients. Overall, PSI ultimately managed surgically in pediatric patients is associated with a high rate of localized pain, neurological compromise, and treatment failure when compared with nonsurgically managed pediatric spinal infections. LESSONS PSIs managed surgically in the pediatric population were found to be caused by Mycobacterium tuberculosis in 74.4% of cases and were associated with higher rates of localized pain, neurological compromise, and treatment failure than nonsurgically managed pediatric spinal infections. Thoracic involvement (71.8%) in the spinal infection was reported most commonly in our review. When omitting the cases involving M. tuberculosis infection, it was revealed that 50% of the pediatric cases involved infection in the cervical region, suggesting increased severity and disease course of cervical spinal infections in the pediatric population. Surgical treatment is indicated only in cases of severe neurological compromise and treatment failure.
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Affiliation(s)
| | | | | | - Andrew Nguyen
- Neurosurgery, University of California, Irvine, Irvine, California; and
| | - Nolan J. Brown
- Neurosurgery, University of California, Irvine, Irvine, California; and
| | | | - Nestor R. Davies
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Michael Oh
- Neurosurgery, University of California, Irvine, Irvine, California; and
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Ujigo S, Kishi K, Imada H, Shibuya H, Nakanishi K, Adachi N. Upper Cervical Osteomyelitis with Odontoid Process Destruction Treated with a Halo Vest in a Child: A Case Report. Spine Surg Relat Res 2020; 4:287-289. [PMID: 32864500 PMCID: PMC7447345 DOI: 10.22603/ssrr.2019-0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/07/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Satoshi Ujigo
- Department of Orthopaedic Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Kazuhiko Kishi
- Department of Orthopaedic Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Hideaki Imada
- Department of Orthopaedic Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Hayatoshi Shibuya
- Department of Orthopaedic Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Kobayashi T, Morimoto T, Maeda K, Toda Y, Hirata H, Yoshihara T, Mawatari M. Transoral Mandibular Tongue-Splitting Approach in Upper Cervical Epidural Abscess: A Case Report and Review of the Literature. Spine Surg Relat Res 2020; 4:178-183. [PMID: 32405566 PMCID: PMC7217670 DOI: 10.22603/ssrr.2019-0090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/02/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction The transoral mandibular tongue-splitting approach is typically performed for the treatment of upper cervical tumor and instability but has not been performed for the treatment of upper cervical epidural abscess (UCEA). We report the first case of UCEA successfully treated with a transoral mandibular tongue-splitting approach. Technical Note A 62-year-old man who had medical histories of tracheotomy with intubation and dermatopathy due to radiation therapy for the treatment of nasopharyngeal carcinoma presented with neck pain and limb weakness. The imaging examination revealed bone erosion of C2-C4 vertebrae and abscess at the level of C2-C4, supporting a diagnosis of UCEA. The transcervical approach could not be used for treatment; therefore, the transoral mandibular tongue-splitting approach was used successfully to perform decompression, debridement, and iliac bone grafting. Subsequently, we reviewed the literature pertaining to the use of the transoral mandibular tongue-splitting approach. The approach can be invasive and cause some complications. However, no fatal complications have been reported, and all patients demonstrated a favorable neurological outcome with reduced neurological deficits. Conclusions This case and subsequent literature review suggest that the transoral mandibular tongue-splitting approach may be effective for the improvement of neurological outcomes without fatal complications in patients with UCEA. There may be an increasing number of patients with UCEA requiring the transoral mandibular tongue-splitting approach due to the increasing prevalence of immunocompromized status and the aging population.
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Affiliation(s)
- Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Kazumasa Maeda
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yu Toda
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Hirohito Hirata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tomohito Yoshihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Ali NES, Alyono JC, Koltai PJ. Neonatal retropharyngeal abscess with complications: Apnea and cervical osteomyelitis. Int J Pediatr Otorhinolaryngol 2019; 126:109613. [PMID: 31382216 DOI: 10.1016/j.ijporl.2019.109613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the clinical presentation and management strategies for neonatal retropharyngeal abscess (RPA). METHODS Retrospective chart review was performed, and literature reviewed. RESULTS We report two cases of neonatal RPA, with one complicated by cervical osteomyelitis, and the other presenting with apparent life-threatening events (ALTEs). A 6-week-old female underwent transoral drainage of an RPA, which grew methicillin sensitive Staphylococcus aureus. She had a prolonged recovery course and was found to have developed osteomyelitis of the dens and atlas. She was treated with 14 weeks of IV antibiotics and rigid collar fixation for spinal cord instability. A 2-month-old female was admitted after multiple ALTEs with episodes of apnea and pallor. Direct laryngoscopy revealed a bulging RPA, which was drained transorally. This grew multiple organisms including methicillin resistant Staphylococcus aureus, Streptococcal oralis and Prevotella species. CONCLUSIONS Uncommon in neonates, RPA can present in this age group without fever, and are is likely to have airway complications than in older children. In cases with prolonged recovery, additional diagnostic intervention is recommended to rule out rare complications such as osteomyelitis. Emphasis in such complex cases is placed on a multidisciplinary approach to patient care, coordinating neonatologists, infectious disease specialists, neurosurgeons, and otolaryngologists.
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Affiliation(s)
- Noor-E-Seher Ali
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer C Alyono
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter J Koltai
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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Abstract
OBJECTIVE To report clinical, laboratory and radiologic manifestations in 2 infants with osteomyelitis of the odontoid process (dens). BACKGROUND Vertebral osteomyelitis is uncommon, and osteomyelitis of the dens has rarely been reported in the pediatric population. METHODS The medical records of 2 infants diagnosed with dens osteomyelitis were reviewed. RESULTS Both infants had fever, which resolved spontaneously before admission. Both were nontoxic appearing with persistent neck stiffness and torticollis. White blood count and C-reactive protein were only mildly elevated in both cases. Blood cultures were sterile. Magnetic resonance imaging revealed the diagnosis. They both fully recovered. CONCLUSIONS We report 2 cases of dens osteomyelitis. These cases emphasize the need to consider C1-C2 osteomyelitis in the differential diagnosis of neck stiffness and torticollis.
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Eltorai AEM, Naqvi SS, Seetharam A, Brea BA, Simon C. Recent Developments in the Treatment of Spinal Epidural Abscesses. Orthop Rev (Pavia) 2017; 9:7010. [PMID: 28713526 PMCID: PMC5505082 DOI: 10.4081/or.2017.7010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 04/04/2017] [Accepted: 04/14/2017] [Indexed: 12/19/2022] Open
Abstract
Spinal epidural abscess (SEA) is a serious condition that can be challenging to diagnose due to nonspecific symptomology and delayed presentation. Despite this, it requires prompt recognition and management in order to prevent permanent neurologic sequelae. Several recent studies have improved our understanding of SEA. Herein, we summarize the recent literature from the past 10 years relevant to SEA diagnosis, management and outcome. While surgical care remains the mainstay of treatment, a select subset of SEA patients may be managed without operative intervention. Multidisciplinary management involves internal medicine, infectious disease, critical care, and spine surgeons in order to optimize care.
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Affiliation(s)
- Adam E M Eltorai
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Syed S Naqvi
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Ashok Seetharam
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Bielinsky A Brea
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Chad Simon
- Warren Alpert Medical School, Brown University, Providence, RI, USA
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Park H, Byeon HK, Kim HS, Hong JJ, Suk KS. Odontoid osteomyelitis with atlantoaxial subluxation in an infant. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:136-140. [PMID: 28012078 DOI: 10.1007/s00586-016-4919-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/14/2016] [Accepted: 12/07/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a rare case of odontoid osteomyelitis with atlantoaxial subluxation in a 6-month-old infant. BACKGROUND Odontoid osteomyelitis with atlantoaxial subluxation is extremely rare in children. Although several cases have been reported, there have been no studies concerning proper surgical drainage and immobilization in this disease. METHODS A 6-month-old infant with odontoid osteomyelitis with atlantoaxial subluxation was surgically treated. The patient underwent a 3-month intravenous and oral antibiotic course and the Minerva body jacket cast was used for 3 months. Follow-up was carried out with computed tomographic scans and a cervical spine dynamogram. RESULTS At 18 months post-surgery, the patient had completely recovered with no cervical instability. Computed tomographic scans revealed complete fusion of odontoid synchondrosis. The infant remained asymptomatic with a full range of head movement. CONCLUSION Surgical drainage and proper immobilization appears to be a satisfactory treatment for pyogenic osteomyelitis of odontoid synchondrosis secondary to retropharyngeal abscess and atlantoaxial subluxation. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Hoon Park
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Hyung Kwon Byeon
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Hak-Sun Kim
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Jung Jun Hong
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Kyung-Soo Suk
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.
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Zimmermann P, Ritz N, Stranzinger E. Odontoid Osteomyelitis in Children: Illustrative Case Reports and Review of the Literature. Pediatr Infect Dis J 2016; 35:920-3. [PMID: 27164466 DOI: 10.1097/inf.0000000000001192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Odontoid osteomyelitis is a rare disease which is frequently misdiagnosed as torticollis, leading to a delay in diagnosis. We present 2 illustrative cases and a systematic literature review summarizing previously reported cases. Odontoid osteomyelitis should be considered in children presenting with decreased head movements and with elevated erythrocyte sedimentation rate, particularly without improvement while receiving antiinflammatory treatment. Plain radiographs can be misleading, and magnetic resonance imaging should be performed for better visualization.
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Affiliation(s)
- Petra Zimmermann
- From the *Infectious Diseases Unit and †Department of Diagnostic, Interventional and Paediatric Radiology, University Children's Hospital, Berne, Switzerland; ‡Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; §Infectious Diseases Unit and Paediatric Pharmacology, University of Basel Children's Hospital Basel, Basel, Switzerland; and ¶Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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Horner K, Yamada M, Zuccoli G, Rosenberg S, Greene S, Vellody K, Zuckerbraun NS. A 34-Day-Old With Fever, Cerebrospinal Fluid Pleocytosis, and Staphylococcus aureus Bacteremia. Pediatrics 2016; 137:peds.2015-1406. [PMID: 26644490 DOI: 10.1542/peds.2015-1406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 11/24/2022] Open
Abstract
A 34-day-old previously healthy boy born full term presented to the emergency department with fever at home (38.1°C), fussiness, and decreased oral intake for 1 day. He was difficult to console at home. He had decreased oral intake without emesis, diarrhea, or a change in urine output. He did not have rhinorrhea, cough, or increased work of breathing noted by parents. He lived at home with his parents and 13-year-old brother, did not attend day care, and had no sick contacts. On examination, he was fussy but consolable. He was febrile to 39.3°C, tachycardic (180 beats per minute), and tachypneic (64 breaths per minute), with mottling and a capillary refill of 3 seconds. The remainder of his examination was normal, without an infectious focus for his fever. A complete blood cell count with differential revealed leukocytosis. A basic metabolic panel was normal. A catheter urinalysis was normal. Cerebrospinal fluid examination yielded pleocytosis, low glucose, and elevated protein. Blood cultures were persistently positive with methicillin-sensitive Staphylococcus aureus, but cerebrospinal fluid cultures remained negative. We present his case, management, and ultimate diagnosis.
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Affiliation(s)
| | | | | | | | - Stephanie Greene
- Neurosurgery, The Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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Mirouse G, Journe A, Casabianca L, Moreau PE, Pannier S, Glorion C. Bartonella henselae osteoarthritis of the upper cervical spine in a 14-year-old boy. Orthop Traumatol Surg Res 2015; 101:519-22. [PMID: 25881557 DOI: 10.1016/j.otsr.2015.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 01/28/2015] [Accepted: 02/19/2015] [Indexed: 02/02/2023]
Abstract
We report a case of Bartonella henselae, an agent of cat scratch disease, C1-C2 osteoarthritis with osteolysis of the lateral mass of C2 in a 14-year-old boy. Oral antibiotics did not successfully treat the infection and surgery was necessary to treat the septic arthritis. The case opens discussion about bacterial osteoarthritis of the cervical spine and bone involvement in disseminated bartonellosis.
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Affiliation(s)
- G Mirouse
- Service d'orthopédie infantile, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Faculté de médecine Paris Descartes, Université Sorbonne Paris Cité, 149, rue de Sèvres, 75015 Paris, France.
| | - A Journe
- Service d'orthopédie infantile, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Faculté de médecine Paris Descartes, Université Sorbonne Paris Cité, 149, rue de Sèvres, 75015 Paris, France
| | - L Casabianca
- Service d'orthopédie infantile, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Faculté de médecine Paris Descartes, Université Sorbonne Paris Cité, 149, rue de Sèvres, 75015 Paris, France
| | - P E Moreau
- Service d'orthopédie infantile, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Faculté de médecine Paris Descartes, Université Sorbonne Paris Cité, 149, rue de Sèvres, 75015 Paris, France
| | - S Pannier
- Service d'orthopédie infantile, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Faculté de médecine Paris Descartes, Université Sorbonne Paris Cité, 149, rue de Sèvres, 75015 Paris, France
| | - C Glorion
- Service d'orthopédie infantile, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Faculté de médecine Paris Descartes, Université Sorbonne Paris Cité, 149, rue de Sèvres, 75015 Paris, France
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