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Ross JJ, Ard KL. Septic Arthritis of the Spinal Facet Joint: Review of 117 Cases. Open Forum Infect Dis 2024; 11:ofae091. [PMID: 38449920 PMCID: PMC10917203 DOI: 10.1093/ofid/ofae091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Background Septic arthritis of the spinal facet joints is increasingly recognized in the era of magnetic resonance imaging, but its epidemiology, clinical features, management, and prognosis are ill-defined. Methods We review 101 previously published cases and report 16 cases occurring at our institutions between 2006 and 2018. Results Most patients presented with fever (60%) and back or neck pain (86%). Radiation into the hip, buttock, or limb was present in 34%. The lumbosacral vertebral segments were involved in 78% of cases. Most cases (64%) were due to Staphylococcus aureus. Bacteremia was present in 66% and paraspinal muscle abscesses in 54%. While epidural abscesses were present in 56%, neurologic complications were seen in only 9%, likely because most abscesses arose below the conus medullaris. Neurologic complications were more common with cervical or thoracic involvement than lumbosacral (32% vs 2%, P < .0001). Extraspinal infection, such as endocarditis, was identified in only 22% of cases. An overall 98% of patients survived, with only 5% having neurologic sequelae. Conclusions Septic arthritis of the facet joint is a distinct clinical syndrome typically involving the lumbar spine and is frequently associated with bacteremia, posterior epidural abscesses, and paraspinal pyomyositis. Neurologic outcomes are usually good with medical management alone.
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Affiliation(s)
- John J Ross
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kevin L Ard
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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2
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Mo YF, Mu ZS, Zhou K, Pan D, Zhan HT, Tang YH. Surgery combined with antibiotics for thoracic vertebral Escherichia coli infection after acupuncture: A case report. World J Clin Cases 2022; 10:13099-13107. [PMID: 36569001 PMCID: PMC9782942 DOI: 10.12998/wjcc.v10.i35.13099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/02/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Ya-Feng Mo
- Department of Orthopaedics, Zhejiang Chinese Medical University, Hangzhou 311200, Zhejiang Province, China
| | - Zhuo-Song Mu
- Department of Orthopaedics, Zhejiang Chinese Medical University, Hangzhou 311200, Zhejiang Province, China
| | - Kun Zhou
- Department of Orthopaedics, Zhejiang Chinese Medical University, Hangzhou 311200, Zhejiang Province, China
| | - Dong Pan
- Department of Orthopaedics, Zhejiang Chinese Medical University, Hangzhou 311200, Zhejiang Province, China
| | - Huan-Teng Zhan
- Department of Orthopaedics, Hospital of Traditional Chinese Medicine of Xinyu City, Xinyu 338000, Jiangxi Province, China
| | - Yang-Hua Tang
- Department of Orthopaedics, Hospital of Traditional Chinese Medicine of Xiaoshan District, Hangzhou 310000, Zhejiang Province, China
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Kalanjiyam GP, Shanmuganathan R, Shetty AP, Kanna RM, Thippesamy PB, Raja DC. Rare Presentation of Meningitis Due to Lumbar Facetal Septic Abscess: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00055. [PMID: 35703159 DOI: 10.2106/jbjs.cc.22.00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE An elderly obese woman with comorbidities presented with acute-onset altered sensorium. She was diagnosed with meningitis and started on empirical antibiotics. She became oriented after 48 hours and mentioned that she had severe low backache in the previous week. Examination revealed bilateral lower limb weakness. Magnetic resonance imaging showed L3-L4 lumbar facetal abscess (LFA) with epidural extension. Posterior instrumented decompression was performed. Tissue culture grew Enterococcus, and the patient was administered vancomycin and linezolid. At 3 months, there was complete neurological recovery, and she was normal at the 1-year follow-up. CONCLUSION This report highlights the rare presentation of LFA complicating meningitis and its treatment.
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Affiliation(s)
| | | | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | | | - Dilip Chand Raja
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
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Diaz-Dilernia F, Costantini J, Nicolino TI, Sanchez MDL, Carbo L. Unusual Listeria monocytogenes hematogenous infection in total knee replacement treated with one-stage revision surgery. Arthroplast Today 2019; 5:296-300. [PMID: 31516969 PMCID: PMC6728532 DOI: 10.1016/j.artd.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 12/17/2022] Open
Abstract
Septic arthritis due to Listeria monocytogenes (LM) is extremely rare and most infections due to this organism are seen in immunocompromised patients. We describe a patient without immunological compromise, with a late total knee arthroplasty infection caused by LM treated with one-stage revision surgery. She had an elevated erythrocyte sedimentation rate (79 mm/h) and C-reactive protein (13 mg/dL). Aspiration of the knee joint yielded purulent fluid; cultures showed LM. The patient was given 6 weeks of intravenous ampicillin, followed by trimethoprim/sulfamethoxazole, and finally amoxicillin orally for 7 months. Two years after revision surgery, radiographs showed no evidence of implant loosening. This is a single case and although one-stage approach seemed to have worked, it should not be recommended on the basis of a single report.
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Affiliation(s)
- Fernando Diaz-Dilernia
- Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Julian Costantini
- Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Tomas I Nicolino
- Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Marisa Del Lujan Sanchez
- Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Lisandro Carbo
- Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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5
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Septic arthritis of the lumbar facet joint presenting as spontaneous bacterial peritonitis: a rare case requiring surgical intervention. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:175-178. [PMID: 31463672 DOI: 10.1007/s00590-019-02527-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/03/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To report and discuss a rare case of septic arthritis of a lumbar facet joint presenting as septic bacterial peritonitis and requiring surgical debridement. METHODS A 55-year-old man, with a history of intravenous drug usage and hepatitis C, presented to the emergency department with fever, abdominal and lumbar pain. Examination showed ascites. Erythrocyte sedimentation rate and C-reactive protein were elevated. A paracentesis was performed, and a diagnosis of spontaneous bacterial peritonitis was assumed as acute on chronic liver failure. The patient was admitted for antibiotic treatment with cefotaxime. Staphylococcus aureus was isolated in blood cultures. Despite directed treatment, there were persistent fever, back pain and continuous elevation of serum inflammatory markers. An MRI of the lumbar spine was performed 14 days after presentation and identified septic arthritis of the left L4-L5 facet joint. In the absence of a response to the medical treatment, surgical debridement of the facet joint was performed. After surgery, back pain resolved and inflammatory markers started to decline. One year after surgery, the patient is asymptomatic and has normalization of the inflammatory markers of infection. Follow-up MRI shows complete resolution of the infection. CONCLUSIONS Septic arthritis of the lumbar facet joints is a rare condition with no more than 50 cases reported in the literature. This infection, which can cause significant morbidity, can result from local or systemic inoculation. MRI is the diagnostic method of choice. While antibiotic therapy is the first line of treatment, when it fails, surgical debridement may be necessary.
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Huguet S, Ibáñez N, Bernaus M, Font-Vizcarra L. Acute medullar compression secondary to a septic arthritis of a thoracic facet joint: a case report and review of literature. Spinal Cord Ser Cases 2018; 4:80. [PMID: 30210812 DOI: 10.1038/s41394-018-0117-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/09/2018] [Accepted: 08/12/2018] [Indexed: 12/17/2022] Open
Abstract
Introduction Septic arthritis of a facet joint (SAFJ) is a rare entity and frequently underdiagnosed. It is most frequently localised in the lumbar segment. Case presentation A 48-year-old woman presented at our emergency room with a chief complaint of lumbar pain and perineal hypoesthesia. An urgent lumbar Magnetic Resonance Imaging (MRI) was performed showing no signs of compressive pathology. Intravenous painkillers were administered improving her clinical symptoms, so she was discharged from the emergency department to be followed at our out-patient clinic. After 12 h, the patient presented again referring an acute loss of strength in her lower limbs and paresthesias at a T10 sensitive level. Due to the severity of the symptoms, we performed an urgent dorsal MRI that showed a septic arthritis of the left T8-T9 facet joint and an epidural abscess causing a medullar compression. Blood cultures were performed before surgical treatment. An urgent laminectomy of T8 and debridement of the abscess were performed. Intraoperative microbiology and blood cultures were positive for Streptococcus constellatus. After surgery, the patient presented a progressive improvement of her symptomatology. Discussion Physicians should have in mind and rule out this clinical entity to avoid severe consequences that a misdiagnosed SAFJ could develop.
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Affiliation(s)
- Sandra Huguet
- 1Department of Traumatology and Orthopedics, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Natàlia Ibáñez
- Department of Traumatology and Orthopedics, Consorci Sanitari del Garraf, Barcelona, Spain
| | - Martí Bernaus
- 3Osteoarticular Infections Unit - Department of Traumatology and Orthopedics, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Lluís Font-Vizcarra
- 4Osteoarticular Infections Unit - Department of Traumatology and Orthopedics, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
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Bureta C, Tominaga H, Yamamoto T, Setoguchi T, Kawamura H, Nagano S, Kawamura I, Abematsu M, Kakoi H, Ishidou Y, Komiya S. Lumbar spine epidural abscess and facet joint septic arthritis due to Streptococcus agalactiae: a case report. BMC Surg 2018. [PMID: 29534714 PMCID: PMC5851089 DOI: 10.1186/s12893-018-0350-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Here we report a rare case of lumbar spine epidural abscess and facet joint septic arthritis caused by Streptococcus agalactiae, which had spread to the iliopsoas muscles, leading to urine retention. Case presentation A 68-year-old woman with low back pain experienced a sudden onset of bilateral lower limb weakness, it was followed 14 days later by urine retention. At consultation, magnetic resonance imaging and identification of serum β-hemolytic streptococci provided a diagnosis of Streptococcus agalactiae infection. She was started on antibiotics. Despite diminishing signs of inflammation, preoperative MRI showed an epidural mass at T12-L4 compressing the cord and involving the paravertebral muscles as well. Group B beta-hemolytic streptococci were detected in both urine and blood. Because of bilateral lower limb weakness and urine retention, T12-L4 hemilaminectomy was performed. The L3/L4 intertransverse ligament resected and abscess drained. Histopathology revealed that inflammatory cells had invaded the facet joint. Group B beta-hemolytic streptococci were identified, confirming the diagnosis. The patient continued with the antibiotics postoperatively, and her health rapidly improved. Conclusion Lumbar spine epidural abscess and facet joint septic arthritis caused by Streptococcus agalactiae is a clinical emergency, with significant morbidity and mortality especially with delayed diagnosis. A delay in both diagnosis and aggressive treatment can lead to not only severe neurological deficit but also to septicaemia, multiorgan failure, and even death.
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Affiliation(s)
- Costansia Bureta
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan. .,Department of Neurosurgery, Muhimbili Orthopaedic and Neurosurgical Institute, P.O. Box 65474, Dar es Salaam, Tanzania.
| | - Hiroyuki Tominaga
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Takuya Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Takao Setoguchi
- The Near-Future Locomotor Organ Medicine Creation Course (Kusunoki Kai), Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hideki Kawamura
- Division of Medical and Environmental Safety, Kagoshima University Medical and Dental Hospital, Kagoshima, Japan
| | - Satoshi Nagano
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Ichiro Kawamura
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Masahiko Abematsu
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Hironori Kakoi
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yasuhiro Ishidou
- Medical Joint Materials, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Setsuro Komiya
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
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Cupler ZA, Anderson MT, Stancik TJ. Thoracic Spondylodiscitis Epidural Abscess in an Afebrile Navy Veteran: A Case Report. J Chiropr Med 2017; 16:246-251. [PMID: 29097956 DOI: 10.1016/j.jcm.2017.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/13/2017] [Accepted: 03/28/2017] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Zachary A Cupler
- Physical Medicine & Rehabilitative Services, VA Butler Healthcare, Butler, Pennsylvania
| | - Michael T Anderson
- Physical Medicine & Rehabilitative Services, VA Butler Healthcare, Butler, Pennsylvania
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Robinson A, Lind CRP, Smith RJ, Kodali V. Atlanto-Axial Infection after Acupuncture. Acupunct Med 2016; 34:149-51. [DOI: 10.1136/acupmed-2015-212110rep] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2015] [Indexed: 12/17/2022]
Abstract
A 67-year-old man presented with neck cellulitis following acupuncture for cervical spondylosis. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Increased neck pain and bacteraemia prompted MRI, which showed atlanto-axial septic arthritis without signs of infection of the tissues between the superficial cellulitic area and the atlanto-axial joint, thus making direct extension of infection unlikely. It is more likely that haematogenous spread of infection resulted in seeding in the atlanto-axial joint, with the proximity of the arthritis and acupuncture site being coincidental. Acupuncture is a treatment option for some indolent pain conditions. As such, acupuncture services are likely to be more frequently utilised. A history of acupuncture is rarely requested by the admitting doctor and seldom offered voluntarily by the patient, especially where the site of infection due to haematogenous spread is distant from the needling location. Awareness of infectious complications following acupuncture can reduce morbidity through early intervention.
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Affiliation(s)
- A Robinson
- Department of Medicine, Geraldton Regional Hospital, Geraldton, Western Australia, Australia
| | - C R P Lind
- University of Western Australia, Perth, Australia
- Neurosurgical Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Australia
| | - R J Smith
- Department of Medicine, Geraldton Regional Hospital, Geraldton, Western Australia, Australia
| | - V Kodali
- Department of Medicine, Geraldton Regional Hospital, Geraldton, Western Australia, Australia
- University of Western Australia, Perth, Australia
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10
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Robinson A, Lind CRP, Smith RJ, Kodali V. Atlanto-axial infection after acupuncture. BMJ Case Rep 2015; 2015:bcr-2015-212110. [PMID: 26655668 DOI: 10.1136/bcr-2015-212110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 67-year-old man presented with neck cellulitis following acupuncture for cervical spondylosis. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Increased neck pain and bacteraemia prompted MRI, which showed atlanto-axial septic arthritis without signs of infection of the tissues between the superficial cellulitic area and the atlanto-axial joint, thus making direct extension of infection unlikely. It is more likely that haematogenous spread of infection resulted in seeding in the atlanto-axial joint, with the proximity of the arthritis and acupuncture site being coincidental. Acupuncture is a treatment option for some indolent pain conditions. As such, acupuncture services are likely to be more frequently utilised. A history of acupuncture is rarely requested by the admitting doctor and seldom offered voluntarily by the patient, especially where the site of infection due to haematogenous spread is distant from the needling location. Awareness of infectious complications following acupuncture can reduce morbidity through early intervention.
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Affiliation(s)
- A Robinson
- Department of Medicine, Geraldton Regional Hospital, Geraldton, Western Australia, Australia
| | - C R P Lind
- University of Western Australia, Perth, Australia Neurosurgical Service of Western Australia, Sir Charles Gairdner Hospital, Perth, Australia
| | - R J Smith
- Department of Medicine, Geraldton Regional Hospital, Geraldton, Western Australia, Australia
| | - V Kodali
- Department of Medicine, Geraldton Regional Hospital, Geraldton, Western Australia, Australia University of Western Australia, Perth, Australia
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Kitova-John MB, Azim-Araghi A, Sheikh FT, Kitov BD. Idiopathic septic arthritis of a lumbar facet joint associated with paraspinal abscess. BMJ Case Rep 2015; 2015:bcr-2015-211135. [PMID: 26272966 DOI: 10.1136/bcr-2015-211135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A 48-year-old woman presented with a 1-month history of severe lower back pain on a background of 24 h of mild fever and general tiredness with an associated right-sided foot drop. Five weeks after the onset and with no improvement in symptoms in spite of analgesia and physiotherapy, the patient had a lumbar spine MRI which demonstrated a collection extending from the facet joints of L5 and L6 to the iliacus muscle on the right. A CT-guided aspiration was performed with a lengthy hospital stay for intravenous antibiotic treatment. The culture and sensitivity study of the aspirate isolated Streptococcus pneumoniae.
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Affiliation(s)
| | | | - Faraz Tariq Sheikh
- Department of Clinical Radiology, Southampton General Hospital, Southampton, UK
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12
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First Reported Case of Methicillin-Resistant Staphylococcus aureus Vertebral Osteomyelitis with Multiple Spinal and Paraspinal Abscesses Associated with Acupuncture. Case Rep Med 2015; 2015:524241. [PMID: 26257786 PMCID: PMC4518153 DOI: 10.1155/2015/524241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 06/29/2015] [Indexed: 12/17/2022] Open
Abstract
Acupuncture is one of the oldest medical procedures in the world and originated in China about 2,000 years ago. Acupuncture is a form of complementary medicine and has gained popularity worldwide in the last few decades. It is mainly used for the treatment of chronic pain. Acupuncture is usually considered a safe procedure but has been reported to cause serious complications including death. It has been associated with transmission of many viruses and bacteria. Two cases of Methicillin-Resistant Staphylococcus aureus have been reported recently following acupuncture therapy. We are reporting a case of a 57-year-old Korean female who developed vertebral osteomyelitis and intraspinal and paraspinal abscesses as a complication of acupuncture. Blood cultures, skin lesion culture, and body fluid culture yielded Methicillin-Resistant Staphylococcus aureus (MRSA). Good anatomical and medical knowledge, good hygiene standards, and proper acupuncture techniques should be followed to prevent the complications. Acupuncturists should consistently review the infection control guidelines to acupuncture. This case should raise awareness of such condition and hazards of presumably benign procedures such as acupuncture.
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Abstract
OBJECTIVES There are safety issues associated with acupuncture treatment. Previous studies regarding needling depth of acupuncture points revealed inconsistent results due to vague depth definition, acupuncture point localisation and measuring tools. The objective of this study is to find and compare the differences of the mean depths of 11 acupuncture points in the neck and shoulder region between subjects, with variables including gender and body mass index (BMI). SETTING This study was conducted at a single medical center in Taiwan. PARTICIPANTS Three hundred and ninety-four participants were included in this study. Participants were grouped according to gender and BMI. Acupuncture points were localised by WHO standard and measured by MRI. OUTCOME MEASURES The distance from the needle insertion point (surface of the skin) to any tissues that would cause possible/severe complications. RESULTS Mean depths of 11 points were obtained in groups of different BMI and gender. Mean depths of all participants regardless of BMI and gender are as follows, in centimetres: GB21=5.6, SI14=5.2, SI15=8.8, GV15=4.9, GV16=4.6, GB20=5.0, ST9=1.6, SI16=1.8, SI17=2.4, TE16=3.1, LI18=1.3. Participants with higher BMI had greater measured depths in both gender groups. Male participants had larger mean depths than female participants regardless of BMI except in SI17 and LI18. When taking BMI into consideration, depths in male participants are greater than in female participants in most of the points except the following: GB21, TE16 in obesity group; ST9 in underweight and obesity group; SI16 in ideal body weight, overweight and obesity group; SI17, LI18 in each group. CONCLUSIONS Participants with higher BMI had greater measured depths and males tended to have greater depths in most of the points. Clinical practitioners are recommended to consider this information to prevent complications when applying acupuncture treatment to their patients.
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Affiliation(s)
- Pei-Chi Chou
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan Department of Traditional Chinese Medicine, China Medical University Hospital Eastern Branch, Taichung, Taiwan
| | - Yu-Chuen Huang
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Jen Hsueh
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jaung-Geng Lin
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Heng-Yi Chu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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14
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Purushothaman R, Inassi J, Marthya A. Facet joint septic arthritis due to community acquired methicillin resistant Staphylococcus aureus (MRSA) - A case report. J Orthop 2015; 12:S117-20. [PMID: 26719620 DOI: 10.1016/j.jor.2015.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 01/27/2015] [Indexed: 12/17/2022] Open
Abstract
Septic arthritis of facet joint (SAFJ) is extremely rare. Only about sixty cases have been reported so far. A single case of SAFJ in a series of 491 cases of spinal infections was first reported by David-Chaussé in 1981. A case report of SAFJ was published by Halpin in 1987. With the growing availability and use of MRI, more and more cases are being reported. The most common organism that causes SAFJ is Staphylococcus aureus. We are reporting a case of SAFJ caused by community acquired, methicillin resistant S aureus (MRSA) successfully treated by Linezolid.
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Affiliation(s)
| | - Jojo Inassi
- Department of Orthopaedics, Medical College, Calicut, 673009, India
| | - Anwar Marthya
- Department of Orthopaedics, KMCT Medical College, Manassery, 673602, India
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15
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[Septic arthritis of a lumbar facet joint with epidural and paraspinal abscess: Report of a case]. Enferm Infecc Microbiol Clin 2014; 34:76-7. [PMID: 25533741 DOI: 10.1016/j.eimc.2014.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 12/17/2022]
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Adverse events of acupuncture: a systematic review of case reports. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:581203. [PMID: 23573135 PMCID: PMC3616356 DOI: 10.1155/2013/581203] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 02/08/2013] [Indexed: 12/17/2022]
Abstract
Acupuncture, moxibustion, and cupping, important in traditional Eastern medicine, are increasingly used in the West. Their widening acceptance demands continual safety assessment. This review, a sequel to one our team published 10 years ago, is an evaluation of the frequency and severity of adverse events (AEs) reported for acupuncture, moxibustion, and cupping between 2000 and 2011. Relevant English-language reports in six databases were identified and assessed by two reviewers. During this 12-year period, 117 reports of 308 AEs from 25 countries and regions were associated with acupuncture (294 cases), moxibustion (4 cases), or cupping (10 cases). Country of occurrence, patient's sex and age, and outcome were extracted. Infections, mycobacterial, staphylococcal, and others, were the main complication of acupuncture. In the previous review, we found the main source of infection to be hepatitis, caused by reusable needles. In this review, we found the majority of infections to be bacterial, caused by skin contact at acupoint sites; we found no cases of hepatitis. Although the route of infection had changed, infections were still the major complication of acupuncture. Clearly, guidelines such as Clean Needle Technique must be followed in order to minimize acupuncture AEs.
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Harries LW, Watura R. Septic arthritis of unilateral lumbar facet joint with contiguous abscess, without prior intervention. BMJ Case Rep 2012; 2012:bcr0920114849. [PMID: 22602829 PMCID: PMC3339176 DOI: 10.1136/bcr.09.2011.4849] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A 40-year-old female patient presented with persistent severe back pain radiating to the right leg, abdominal pain and constipation. Other clinical symptoms included nausea, vomiting and high-grade fever. Clinical examination showed generalised abdominal and lower back tenderness. There was no sensory loss or motor weakness in lower limbs, however investigations showed raised inflammatory markers. Radiographs of the lumbar spine and hip joint were normal. MRI revealed a septic arthritis of the right L3/4 facet joint, associated with a large abscess extending anteriorly to the right paraspinal muscles and posteriorly into the right posterolateral aspect of the epidural space in the central spinal canal, with moderate compression of the dural sac. Unlike any other reported similar case, this septic arthritis developed without prior medical intervention. The patient was treated successfully with ultrasound guided drainage of the facet joint/abscess and antibiotics.
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Affiliation(s)
- Mike Cummings
- British Medical Acupuncture Society, Royal London Hospital for Integrated Medicine, London, UK.
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Ernst E, Lee MS, Choi TY. Acupuncture: does it alleviate pain and are there serious risks? A review of reviews. Pain 2011; 152:755-764. [PMID: 21440191 DOI: 10.1016/j.pain.2010.11.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 11/01/2010] [Accepted: 11/03/2010] [Indexed: 12/17/2022]
Abstract
Acupuncture is commonly used for pain control, but doubts about its effectiveness and safety remain. This review was aimed at critically evaluating systematic reviews of acupuncture as a treatment of pain and at summarizing reports of serious adverse effects published since 2000. Literature searches were carried out in 11 databases without language restrictions. Systematic reviews were considered for the evaluation of effectiveness and case series or case reports for summarizing adverse events. Data were extracted according to predefined criteria. Fifty-seven systematic reviews met the inclusion criteria. Four were of excellent methodological quality. Numerous contradictions and caveats emerged. Unanimously positive conclusions from more than one high-quality systematic review existed only for neck pain. Ninety-five cases of severe adverse effects including 5 fatalities were included. Pneumothorax and infections were the most frequently reported adverse effects. In conclusion, numerous systematic reviews have generated little truly convincing evidence that acupuncture is effective in reducing pain. Serious adverse effects continue to be reported. Numerous reviews have produced little convincing evidence that acupuncture is effective in reducing pain. Serious adverse events, including deaths, continue to be reported.
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Affiliation(s)
- E Ernst
- Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, UK Division of Standard Research, Korea Institute of Oriental Medicine, Daejeon, South Korea
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McDowell JM, Johnson GM, Bradnam LV. Towards a neurophysiological mechanisms-based classification of adverse reactions to acupuncture. PHYSICAL THERAPY REVIEWS 2011. [DOI: 10.1179/1743288x11y.0000000008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Herrero Herrero JI, García Aparicio J. Escherichia coli septic arthritis of a lumbar facet joint following urinary tract infection. Int J Infect Dis 2010; 15:e63-5. [PMID: 21093340 DOI: 10.1016/j.ijid.2009.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Accepted: 11/02/2009] [Indexed: 12/17/2022] Open
Abstract
Septic arthritis of a lumbar facet joint is a rare condition. We report the case of a 77-year-old diabetic woman who developed fever and back pain 15 days after she had been diagnosed with a genitourinary infection for which she had received ciprofloxacin. Physical examination showed fever (38°C) and pain on pressure over the lower lumbar spinous vertebral apophyses and over the lower left paraspinal musculature. Investigations showed a white cell count of 8.4×10⁹/l, neutrophils 85.3%, erythrocyte sedimentation rate of 125 mm/h, and C-reactive protein of ≥9 mg/dl. Two blood cultures were both positive for Escherichia coli resistant to ciprofloxacin. There was no growth of pathogens from the urine cultures. Scintigraphy with gallium citrate Ga⁶⁷ showed vertical lower lumbar (L4-L5) radionuclide uptake lateralized to the left. Magnetic resonance imaging of the lumbar spine demonstrated signal changes and alteration of the structure at the left interapophyseal L4-L5 joint, an adjacent small collection of 1cm in diameter, and infiltration of the surrounding soft tissues, which extended to the epidural area, left conjunction hole, and paraspinal muscles. The patient was treated with intravenous cefotaxime and gentamicin and bed rest for 21 days, and recovered. This is the first report of interapophyseal arthritis caused by E. coli.
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Affiliation(s)
- José Ignacio Herrero Herrero
- Servicio de Medicina Interna, Hospital Los Montalvos, Hospital Universitario de Salamanca, Los Montalvos, s/n, 37192 Salamanca, Spain.
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Abstract
STUDY DESIGN : Case report. OBJECTIVE : To describe a case of septic arthritis of the facet joint in an infant. SUMMARY OF BACKGROUND DATA : To our knowledge, no more than 50 cases of septic arthritis of a facet joint are reported in literature, including only 4 cases in children and none in infants. METHODS : A girl of age 18 months presented with a fever pattern of 4 days evolution, right lumbar paravertebral tumefaction with local inflammatory signs and limping related to pain with weight-bearing on the right lower extremity. The mother reported a pharyngeal infection 2 weeks earlier.Conventional radiology showed no alterations. MR and scintigraphy with radioactivity-marked leukocytes showed affectation only of the posterior facet joint of right L4-L5, without associated collections. Blood and urine cultures were negative. The diagnosis was established as right L4-L5 septic arthritis of a lumbar facet joint, probably of hematogenous origin. RESULTS : The fever pattern and the limp disappeared in 24 hours with wide-spectrum empirical intravenous antibiotherapy. Although no microorganism was isolated, the good response to the empirical treatment and the background of pharyngeal infection point to a hematogenous dissemination by Staphylococcus aureus or Streptococcus spp. CONCLUSION : Septic arthritis of a facet joint does not differ clinically from other spinal infections and its incidence is possibly underestimated in favor of other more common entities. Only imaging techniques can differentiate the affected structures and establish the exact diagnosis.MR allows the detection in initial stages, delimits the affectation and extension through the soft tissues, and rules out other more common entities such as discitis. Scintigraphy and SPECT can detect other active foci and be useful in the follow-up.The result achieved with antibiotic treatment in early stages is usually satisfactory. Surgical debridement is only necessary when associated purulent collections appear. From the pediatric point of view, spinal infections should also be taken into consideration within the differential diagnostic of limp in children.
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Woo PC, Lau SK, Yuen KY. First report of methicillin-resistant Staphylococcus aureus septic arthritis complicating acupuncture: simple procedure resulting in most devastating outcome. Diagn Microbiol Infect Dis 2009; 63:92-5. [DOI: 10.1016/j.diagmicrobio.2008.08.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 08/27/2008] [Accepted: 08/29/2008] [Indexed: 12/17/2022]
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Acupuncture-associated Listeria monocytogenes arthritis in a patient with rheumatoid arthritis. Joint Bone Spine 2008; 75:502-3. [DOI: 10.1016/j.jbspin.2007.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 08/09/2007] [Indexed: 12/17/2022]
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Michel-Batôt C, Dintinger H, Blum A, Olivier P, Laborde F, Bettembourg-Brault I, Pourel J, Loeuille D, Chary-Valckenaere I. A particular form of septic arthritis: Septic arthritis of facet joint. Joint Bone Spine 2008; 75:78-83. [DOI: 10.1016/j.jbspin.2007.02.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Accepted: 02/07/2007] [Indexed: 12/17/2022]
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Yücesoy K, Yüksel KZ, Baek S, Sonntag VKH, Crawford NR. Biomechanics of unilateral compared with bilateral lumbar pedicle screw fixation for stabilization of unilateral vertebral disease. J Neurosurg Spine 2008; 8:44-51. [DOI: 10.3171/spi-08/01/044] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Object
An in vitro flexibility experiment was performed to compare the biomechanical stability of asymmetrical lumbar pedicle screw fixation (longer hardware attached ipsilaterally to a 1-sided lesion), short and long fixation, and fixation with and without interconnection to the involved vertebra.
Methods
Seven human cadaveric specimens (T12–S1) were studied intact; after simulated unilateral lesions were created at L2–3 and L3-4, the segments were stabilized by 1) L2–4 unilateral fixation (L-3 excluded), 2) L2–4 bilateral fixation (L-3 included contralaterally), 3) L2–5 unilateral fixation (L-3 excluded), 4) L2–5 fixation ipsilateral (L-3 excluded) and L2–4 fixation contralateral (L-3 included), 5) L2–5 bilateral fixation (L-3 included contralaterally), and 6) L2–5 bilateral fixation (L-3 excluded). The testing order varied among specimens. Angular range of motion (ROM) and lax zone were recorded optically while loading to 6.0 Nm was created with nonconstraining pure moments.
Results
Unilateral short fixation provided significantly worse stabilization than any other construct tested in all loading modes (p < 0.05, repeated-measures analysis of variance). There was a mean 56% reduction in ROM across the lesion after adding 1 additional level rostrally and caudally. Asymmetrical long/short stabilization provided similar stability to symmetrical long stabilization. Minimal additional stability was gained by including L-3 in the long bilateral fixation construct.
Conclusions
Unilateral fixation is inadequate for stabilizing a 2-level unilateral lesion. Bilateral fixation, whether symmetrical or asymmetrical, provides good stabilization for this injury. It is not important for stability to include the level of the lesion within the long construct contralaterally.
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Affiliation(s)
- Kemal Yücesoy
- 1Department of Neurosurgery, Dokuz Eylül Üniversitesi, Izmir, Turkey
| | - K. Zafer Yüksel
- 2Spinal Biomechanics Research Laboratory and
- 4Kahramanmaraş Sütçü İmam Üniversitesi, Kahramanmaraş, Turkey
| | | | - Volker K. H. Sonntag
- 3Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Prompt recognition of a rare type of infectious arthritis. JAAPA 2007; 20:26-8. [PMID: 18019326 DOI: 10.1097/01720610-200710000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
This article reviews the pathophysiology of spinal infection and its relevance for imaging. Magnetic resonance imaging (MRI) is the modality with by far the best sensitivity and specificity for spinal infection. The imaging appearances of spinal infection in MRI are outlined, and imaging techniques are discussed. The problems of clinical diagnosis are outlined. There is some emphasis on the MRI differentiation of pyogenic and nonpyogenic infection and on the differential diagnosis of spinal infection centered on the imaging presentation.
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Affiliation(s)
- Bernhard J Tins
- Department of Radiology, The Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, United Kingdom.
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48 Treatments used in complementary and alternative medicine. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s0378-6080(06)29048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Abstract
Septic arthritis still continues to be a common and serious problem at major urban medical centers and is one of the most rapidly destructive forms of acute arthritis. The yearly incidence of bacterial arthritis varies from 2 to 10 per 100,000 in the general population to 30 to 70 per 100,000 in patients with rheumatoid arthritis and in patients with joint prostheses. Irreversible loss of joint function may develop in up to 50% of the patients. Despite better antimicrobial agents and improved hospital care, the fatality rate for this medical problem has not changed substantially during the past 30 years. An understanding of the risk factors and the pathogenesis of nongonoccocal bacterial arthritis and other forms of infectious arthritis, primarily in the context of a differential diagnosis and treatment, are important to avoid the delay in making a correct diagnosis and to improve the prognosis.
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Affiliation(s)
- Ignacio García-De La Torre
- Department of Immunology and Rheumatology, Hospital General de Occidente, Secretaría de Salud, and Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco 44690, Mexico.
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Sarzi-Puttini P, Atzeni F. Pyogenic Arthritis of the Facet Joints: A Growing Problem for Patients, A Growing Concern for Clinicians. Semin Arthritis Rheum 2006; 35:269-70. [PMID: 16616148 DOI: 10.1016/j.semarthrit.2005.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Masson C, Bouvard B, Laffitte A, Audran M. Arthrite septique de l'articulation interapophysaire postérieure du rachis. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.rhum.2005.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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