Cervical discitis associated with spinal epidural abscess caused by methicillin-resistant staphylococcus aureus

Cervical Spinal Epidural Abscess: Diagnosis, Treatment, and Outcomes: A Case Series and a Literature Review

Although recent diagnostic and management methods have improved the prognosis of cervical epidural abscesses, morbidity and mortality remain significant. The purpose of our study is to define the clinical presentation of cervical spinal epidural abscess, to determine the early clinical outcome of surgical treatment, and to identify the most effective diagnostic and treatment approaches. Additionally, we analyzed studies regarding cervical epidural abscesses and performed a review of the literature. In this study, four patients with spinal epidural abscess were included. There were three men and one woman with a mean age of 53 years. Three patients presented with motor deficits, and one patient was diagnosed incidentally through spinal imaging. All the patients had fever, and blood cultures were positive. Staphylococcus aureus was the most common organism cultured from abscesses. All patients underwent a surgical procedure, and three patients recovered their normal neurological functions, but one remained with mild neurological disability that was resolved two years postoperatively. The mean follow-up period was 12 months, and no deaths occurred in this series. Furthermore, we identified 85 studies in the literature review and extracted data regarding the diagnosis and management of these patients. The timely detection and effective management of this condition are essential for minimizing its associated morbidity and mortality.

Hematogenous Staphylococcus aureus discitis in adults can start outside the vertebral body

BACKGROUND

Textbooks describe hematogenous discitis in adults as starting in the anterior vertebral body near the endplates.

CASE REPORT

Hematogenous Staphylococcus aureus discitis developed at L1-L2 in an 81-year-old woman. On the first magnetic resonance imaging (MRI) scan performed 4 days after symptom onset, the only abnormalities were high signal from the disk on T2-weighted images, gadolinium enhancement of the soft tissues anterior to L1-L2, and epidural involvement. The endplates and vertebral bodies were normal. A subsequent MRI scan showed features typical of infectious discitis.

DISCUSSION

We found a single similar case report in the medical literature, indicating that discitis starting outside the anterior vertebral body is rare. Nevertheless, an increasing number of similar cases may be diagnosed in the future, as MRI is being performed increasingly early in patients with a clinical suspicion of infectious discitis.

CONCLUSION

Hematogenous infectious discitis in adults may start in some patients within the disk, soft tissues anterior to the disk, or epidural space. To avoid diagnostic and therapeutic delays, physicians should be aware of this unusual presentation of infectious discitis on very early MRI scans. When the clinical picture suggests discitis and findings from the early MRI scan are atypical, a repeat MRI scan should be obtained 1 week later to confirm the diagnosis.

Epidural Abscess of the Cervical Spine With Atypical Manifestations: A Report of Two Cases

BACKGROUND

Epidural abscess of the cervical spine is a medical and surgical emergency, especially when it is located at cervical area, considering this critical anatomic location. Although there is the so-called triad of epidural abscess (fever, local pain, and neurologic deficits), these are not sensitive enough to detect spinal abscess early and prevent significant morbidity and mortality.

REVIEW SUMMARY

We report 2 fatal cases of cervical spine epidural abscess with atypical manifestations. Patient 1 presented as an ascending paraparesis without signs of upper motor neuron involvement. The initial presentation was only lumbago and paraparesis. Patient 2 presented as a pure motor monoparesis of the lower limbs with lumbago. However, both had no neck pain or percussion tenderness initially. There was also no fever in patient 1. The diagnosis was made on the fourth and eighth days, respectively. They both had longstanding diabetes mellitus (DM) and presumably were not well controlled. Diabetic neuropathy and an immunocompromised status resulted in delayed diagnosis. Neither received surgical intervention. Both patients died despite correct empiric antibiotic therapy.

CONCLUSION

A high index of suspicion is most important in making a rapid, correct diagnosis of spinal epidural abscess (SEA) when a patient presents with local spinal pain and has risk factors like DM. The classic symptom triad of SEA is not sensitive enough for early detection, so a erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and CRP can be used to improve the accurate diagnosis. Spinal MRI should be performed as soon as possible. When patients present with neurologic deficits, surgical intervention is essential if there is no contraindication.

Cervical spine infection presenting as angina

The exact diagnosis for the cause of chest pain is not always straightforward as some unusual conditions may present with this symptom. We report one case of ‘cervical angina’ where a diabetic patient with infective discitis presented with a pain mimicking anginal chest pain.