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Papadakis SA, Ampadiotaki MM, Pallis D, Tsivelekas K, Nikolakakos P, Agapitou L, Sapkas G. Cervical Spinal Epidural Abscess: Diagnosis, Treatment, and Outcomes: A Case Series and a Literature Review. J Clin Med 2023; 12:4509. [PMID: 37445544 DOI: 10.3390/jcm12134509] [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: 05/30/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - Dimitrios Pallis
- B' Orthopaedic Department, KAT General Hospital of Attica, 14561 Kifissia, Greece
| | | | - Petros Nikolakakos
- B' Orthopaedic Department, KAT General Hospital of Attica, 14561 Kifissia, Greece
| | - Labrini Agapitou
- B' Orthopaedic Department, KAT General Hospital of Attica, 14561 Kifissia, Greece
| | - George Sapkas
- Orthopaedic Department, Metropolitan Hospital, 18547 Athens, Greece
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Velnar T, Kocivnik N, Bosnjak R. Clinical infections in neurosurgical oncology: An overview. World J Clin Cases 2023; 11:3418-3433. [PMID: 37383906 PMCID: PMC10294202 DOI: 10.12998/wjcc.v11.i15.3418] [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: 01/21/2023] [Revised: 03/05/2023] [Accepted: 04/13/2023] [Indexed: 05/25/2023] Open
Abstract
Central nervous system (CNS) infections are urgent conditions with high morbidity and mortality. Bacteria, viruses, parasites or fungi can cause them. Intracranial infections after craniotomies are an important complication of treatment, especially in oncological patients that are already immunologically compromised due to the disease and treatment. The consequence of CNS infections in oncological patients includes longer treatment with antibiotics, additional surgical procedures, higher treatment costs and poorer treatment outcomes. Additionally, the management of primary pathology may be prolonged or postponed as a result of the active infection. By introducing new and improved protocols, tightening controls on their implementation, constantly educating the entire team involved in patient treatment and educating both patients and relatives, the incidence of infections can be reduced effectively.
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Affiliation(s)
- Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- Alma Mater Europaea - ECM Maribor, Maribor 2000, Slovenia
| | - Nina Kocivnik
- Faculty of Pharmacy, University of Ljubljana, Ljubljana 1000, Slovenia
| | - Roman Bosnjak
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
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Li HK, Du JP, Huang DG, Shan LQ, He BR, Yan L, Zhao QP, Hao DJ. Surgical treatment of the lower cervical brucellosis with osteoporosis in the northwest region of China: review of 22 cases. Am J Transl Res 2022; 14:909-917. [PMID: 35273694 PMCID: PMC8902538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To analyze the surgical treatment of patients with cervical brucellosis with osteoporosis over a 4-year period in Northwest China. METHODS From 2013 to 2018, 22 patients (12 males and 10 females) with lower cervical spine brucellosis (C3-C7) underwent anterior lesion debridement, decompression, bone grafting and internal fixation combined with posterior bone graft fusion and internal fixation (ADDF+PIF). The follow-up period averaged 37.4 months (ranging from 24 to 57 months). RESULTS Involvement of 1 vertebra was observed in 3 patients, involvement of 3 vertebrae was observed in 9 patients, and involvement of 3 vertebrae was observed in 10 patients. Before surgery, 1 patient had Frankel grade B, 2 had grade C, 9 had grade D, and 10 had grade E. In the final follow-up, 12 patients had neurological deficits, 10 patients improved by one grade, 6 patients improved by two grades, and the neurological status of 6 patients remained unchanged. In all cases, it was observed that bone fusion required 6.8 months on average. The kyphosis Cobb angle was enhanced from an average of 11.5° preoperatively (range 0°-24°) to 0.13° postoperatively (range 1°-5°), and there was no vital loss of correction in the follow-up. CONCLUSIONS ADDF+PIF is an effective and safe treatment for patients with lower cervical brucellosis with osteoporosis.
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Affiliation(s)
- Hou-Kun Li
- Xi'an Jiaotong University No. 25 Zhuquan Road, Xi'an 710054, Shaanxi, China
| | - Jin-Peng Du
- Xi'an Jiaotong University No. 25 Zhuquan Road, Xi'an 710054, Shaanxi, China
| | - Da-Geng Huang
- Xi'an Jiaotong University No. 25 Zhuquan Road, Xi'an 710054, Shaanxi, China
| | - Le-Qun Shan
- Xi'an Jiaotong University No. 25 Zhuquan Road, Xi'an 710054, Shaanxi, China
| | - Bao-Rong He
- Xi'an Jiaotong University No. 25 Zhuquan Road, Xi'an 710054, Shaanxi, China
| | - Liang Yan
- Xi'an Jiaotong University No. 25 Zhuquan Road, Xi'an 710054, Shaanxi, China
| | - Qing-Peng Zhao
- Xi'an Jiaotong University No. 25 Zhuquan Road, Xi'an 710054, Shaanxi, China
| | - Ding-Jun Hao
- Xi'an Jiaotong University No. 25 Zhuquan Road, Xi'an 710054, Shaanxi, China
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Khan MM, Babu RA, Iqbal J, Batas SN, Raza A. Cervical Epidural Abscess due to Brucella Treated with Decompression and Instrumentation: A Case Report and Review of Literature. Asian J Neurosurg 2020; 15:440-444. [PMID: 32656150 PMCID: PMC7335118 DOI: 10.4103/ajns.ajns_358_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/05/2020] [Accepted: 03/17/2020] [Indexed: 01/18/2023] Open
Abstract
Brucella is caused by a Gram-negative bacillus and is a common disease in endemic areas where people are in close contact with animals and dairy products, but brucellar cervical epidural abscess is rare. We describe a rare case of a C5–6 brucellar epidural abscess in a veterinary doctor who was treated with decompression and instrumentation. We also review the cases of cervical brucellar epidural abscess treated with instrumentation in the literature.
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Affiliation(s)
| | - R Arun Babu
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
| | - Javeed Iqbal
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Ali Raza
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
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Arslan A, Çavuş G, Bilgin E, Ökten Aİ, Gezercan Y, Atmiş A, Çelik Ü. Brucella Case That Led to Atlantoaxial Spinal Instability in Childhood. World Neurosurg 2019; 131:108-111. [PMID: 31323407 DOI: 10.1016/j.wneu.2019.07.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atlantoaxial subluxation caused by Brucella infection is rarely seen in children. CASE DESCRIPTION C1-C2 dislocation, erosion in the odontoid bone, and compression to the brainstem were detected on cervical computed tomography and magnetic resonance imaging in a 6-year-old patient who suffered neck pain, deviation to the right in the neck, fever, and pain in his extremities. He was hospitalized in the Clinic of Pediatric Infectious Diseases. Positive Brucella agglutination tests were obtained, so C1-C2 stabilization and fusion were performed. Antibrucellosis antibiotic treatment was administered for 6 months. It was suggested that the dislocation was related to odontoid erosion and laxity of the atlantoaxial ligamentous structures during Brucella infection. CONCLUSIONS Atlantoaxial dislocation and instability develops secondarily to paravertebral abscesses, only rarely. Like brucellosis of childhood, granulomatous infectious diseases rarely cause atlantoaxial subluxation or dislocation. Torticollis and neck pains should be taken seriously for the purpose of early diagnosis of patients at risk in endemic regions. Stabilization and fusion should be performed when instability is detected, and these patients should be assessed with both pediatric infectious diseases and neurosurgery clinics. Our case is the first one in the literature in which atlantoaxial instability developed due to Brucella infection and stabilization was performed.
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Affiliation(s)
- Ali Arslan
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Gökhan Çavuş
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey.
| | - Emre Bilgin
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Ali İhsan Ökten
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Yurdal Gezercan
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
| | - Anıl Atmiş
- Department of Pediatric Infectious Diseases and Neurology, Adana City Training and Research Hospital, Adana, Turkey
| | - Ümit Çelik
- Department of Pediatric Infectious Diseases and Neurology, Adana City Training and Research Hospital, Adana, Turkey
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Shweikeh F, Hussain M, Sangtani A, Issa H, Bashir A, Johnson JP, Markarian GZ. Cervical spine epidural abscess: a single center analytical comparison to the literature. Spinal Cord Ser Cases 2017; 3:17036. [PMID: 28690871 PMCID: PMC5498827 DOI: 10.1038/scsandc.2017.36] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/16/2017] [Accepted: 05/20/2017] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Retrospective review of patient charts. OBJECTIVES Cervical spine epidural abscess (CSEA) is uncommon. In this study, characteristics of CSEA patients are described through an institutional analysis and literature review. SETTING University-affiliated city hospital. METHODS The electronic medical record was searched from 01/2001 to 01/2012. Data on presentation, comorbidities, diagnostic modalities, pathogens, treatments, and neurological recovery were collected. RESULTS Sixteen patients were identified with a mean age of 57.9 years (33-83). Nine were females. Common symptoms were neck/back pain (62.5%), neurological deficits (62.5%), and fever (31.3%). Comorbidities included cardiovascular disease (56.3%), renal disease (37.5%), and diabetes mellitus (37.5%). Lower levels were more likely afflicted (C5-C7). Microorganisms were commonly Staphylococcus and Streptococcus (68.8%). Eight (50.0%) received surgery (anterior [87.5%] and posterior [12.5%] cervical fusion and corpectomy [37.5%]) plus antibiotics and 8 (50.0%) were treated with antibiotics only. Patients with less comorbidities were more likely to receive surgery; more comorbidities were was associated with a poor prognosis. Eight patients (50%) made had full neurological recovery, 2 (12.5%) with had minimal recovery, 2 deaths died, and the remaining (25%) 1 was were sent to a skilled facility and 1or lost to follow-up. CONCLUSIONS Cervical SEA can be problematic. The vast majority do not present classically and treatment does vary. It occurs more frequently in the lower cervical levels. Though antibiotics alone may suffice, surgery is frequently employed and a multitude of techniques are at the utility of the spine surgeon. Cardiovascular comorbidities are associated with a poorer outcome. In order to improve prognosis, management considerations should include both patient factors and multidisciplinary efforts.
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Affiliation(s)
- Faris Shweikeh
- Summa Health System, College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
- Department of Neurosurgery, Cedars-Sinai Medical Center, Maxine Dunitz Neurosurgical Institute, Los Angeles, CA, USA
| | - Mohammed Hussain
- New Jersey Neuroscience Institute, JFK Medical Center, Edison, NJ, USA
| | - Ajleeta Sangtani
- Summa Health System, College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Husam Issa
- Memorial Hermann Hospital, University of Texas Health Science Center, Houston, TX, USA
| | - Asif Bashir
- New Jersey Neuroscience Institute, JFK Medical Center, Edison, NJ, USA
| | - J Patrick Johnson
- Department of Neurosurgery, Cedars-Sinai Medical Center, Maxine Dunitz Neurosurgical Institute, Los Angeles, CA, USA
| | - Georges Z Markarian
- Summa Health System, College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
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Abstract
Spinal infection is rare. Clinical suspicion is important in patients with nonmechanical neck and/or back pain to make the proper diagnosis in early disease. Before planning surgery, a thorough evaluation of the spinal stability, alignment, and deformity is necessary. Timing of surgery, side of approach, appropriate surgical technique, and spinal instruments used are crucial. Biomechanical preservation of the spinal column during and after the infection is a significant issue. Postoperative spine infection is another entity of which spinal surgeons should be aware of. Proper septic conditions with meticulous planning of surgery are essential for successful spine surgery and better outcome.
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Affiliation(s)
- Derya Burcu Hazer
- Department of Neurosurgery, Mugla Sitki Kocman University School of Medicine, Orhaniye Mahallesi, Haluk Ozsoy Caddesi, Mugla 48000, Turkey
| | - Selim Ayhan
- Malatya State Hospital, Department of Neurosurgery, Firat Mahallesi, Hastane Caddesi, Malatya 44330, Turkey
| | - Selcuk Palaoglu
- Department of Neurosurgery, Hacettepe University School of Medicine, Sihhiye, Altindag, Ankara 06100, Turkey.
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