Cervical Spinal Epidural Abscess Following Acupuncture: Successful Treatment with Antibiotics.

Establishing the diagnosis of cervical osteomyelitis in a timely fashion is critical to prevent catastrophic neurological injury. In the modern imaging era, magnetic resonance imaging in particular has facilitated the diagnosis of cervical osteomyelitis, even before the onset of neurological signs or symptoms. Nevertheless, despite advancements in diagnosis, disagreement remains regarding appropriate surgical treatment. The role of instrumentation and type of graft material after cervical decompression remain controversial. The authors describe the epidemiological features, pathogenesis, and diagnostic evaluation, and the surgical and nonsurgical interventions that can be used to treat osteomyelitis of the cervical spine. They also review the current debate about the role of instrumentation in preventing spinal deformity after surgical decompression for cervical osteomyelitis. Based on this review, the authors conclude that nonsurgical therapy is appropriate if neurological signs or symptoms, instability, deformity, or spinal cord compression are absent. Surgical decompression, debridement, stabilization, and deformity correction are the goals once the decision to perform surgery has been made. The roles of autogenous graft, instrumentation, and allograft have not been clearly delineated with Class I data, but the authors believe that spinal stability and decompression override creating an environment that can be completely sterilized by antibiotic drugs.

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“…32,37 Hematogenous seeding, though, remains the most common route for spread of infection to the cervical spine. 13,57,71 …”

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confidence: 99%

Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine

Acosta

Chin

Quiñones‐Hinojosa³

et al. 2004

FOC

117

119

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“…Apart from blood-borne infections due to patient-to-patient transmission, acupuncture can also be complicated by infections caused by environmental microorganisms or the patient's own skin flora, as the most commonly used skin disinfectant in acupuncture clinics is alcohol. There have been case reports of such bacterial infections as well as abscess formation without proven microbiological causes complicating acupuncture (4,10,11,12,14,16,19,24,26,45).…”

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confidence: 99%

Relatively Alcohol-Resistant Mycobacteria Are Emerging Pathogens in Patients Receiving Acupuncture Treatment

et al. 2002

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Acupuncture has been gaining popularity as a form of alternative medicine. In the past, only blood-borne viruses and anecdotal reports of bacterial infections have been associated with acupuncture. We report on four patients with mycobacterial infections complicating acupuncture who were encountered in a 2-year period. All had clinical and/or radiological lesions at acupuncture point-and meridian-specific locations. There was no other history of trauma or other clinical foci of infections, and the chest radiographs were normal. Histological studies of biopsy specimens of all four patients showed changes compatible with chronic inflammation, with granulomatous inflammation present in three patients and acid-fast bacilli present in two. Conventional biochemical tests and whole-cell fatty acid analysis for identification were inconclusive for all four nonpigmented mycobacteria recovered from tissue biopsies. 16S rRNA gene sequencing showed that the strains from two patients were Mycobacterium chelonae and that those from the other two were Mycobacterium nonchromogenicum. Alcohol resistance assay using the quantitative suspension test revealed that all four strains showed prolonged survival in 75% alcohol compared to other skin flora. Mycobacterial infections transmitted by acupuncture are an emerging problem. A high index of suspicion is essential to recognize this clinical syndrome, and strict implementation of proper infection control guidelines for acupuncture is mandatory.Acupuncture has been gaining popularity as a form of alternative medicine in both Asian and Western countries for chronic pain problems, digestive disorders, allergic disorders, psychosomatic problems, menstrual disorders, and drug and alcohol rehabilitation. However, in most countries, monitoring and control over the practice and its associated complications are far from adequate. Although infection control guidelines for acupuncture are available (1), the implementation, especially in developing countries where acupuncture is very popular, is far from ideal. In the past, needles used for acupuncture were usually reused and often inadequately sterilized. Such inadequate disinfection has led to the transmission of infectious diseases from patient to patient. The best-documented acupuncture-transmitted microorganisms are the blood-borne viruses, including human immunodeficiency virus, hepatitis B virus, and hepatitis C virus (13,32,44). Apart from blood-borne infections due to patient-to-patient transmission, acupuncture can also be complicated by infections caused by environmental microorganisms or the patient's own skin flora, as the most commonly used skin disinfectant in acupuncture clinics is alcohol. There have been case reports of such bacterial infections as well as abscess formation without proven microbiological causes complicating acupuncture (4,10,11,12,14,16,19,24,26,45).Mycobacteria are well known to be relatively resistant to disinfectants, and the mechanism of disinfectant resistance has been described for some mycobacteria (18)...

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“…Since 1982, there have been at least 16 reports in the English literature of SEA secondary to acupuncture treatment. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] It has been proposed that poorly controlled hygiene in acupuncture practice might lead to epidural infections. [17][18][19]22,25 All invasive procedures that break the skin carry the risk of infection.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] In this report, we describe a case of SEA in a man who presented to a chiropractic office for acupuncture at a Veterans Affairs Medical Center. The purpose of this case study is 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.…”

Section: Introductionmentioning

confidence: 99%

Thoracic Spondylodiscitis Epidural Abscess in an Afebrile Navy Veteran: A Case Report

Cupler

Anderson

Stancik

2017

Journal of Chiropractic Medicine

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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. (J Chiropr Med 2017;16:246-251)

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Cervical Spinal Epidural Abscess Following Acupuncture: Successful Treatment with Antibiotics.

Cited by 44 publications

References 11 publications

Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine

Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine

Relatively Alcohol-Resistant Mycobacteria Are Emerging Pathogens in Patients Receiving Acupuncture Treatment

Thoracic Spondylodiscitis Epidural Abscess in an Afebrile Navy Veteran: A Case Report

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