Features of prevertebral disease in patients presenting to a head and neck surgery clinic with neck pain

Abstract

Introduction:Untreated prevertebral space infections, which can be overlooked because of connections with surrounding spaces, may lead to spinal epidural accumulations that cause cord compression. The aim of this study was to analyze the epidemiologic and diagnostic features of cases of prevertebral disease encountered by head and neck specialists.Materials and Methods:The study was designed as a retrospective chart review of 11 patients with prevertebral disease who presented to a head and neck surgery specialist for consultation from 2004 to 2010. Epidemiologic characteristics, clinical signs, diagnostic modalities, time to diagnosis, treatment, and final outcome were analyzed.Ethical Approval:This article does not contain any studies with human participants or animals performed by any of the authors.Results:Seven patients were diagnosed with prevertebral abscess, two with prevertebral cellulitis, and two with calcific cervical tendonitis. The most common presenting signs were neck pain (100%), odynophagia (54%), dysphagia (36%), neck rigidity (36%), fever (27%), and back pain (9%). Five patients (45.5%) showed a bulge on the posterior pharyngeal wall. Four patients with prevertebral abscess showed epidural accumulations on magnetic resonance imaging. Patients with prevertebral abscess and cellulitis were treated with surgical drainage or intravenous antibiotics or both while patients with calcific cervical tendonitis were treated with anti-inflammatory and pain medications. Ten patients were cured, and one with multiple comorbidities succumbed to the disease.Conclusion:Clinicians should have a high index of suspicion of prevertebral abscess or cellulitis in patients presenting with neck pain, fever, dysphagia, and limited range of motion of the neck. Head and neck specialists may be the first to encounter and diagnose this highly morbid disease.

Quadriparesis caused by retropharyngeal and epidural abscess in COVID-19 patients

“…In this regard, a case of retro-pharyngeal abscess in a 62-year-old patient receiving immunomodulation therapy for rheumatoid arthritis was reported by Kakarala K et al [ 6 ]. Neurologic signs like quadriparesis are an exceedingly rare clinical presentation of a retro-pharyngeal abscess, with only two reports describing an extension into the epidural spaces and neurologic deficits [ 7 , 8 ]. Decompressive laminectomy, debridement, and evacuation of infected tissues represent the treatment of choice and must be followed by specific culture-guided intravenous antibiotics for 4–6 weeks.…”

Pancreatitis with infected pseudocyst presenting as a prevertebral abscess with spontaneous rupture into the oesophagus

“…Initial treatment with broad-spectrum antibiotics, with modification to sensitive antibiotics when a culture report is available, is a prudent approach 6 10. The current recommendation for antibiotic therapy for prevertebral infections includes uncomplicated prevertebral space infections without evidence of discitis or osteomyelitis 17. Surgical drainage is almost always required in patients with prevertebral abscesses.…”

“…Surgical drainage is almost always required in patients with prevertebral abscesses. It has been seen in previous studies that patients managed only conservatively usually have higher morbidity and mortality and eventually need surgical drainage 17. Emergency surgical intervention is usually done as soon as a diagnosis of complicated or severe deep neck space infection is made.…”

Acute prevertebral abscess as unusual cause of low back pain: Case report

“…As prevertebral abscess is one of the uncommon deep spine space infection it can be overlooked because of connections with surrounding spaces, and due to nonspecific symptoms such as lower back pain [1]. Patients with spinal prevertebral abscess may be normothermic and have normal WBC counts.…”

“…The infection is usually due to bacteria. Osteomyelitis, back injuries or trauma, boils on the skin, complication of lumbar puncture or back surgery, spread of any infection through the bloodstream from another part of the body (bacteremia), increase risk for a spinal abscess [1,2].…”