Rapidly Progressive Gas-containing Lumbar Spinal Epidural Abscess

Bang, Jin Hyuk; Cho, Keun-Tae

doi:10.14245/kjs.2015.12.3.139

Cited by 13 publications

(12 citation statements)

References 19 publications

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“…Emphysematous osteomyelitis is commonly located in vertebral bones, however, unusual locations such as tarsal bones are also reported [ 2 5 7 ]. Moreover, emphysematous infections of soft tissue and epidural space adjacent to bones have been described in previous reports [ 8 9 ]. Among several comorbidities that may predispose patients to the development of emphysematous osteomyelitis, diabetes mellitus is one of the most commonly associated diseases [ 2 ].…”

Section: Discussionmentioning

confidence: 98%

Rapidly Fatal Emphysematous Osteomyelitis with Multiple Septic Emboli and Liver Abscess Caused by Klebsiella pneumoniae

Kim

Jang

et al. 2018

Infect Chemother

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Emphysematous osteomyelitis, characterized by intraosseous gas, is a rare but potentially fatal condition that requires prompt diagnosis and aggressive therapy. Causative organisms are members of the bacterial family Enterobacteriaceae or anaerobes in most cases and significant comorbidities such as diabetes mellitus and malignancy, may predispose an individual to the development of emphysematous osteomyelitis. We report a case of extensive emphysematous osteomyelitis via hematogenous spread from Klebsiella pneumoniae liver abscess, complicated by gas-containing abscesses in adjacent soft tissues and epidural space, and multiple systemic septic emboli in a diabetic patient.

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Section: Discussionmentioning

confidence: 98%

Rapidly Fatal Emphysematous Osteomyelitis with Multiple Septic Emboli and Liver Abscess Caused by Klebsiella pneumoniae

Kim

Jang

et al. 2018

Infect Chemother

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“…The culprit gas-producing organism, Escherichia coli, facilitated the contiguous spread of bacteria into the spinal epidural space. This aggressive pathogen, in a poorly controlled diabetic patient, may lead to an insidious disease course, with an associated high morbidity and mortality [9] . Contrast-enhanced MRI is a pivotal diagnostic tool, with an approximate 90% sensitivity and specificity [8,10,11] .…”

Section: Discussionmentioning

confidence: 99%

Holospinal epidural abscess: An unexpected find

Calderón¹,

Haralsingh²,

Ramnarine³

2020

Int. J. Orthop. Sci.

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Introduction: Spinal epidural abscesses present infrequently in surgical practice resulting in neurological morbidity, and mortality. A rare find is the presence of an abscess involving the entire cervical, thoracic and lumbosacral regions of the spine, with limited reported cases in literature. When this is encountered urgent neurosurgical intervention is required to improve patient prognosis. Case Description: A 58-year-old, poorly controlled type II diabetic male, presented with a 3-week history of lower back pain and progressive limitation in ambulation. Further deterioration was observed in-hospital, with a sudden decline in power of the lower limbs from a Medical Research Council (MRC) grade 5 to 2. This prompted urgent magnetic resonance imaging of the whole spine, which depicted an epidural abscess extending from the cervical vertebrae -C3, to the sacrum -S1, with resulting compression of the spinal cord. An emergency multi-level laminectomy was performed with drainage of the epidural space. There was resolution of his sensory deficits and objective improvement in power of the lower limbs post-operation. Culture reports showed the culprit organism to be Escherichia coli. Conclusion:Severe back pain in the diabetic patient requires careful assessment and monitoring. Emergency surgical decompression within 72 hours of neurological symptoms improves prognostic outcomes in patients with spinal epidural abscesses. We contend that performing a multi-level laminectomy procedure is the best option for an extensive posterior spinal epidural abscesses without bony involvement. Other methods such as image-guided percutaneous drainage, catheter procedures and intermediate level fenestration procedures, while less invasive, may be more likely to fail.

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Section: Introductionmentioning

confidence: 99%

“…To the best of our knowledge, only 10 reports of pneumorachis with epidural abscess have been identified, and in most of these cases, the gas is observed in a limited region in the spinal canal. [3][4][5][6][7][8][9][10][11][12] Epidural abscess is a rare and potentially serious pyogenic infection. 13 Urgent surgical intervention is one of the management methods of epidural abscess, but with earlier diagnosis based on computed tomography (CT) and magnetic resonance imaging (MRI), some studies indicate successful outcomes with nonoperative medical treatment alone.…”

Section: Introductionmentioning

confidence: 99%

Pneumorachis from the cervical to the sacral spinal canal with spinal epidural abscess by gas gangrene

Matsuo

Tanji

Tateyama

et al. 2019

J Orthop Surg (Hong Kong)

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We present a 70-year-old woman with severe diabetes mellitus, who experienced low back pain and left lower leg paralysis. Computed tomography showed air in the spinal canal from C4 to S5, and magnetic resonance imaging revealed an epidural abscess from Th11 to L1. Laboratory findings showed increases in inflammatory indicators and blood culture indicated the presence of Escherichia coli. The patient was treated conservatively with antibiotics. Neurological deficits and inflammatory data improved during the course. Follow-up imaging studies showed the disappearance of gas and epidural abscess. The existence of air in the spinal canal is a rare condition known as pneumorachis. To the best of our knowledge, such a long pneumorachis ranging from the cervical to the sacral spinal canal with epidural abscess caused by gas gangrene has not yet been described. We should therefore realize the possibility of epidural abscess produced by gas gangrene and treat it appropriately.

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Rapidly Progressive Gas-containing Lumbar Spinal Epidural Abscess

Cited by 13 publications

References 19 publications

Rapidly Fatal Emphysematous Osteomyelitis with Multiple Septic Emboli and Liver Abscess Caused by Klebsiella pneumoniae

Rapidly Fatal Emphysematous Osteomyelitis with Multiple Septic Emboli and Liver Abscess Caused by Klebsiella pneumoniae

Holospinal epidural abscess: An unexpected find

Pneumorachis from the cervical to the sacral spinal canal with spinal epidural abscess by gas gangrene

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