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

Cupler, Zachary A.; Anderson, Michael T.; Stancik, Thomas J.

doi:10.1016/j.jcm.2017.03.002

Cited by 7 publications

(3 citation statements)

References 33 publications

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“…This search identified nine cases (Table 1) [4,6,7,[15][16][17][18]. Including the current case, there were 10 patients, with a mean age of 55±12, a symptom duration of 7±15 weeks, and 90% of patients were male.…”

Section: Discussionmentioning

confidence: 99%

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Spondylodiscitis Presenting to a Chiropractor: A Case Report and Literature Review

Chu¹,

Trager²,

Goh³

et al. 2023

Cureus

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An 80-year-old man under combination therapy for pulmonary tuberculosis presented to a chiropractor with a one-month history of worsening chronic low back pain, yet denied having any respiratory symptoms, weight loss, or night sweats. Two weeks prior, he saw an orthopedist who ordered lumbar radiographs and magnetic resonance imaging (MRI), showing degenerative changes and subtle findings of spondylodiscitis, but was treated conservatively with a nonsteroidal anti-inflammatory drug. The patient was afebrile, yet considering his older age and worsening symptoms, the chiropractor ordered a repeat MRI with contrast, which revealed more advanced findings of spondylodiscitis, psoas abscesses, and epidural phlegmon, and referred the patient to the emergency department. A biopsy and culture confirmed Staphylococcus aureus infection and were negative for Mycobacterium tuberculosis . The patient was admitted and treated with intravenous antibiotics. We conducted a literature review revealing nine previously published cases of patients with spinal infection presenting to a chiropractor, who were typically afebrile men with severe low back pain. Chiropractors rarely encounter patients with undiagnosed spinal infections and should manage those suspected of infection with urgency via advanced imaging and/or referral.

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Section: Discussionmentioning

confidence: 99%

“…While spinal manipulation is generally safe, it may fracture already weakened bone [ 5 ]. Despite the importance of this topic, presentations of spinal infection in the chiropractic office are seldom reported in the literature [ 4 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Spondylodiscitis Presenting to a Chiropractor: A Case Report and Literature Review

Chu¹,

Trager²,

Goh³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…As chiropractors are portal of entry providers that often manage spinal pain [ 19 ], they may rarely encounter patients with spinal infection [ 20 – 25 ]. However, given the potential rise in cases of pyogenic spinal infections related to COVID-19 [ 11 ], an aging population, drug use, or spine procedures [ 3 ], and considering these patients may present with back or neck pain as an isolated finding [ 1 , 3 ], it is possible patients with this condition could seek chiropractic care.…”

Section: Introductionmentioning

confidence: 99%

A 60-Year-Old Man with Gingivitis and Poorly Controlled Diabetes Developing Low Back Pain 1 Week Following Recovery from COVID-19 Diagnosed with Spinal Abscess Due to Streptococcus oralis

Chu¹,

Trager

Chen³

et al. 2022

Am J Case Rep

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Patient: Male, 60-year-old Final Diagnosis: Pyogenic spinal infection Symptoms: Low back pain • neck pain Medication: — Clinical Procedure: Fine needle biopsy • magnetic resonance imaging Specialty: Infectious Diseases • Rehabilitation Objective: Rare disease Background: Streptococcus oralis ( S. oralis ) is a gram-positive bacterium and component of the oral microbiota that can rarely cause opportunistic infection in the immunosuppressed. This report presents a 60-year-old man from Hong Kong with gingivitis and poorly controlled diabetes who visited his chiropractor with low back pain 2 weeks following mild COVID-19 and was diagnosed with paraspinal, psoas, and epidural abscess due to S. oralis . Case Report: The patient tested positive for COVID-19 when asymptomatic, then had a mild 10-day course of the illness, followed by low back pain 1 week later, prompting him to visit his primary care provider, who diagnosed sciatica and treated him with opioid analgesics. He presented to a chiropractor the following week, noting severe low back pain with radiation into the gluteal regions and posterior thighs, difficulty with ambulation, and mild neck pain. Considering the patient’s diabetes, widespread symptoms, and weakness, the chiropractor ordered whole-spine magnetic resonance imaging, which suggested possible multifocal spinal abscess and referred him urgently to a spine surgeon. The surgeon conducted testing consistent with bacterial infection, and referred to an infectious disease specialist, who confirmed S. oralis spinal infection via lumbar paraspinal needle biopsy and culture. The patient was first treated with oral antibiotics, then intravenous antibiotics in a hospital. Over 4 weeks, his spinal pain improved, and laboratory markers of infection normalized. Conclusions: This case illustrates an opportunistic pyogenic spinal infection including paraspinal, psoas, and epidural abscesses caused by S. oralis in an immunocompromised patient following COVID-19 illness.

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Manipulative and manual therapies in the management of patients with prior lumbar surgery: A systematic review

Daniels

Cupler

Gliedt

et al. 2021

Complementary Therapies in Clinical Practice

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Background The purpose was to identify, summarize, and rate scholarly literature that describes manipulative and manual therapy following lumbar surgery. Methods The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered with PROSPERO. PubMed, Cochrane Database of Systematic Reviews, ICL, CINAHL, and PEDro were searched through July 2019. Articles were screened independently by at least two reviewers for inclusion. Articles included described the practice, utilization, and/or clinical decision making to post surgical intervention with manipulative and/or manual therapies. Data extraction consisted of principal findings, pain and function/disability, patient satisfaction, opioid/medication consumption, and adverse events. Scottish Intercollegiate Guidelines Network critical appraisal checklists were utilized to assess study quality. Results Literature search yielded 1916 articles, 348 duplicates were removed, 109 full-text articles were screened and 50 citations met inclusion criteria. There were 37 case reports/case series, 3 randomized controlled trials, 3 pilot studies, 5 systematic/scoping/narrative reviews, and 2 commentaries. Conclusion The findings of this review may help inform practitioners who utilize manipulative and/or manual therapies regarding levels of evidence for patients with prior lumbar surgery. Following lumbar surgery, the evidence indicated inpatient neural mobilization does not improve outcomes. There is inconclusive evidence to recommend for or against most manual therapies after most surgical interventions.

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

Cited by 7 publications

References 33 publications

Spondylodiscitis Presenting to a Chiropractor: A Case Report and Literature Review

Spondylodiscitis Presenting to a Chiropractor: A Case Report and Literature Review

A 60-Year-Old Man with Gingivitis and Poorly Controlled Diabetes Developing Low Back Pain 1 Week Following Recovery from COVID-19 Diagnosed with Spinal Abscess Due to Streptococcus oralis

Manipulative and manual therapies in the management of patients with prior lumbar surgery: A systematic review

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