The results demonstrate that conservative orthopedic treatment with immobilization in a brace is sufficient to allow for optimal vertebral remodeling. Partial to nearly complete reconstitution of vertebral height was seen in all cases. Thus, operative treatment with curettage of the lesion and bone grafting including multisegmental fusion with instrumentation is not necessary. In instances with neurologic impairment, rarely seen in adults, surgical decompression and short fusion of the spine is necessary. Nevertheless, complete staging and biopsy are mandatory for an accurate diagnosis.
IntroductionSpinal epidural abscess is an uncommon disease, with a reported incidence of 0.2-1.96 per 10,000 hospital admissions [1]. As the presenting symptoms are often non-specific, a high level of suspicion is needed to initiate the appropriate diagnostics and provide prompt treatment. A recent review of the literature reports a suspected diagnosis of spinal epidural abscess in only 40% of cases [1]. Delayed diagnosis and treatment may, however, result in unexpected rapid neurological deterioration, even in patients without prior neurological deficit [1][2][3].We report an unusual case of blunt pelvic trauma with involvement of the sacroiliac joint and delayed diagnosis of a complicating epidural abscess of the lumbosacral spinal canal in a young man with a coexisting urinary tract infection. Case reportA 17-year-old adolescent fell from a height of approximately 1.5 m out of a tree onto his left side and rear pelvic region. Besides pain while walking on the left leg, no serious injury was noted. There was no loss of consciousness and there was no open injury. Twenty-four hours after the accident, pain increased in the lower back and radiated to the dorsal aspect of the left thigh. Three days after the accident, the patient was admitted to the orthopaedic department of another hospital because of persistent symptoms and elevated temperature of 40°C. On admission, the patient complained of the above-mentioned symptoms. The patient was alert and oriented. No motor or sensory deficit was noted on examination. Plain film radiographs of the spine showed a non-traumatic, Abstract A 17-year-old patient with pre-existing grade II spondylolisthesis of L5/S1 sustained a partial disruption of the left sacroiliac joint with haematoma of the iliac muscle after a fall. The haematoma probably led to occlusion of the left ureter, resulting in a urinary tract infection. After initial conservative treatment the patient developed fever and radicular pain of the left leg. Magnetic resonance imaging (MRI) revealed a left-sided epidural abscess at L5/S1, which had probably spread from the infected iliac haematoma along the injured sacroiliac joint. Prompt surgical drainage and antibiotic coverage with cefuroxime and flucloxacillin led to rapid clinical improvement. Staphylococcus aureus was identified as the pathogen. At follow-up 6 months postoperatively all symptoms had resolved, while MRI still revealed residual osseous oedema of the sacroiliac joint. The haematoma of the iliac muscle resolved without surgical intervention.
The indication for operative treatment in spondylolisthesis results from pain, progressive sliding and, in up to 60 % of the patients with progressive dislocation, from radicular malfunction. The posterolateral fusion in situ is a safe procedure, but the deformation remains and in spondyloptosis plastic deformation of the fusion mass can lead to further dislocation. With the external fixator as an instrument for reduction and the internal fixator for stabilization the reduction of even serious spondyloptosis and the recovery of a normal spine alignement and posture is possible, with an acceptable neurological risk. Therefore a concept of treatment is suggested, which as a rule is aiming at the anatomical reduction of the dislocated vertrebra beside stabilization and nerveroot decompression. Depending on the extent of the slip, reduction and stabilization is to be performed in one, two or three stages. An anterior or posterior fusion is sufficient in grade I dislocation. In grade II-V a combined posterior and anterior surgical proceedure is recommended.
The indication for operative treatment in spondylolisthesis results from pain, progressive sliding and, in up to 60% of the patients with progressive dislocation, from radicular malfunction. The posterolateral fusion in situ is a safe procedure, but the deformation remains and in spondyloptosis plastic deformation of the fusion mass can lead to further dislocation. With the external fixator as an instrument for reduction and the internal fixator for stabilization the reduction of even serious spondyloptosis and the recovery of a normal spine alignement and posture is possible, with an acceptable neurological risk. Therefore a concept of treatment is suggested, which as a rule is aiming at the anatomical reduction of the dislocated vertrebra beside stabilization and nerveroot decompression. Depending on the extent of the slip, reduction and stabilization is to be performed in one, two or three stages. An anterior or posterior fusion is sufficient in grade I dislocation. In grade II-V a combined posterior and anterior surgical proceedure is recommended.
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