Cervical subdural empyema following acupuncture

Chen, Ming Hong; Chen, Mei-Hsiu; Huang, Jiejie

doi:10.1016/j.jocn.2004.02.011

Cited by 46 publications

(27 citation statements)

References 13 publications

(3 reference statements)

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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%

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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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Section: Discussionmentioning

confidence: 99%

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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“…12 The third likely mechanism for the spread of bacteria is hematogenous. 4 Subdural empyema has been reported after cervical acupuncture 13 and following meningitis. 4 In our patient negative blood cultures that were obtained before starting antibiotics and lack of systemic clinical signs of bacteremia make hematogenous spread unlikely.…”

Section: Discussionmentioning

confidence: 99%

Spinal Subdural Abscess: A Rare Complication of Decubitus Ulcer

Usoltseva

Medina‐Flores

Rehman

et al. 2014

Clinical Medicine & Research

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A male patient, aged 55 years, presented to the emergency room with complaints of bilateral upper extremity weakness. His past medical history was significant for paraplegia and neurogenic bladder from a spinal cord injury, complicated with decubitus ulcers and end-stage renal disease secondary to type II diabetes mellitus. His past surgical history was significant for posterior spine fusion with Harrington rod instrumentation at the level of T10. He developed subacute onset of bilateral upper extremity weakness and paresthesias on the day of presentation. He reported a 2-day history of neck and back pain that he initially contributed to his bedridden state. The patient denied fever, recent infections, or trauma. His vital signs were unremarkable. Physical examination revealed quadriparesis, absence of deep tendon reflexes, hypoesthesia, and decubitus ulcers (figure 1). He had a normal leukocyte count and elevated C-reactive protein. Blood cultures and cultures from the ulcers were obtained. With the concern of spinal cord compression based on presentation, intravenous corticosteroids and broad spectrum antibiotics were initiated. A magnetic resonance imaging (MRI) scan of the spine (figure 2) revealed large elongated epidural collection posteriorly within the cervical spine, extending into the thoracic spine and inferiorly. Spinal cord compression was prominent in the narrowed areas of disc-osteophyte complexes at the levels of C3-4 and C5-6, where the spinal cord was compressed between these disc-osteophyte complexes and the posterior epidural collection, with some mildly increased signal intensity within the cord. The lumbosacral spine was not well imaged due to artifacts of spinal hardware. Emergent drainage of the collection was indicated, but the patient declined. Per the patient's wishes, palliative care was initiated on the day Spinal subdural abscess (SSA) is an uncommon entity. The exact incidence is unknown, with very few cases reported in the literature. This condition may result in spinal cord compression, thus constituting a medical and neurosurgical emergency. The pathogenesis of SSA is not welldescribed, and the available knowledge is based on case observations only. There is only one case report that describes direct seeding from decubitus ulcers as a possible mechanism for development of SSA. We report a case of subacute onset of quadriplegia in a male patient, age 55 years, due to spinal cord compression from SSA and superimposed spinal subdural hematoma. The direct seeding from decubitus ulcers is thought to be the cause of infection in our patient. We present this case of SSA to elucidate and review the predisposing factors, pathogenesis, clinical presentation, diagnostic modalities, and treatment regarding management of this rare disorder.

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“…Lee & Chee, 2002;Shah et al, 2002;Woo et al, 2003;Y.P. Cho et al, 2003;Lin & Choong, 2003;Kettaneh et al, 2003;Daivajna et al, 2004;Saw et al, 2004;M.H. Chen & Huang, 2004;Studd & Steward, 2004;Vucicevic et al, 2005;Bang & Lim, 2006;Simmons, 2006;Seeley & Chambers, 2006;S.…”

Section: Acupuncture Transmitted Pyogenic Bacterial Infectionsunclassified