High Prevalence of Multifocal Spine Infections Involving the Cervical and Thoracic Regions: A Case for Imaging the Entire Spine

Balcescu, Christian; Odeh, Khalid; Rosinski, Alexander; Wang, Jonathan; Prasad, Priya; Leasure, Jeremi; Ungurean, Victor; Kondrashov, Dimitriy

doi:10.14245/ns.1836296.148

Cited by 8 publications

(7 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This case illustrates a 60-year-old man with gingivitis and immunocompromise related to diabetes who developed multi-focal cervical and lumbar pyogenic infection (ie, paraspinal, psoas, and epidural abscesses) shortly after COVID-19 illness. Accordingly, this case reinforces previous associations between immunocompromise and opportunistic pyogenic spinal infection [ 5 ], and adds to the growing literature showing that COVID-19 illness is another potential risk factor for these types of infections [ 11 – 17 ].…”

Section: Discussionsupporting

confidence: 85%

“…Well-described risk factors for pyogenic spinal infection include immunocompromise, diabetes mellitus, substance abuse, chronic infection such as HIV, malnutrition, long-term systemic steroid use, and spine surgery [ 1 , 4 ]. Pyogenic spinal infections are most common in the lumbar region [ 3 ], and are multifocal in 35% of cases, affecting more than 1 spinal region [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 85%

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

View full text Add to dashboard Cite

show abstract

“…The common finding seen in MRI was epidural empyema with predominantly lumbar spine involvement. In a recent study examining the spinal involvement in PSI, multifocal involvement was found to be common (35%) [23]. This highlights the need to image the entire spine, especially prior to any surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with poor clinical outcome in pyogenic spinal infections: 5-years’ intensive care experience

Milošević¹,

Çevik

Urošević³

et al. 2020

J Infect Dev Ctries

View full text Add to dashboard Cite

Introduction: Management of pyogenic spinal infections (PSI) after the development of neurological deficit has not been specifically addressed in the literature. We aimed to describe real-life clinical outcomes of PSI in patients admitted to an intensive care unit with neurological deficit and identify factors associated with good prognosis. Methodology: Consecutive patients admitted to ICU with a possible diagnosis of spinal infection over five years’ period were included. Descriptive statistics were performed to examine the demographics and clinical parameters. Results: The majority (71%) of patients were male. The mean age was 57.4 years (27-79), and 71% were > 50 years old. At least one underlying risk factor was identified in 68% of the patients; the most common comorbidity was diabetes mellitus (DM). All patients have presented with fever accompanied by a neurological deficit (86%) and back pain (79%). A complete recovery was achieved in 25% of patients. However, the majority of patients had adverse outcomes with 21.4% mortality, and 43% remaining neurological sequelae. Increased age with a cut-off of 65 years and pre-existing DM were identified as being associated with poor outcome. Conclusion: Mortality among patients admitted to ICU with PSI was significantly higher than reported in the literature. The residual neurological deficit was common, one-third of patients had remaining neurological sequelae, and only one-fourth had complete recovery. Increased age and background DM were the most important determinants of poor clinical outcome. The impact of DM appears to be much more important than currently recognised in this population.

show abstract

“…Elucidation of these differences may provide clarity and standardisation in the screening for multifocal infections. Our previous study had investigated those differences and found that patients surgically treated for cervical or thoracic spinal infections had a high rate of multifocal spinal infections (71 % and 83 %, respectively) (Balcescu et al, 2019). However, the power of our study was small due to the sole inclusion of patients who were operated on at a single institution over the course of 6 years.…”

Section: Introductionmentioning

confidence: 86%

“…Therefore, it is imperative to promptly identify all involved regions of the spine so that the appropriate treatment can be administered. Our previous single-institution retrospective study found an incidence of 35 % for multifocal infections in the patients surgically treated for non-tuberculous pyogenic spinal infections (Balcescu et al, 2019). Other studies have reported incidences of multifocal spinal infection ranging from 4 % to 30 % (Ledermann et al, 2003;Mann et al, 2004;Ziu et al, 2014;Cox et al, 2018).…”

Section: Introductionmentioning

confidence: 89%

Pyogenic spinal infections warrant a total spine MRI

Balcescu

Odeh²,

Rosinski³

et al. 2023

J. Bone Joint Infect.

Self Cite

View full text Add to dashboard Cite

Abstract. Study design: retrospective case series. Objective: the presenting clinical symptoms of spinal infections are often nonspecific and a delay in diagnosis can lead to adverse patient outcomes. The morbidity and mortality of patients with multifocal spinal infections is significantly higher compared to unifocal infections. The purpose of the current study was to analyse the risk factors for multifocal spinal infections. Methods: we conducted a retrospective review of all pyogenic non-tuberculous spinal infections treated surgically at a single tertiary care medical center from 2006–2020. The medical records, imaging studies, and laboratory data of 43 patients during this time period were reviewed and analysed after receiving Institutional Review Board approval. Univariate and multivariate analyses were performed to identify factors associated with a multifocal spinal infection. Results: 15 patients (35 %) had multifocal infections. In univariate analysis, there was a significant association with chronic kidney disease (p=0.040), gender (p=0.003), a white blood cell count (p=0.011), and cervical (p<0.001) or thoracic (p<0.001) involvement. In multivariate analysis, both cervical and thoracic involvement remained statistically significant (p=0.001 and p<0.001, respectively). Conclusions: patients with infections in the thoracic or cervical region are more likely to have a multifocal infection. Multifocal pyogenic spinal infections remain a common entity and a total spine MRI should be performed to aid in prompt diagnosis.

show abstract

High Prevalence of Multifocal Spine Infections Involving the Cervical and Thoracic Regions: A Case for Imaging the Entire Spine

Cited by 8 publications

References 32 publications

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

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

Risk factors associated with poor clinical outcome in pyogenic spinal infections: 5-years’ intensive care experience

Pyogenic spinal infections warrant a total spine MRI

Contact Info

Product

Resources

About