Septic Complications of Chemonucleolysis

Brian, Johnny E.; Westerman, G.R.; Chadduck, William M.

doi:10.1227/00006123-198411000-00020

Cited by 14 publications

(4 citation statements)

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“…Although vertebral osteomyelitis is the most common source of contiguous infection,' l '" 24 retropharyngeal, psoas, pulmonary and perinephric abscesses have also been implicated. 25 Epidural abscess has been reported as a complication of gastrointestinal surgery, 26 epidural anesthesia, 27 local anesthetic injection, 28 chemonucleolysis, 29 and serial lumbar punctures. 30 One of our cases, with epidural and subdural empyema, has previously been reported as a complication of cervical discography.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Spinal Epidural Abscess

Redekop

Maestro

1992

Can. j. neurol. sci.

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ABSTRACT:Twenty-five patients with spinal epidural abscess were treated at the University of Western Ontario hospitals between July 1980 and July 1990. There were eighteen males (72%) and seven females (28%), with a median age of 60 years. Concurrent illness resulting in immunocompromise was present in 60%. Eleven presented with complete myelopathy, thirteen had limb weakness, and one had no neurological deficit. In twenty cases the abscess consisted of frankly purulent material, while in five the epidural collection consisted of chronic granulation tissue. Staphylococcus aureus was isolated in 64% of the abscesses. Twenty-seven surgical procedures were performed on 21 patients. Ten cases occurred in the cervical spine (40%), seven in the thoracic spine (28%), three in both the cervical and thoracic spine (12%) and five in the lumbosacral spine (20%). Fourteen patients (56%) retained or recovered ambulation and there were five deaths (20%). The progression from back and radicular pain to weakness and eventual paralysis continues to be characteristic of spinal epidural infection. Morbidity and mortality remain unacceptably high because of delay in diagnosis and treatment. Magnetic resonance imaging is the radiological investigation of choice for the diagnosis of spinal epidural abscess. Prompt intervention, before the development of severe neurological deficits, can improve outcome. Immediate surgical drainage combined with antibiotics remains the treatment of choice.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Spinal Epidural Abscess

Redekop

Maestro

1992

Can. j. neurol. sci.

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“…In general, the invasiveness or complexity of the procedure is directly related to the infectious complication rate. Postprocedural diskitis has been reported after a plethora of spinal interventions including less invasive procedures such as diskography (33), chemonucleosis (34,35), myelography (36), paraspinal injections, lumbar punctures, and epidural injections. Diskectomy has infection rates ranging from 0.6% to 5% (1,37).…”

Section: Surgical Factorsmentioning

confidence: 99%

Postoperative Spinal Wound Infections and Postprocedural Diskitis

Chaudhary¹,

Vives²,

Basra³

et al. 2007

The Journal of Spinal Cord Medicine

115

140

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Background/Objective: Postprocedural infections are a significant cause of morbidity after spinal interventions. Methods: Literature review. An extensive literature review was conducted on postprocedural spinal infections. Relevant articles were reviewed in detail and additional case images were included. Results: Clinical findings, laboratory markers, and imaging modalities play important roles in the detection of postprocedural spinal infections. Treatment may range from biopsy and antibiotics to multiple operations with complex strategies for soft tissue management. Conclusions: Early detection and aggressive treatment are paramount in managing postprocedural spinal infections and limiting their long-term sequelae.

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“…Silber et al (649) described that it is a rare complication after any invasive procedure on the spine with an incidence of 0.2%. However, post procedure discitis represents 30.1% of all cases of pyogenic discitis and has been reported after almost every open and minimally invasive surgical procedure, including laminectomies, discectomies, fusions with or without instrumentation and less invasive procedures, such as discography, chemonucleolysis, myelography, paravertebral injections, and lumbar puncture (649)(650)(651)(652)(653)(654)(655)(656). Similar to postoperative vertebral osteomyelitis, post procedural discitis frequently affects the elderly and immunocompromised and is an important cause of postoperative back pain in the spine patient.…”

Section: Discographymentioning

confidence: 99%

Evidence-Based Practice Guidelines for Interventional Techniques in the Management of Chronic Spinal Pain

Manchikanti

2003

Pain Phys

107

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diagnosis of sacroiliac joint pain, and for transforaminal epidural injections in the preoperative evaluation of patients with negative or inconclusive imaging studies, but with clinical fi ndings of nerve root irritation.Moderate to strong evidence was shown for multiple therapeutic interventional techniques including medial branch blocks and medial branch neurotomy; caudal epidural steroid injections and transforaminal epidural steroid injections; lumbar percutaneous adhesiolysis; and implantable therapies.These guidelines do not constitute infl exible treatment recommendations. It is expected that a provider will establish a plan of care on a case-by-case basis, taking into account an individual patient's medical condition, personal needs, and preferences, and the physician's experience. Based on an individual patient's needs, treatment different from that outlined here could be warranted. These guidelines do not represent "standard of care."

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Septic Complications of Chemonucleolysis

Abstract: The authors present two cases of septic complications after chemonucleolysis with chymopapain. One patient developed overt aortic valve failure. The second patient suffered an epidural abscess.

Cited by 14 publications

References 0 publications

Diagnosis and Management of Spinal Epidural Abscess

Diagnosis and Management of Spinal Epidural Abscess

Postoperative Spinal Wound Infections and Postprocedural Diskitis

Evidence-Based Practice Guidelines for Interventional Techniques in the Management of Chronic Spinal Pain

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