A Rare Case of Thoracic Pyogenic Facet Joint Infection

Pyogenic facet joint infection is a rare but severe infection. The most common complaint on presentation is pain followed by fever, then neurologic impairment. While the lumbar spine is involved in the vast majority of cases presented in the literature, the case presented here occurred in the thoracic spine. The patient was a 48-year-old immune-competent female who presented with left back pain. Magnetic resonance imaging (MRI) indicated a facet effusion, paraspinal abscess, and epidural abscess in the level of 9th-11th thoracic vertebra. On the 6th day of treatment, she presented a neurological disorder and underwent decompressive laminectomy and surgical debridement. We observed immediate improvement as a result of the surgery.

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Rapidly Progressive Spontaneous Spinal Epidural Abscess

Case Reports in Infectious Diseases ◽

10.1155/2016/7958291 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Abdurrahman Aycan ◽

Ozgür Yusuf Aktas ◽

Feyza Karagoz Guzey ◽

Azmi Tufan ◽

Cihan Isler ◽

...

Keyword(s):

Epidural Abscess ◽

Delayed Diagnosis ◽

Clinical Findings ◽

Neurological Deficits ◽

Spinal Epidural Abscess ◽

Low Back ◽

Resonance Imaging ◽

Magnetic Resonance Imaging Mri ◽

Paraspinal Abscess ◽

Spinal Epidural

Spinal epidural abscess (SEA) is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI) remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

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Atlantoaxial epidural abscess secondary to grass awn migration in a dog

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-13-07-0095 ◽

2014 ◽

Vol 27 (02) ◽

pp. 155-158 ◽

Cited By ~ 7

Author(s):

U. Geissbühler ◽

P. Karli ◽

F. Forterre ◽

E. Linon

Keyword(s):

Magnetic Resonance Imaging ◽

Case Report ◽

Epidural Abscess ◽

Cervical Vertebrae ◽

Clinical Signs ◽

Resonance Imaging ◽

Mri Findings ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Grass Awn

SummaryA two-year-old female Lucerne Hound was presented with a one-week history of signs of progressive neck pain, inappetence, apathy, and an elevated rectal temperature. Findings of magnetic resonance imaging (MRI) were consistent with a foreign body abscess in the epidural space at the level of the first and second cervical vertebrae. A leftsided dorso-lateral atlantoaxial approach was performed, revealing an epidural abscess containing a grass awn. The clinical signs resolved within three days of surgery and the dog made a full recovery. This case report shows that grass awns can migrate to the atlantoaxial region in dogs and MRI findings lead to a suspicion of caudo-cranial migration within the spinal canal.

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Optimal Cut-Off Value of the Superior Articular Process Area as a Morphological Parameter to Predict Lumbar Foraminal Stenosis

Pain Research and Management ◽

10.1155/2017/7914836 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Tae-Ha Lim ◽

Soo Il Choi ◽

Hyung Rae Cho ◽

Keum Nae Kang ◽

Chang Joon Rhyu ◽

...

Keyword(s):

Facet Joint ◽

Control Group ◽

Foraminal Stenosis ◽

Morphological Parameter ◽

Resonance Imaging ◽

Cross Sectional ◽

Lumbar Foraminal Stenosis ◽

Articular Process ◽

Magnetic Resonance Imaging Mri ◽

Bone Margin

Background. We devised a new morphological parameter called the superior articular process area (SAPA) to evaluate the connection between lumbar foraminal stenosis (LFS) and the superior articular process. Objective. We hypothesized that the SAPA is an important morphologic parameter in the diagnosis of LFS. Methods. All patients over 60 years of age were included. Data regarding the SAPA were collected from 137 patients with LFS. A total of 167 control subjects underwent lumbar magnetic resonance imaging (MRI) as part of a routine medical examination. We analyzed the cross-sectional area of the bone margin of the superior articular process at the level of L4-L5 facet joint in the axial plane. Results. The average SAPA was 96.3±13.6 mm2 in the control group and 128.1±17.2 mm2 in the LFS group. The LFS group was found to have significantly higher levels of SAPA (p<0.001) in comparison to the control group. In the LFS group, the optimal cut-off value was 112.1 mm2, with 84.4% sensitivity, 83.9% specificity, and AUC of 0.94 (95% CI: 0.91–0.96). Conclusions. Higher SAPA values were associated with a higher possibility of LFS. These results are important in the evaluation of patients with LFS.

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A Case Of Atypical Presentation of Thoracic Osteomyelitis & Paraspinal Abscess

McGill Journal of Medicine ◽

10.26443/mjm.v11i2.565 ◽

2020 ◽

Vol 11 (2) ◽

Author(s):

Utkarsh Acharya

Keyword(s):

Bone Scan ◽

Medical Intervention ◽

Chief Complaint ◽

Resonance Imaging ◽

Anterior Portion ◽

X Ray ◽

Right Lobe ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Paraspinal Abscess

Here presented is a case involving a 44-year-old man with a chief complaint of sharp lateral right-sided rib pain with notable radiation to the anterior portion of the thorax and minor radiation around the lateral back. The etiology of the pain and radiculopathy, which was initially attributed to a right-sided rib fracture, was later accurately credited to a paraspinal abscess discovered on a lateral X-ray of the thoracic spine. Subsequently, studies including Magnetic Resonance Imaging (MRI), Computed Tomography (CT), and bone scan all confirmed the diagnosis of a paraspinal abscess between the right lobe and its neighboring T9 and T10 vertebrae. The mass was biopsied and methicillin sensitive Staphylococcus aureus was isolated. Appropriate surgical and medical intervention was possible due to the early diagnosis of the abscess.

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Holospinal epidural abscess in elderly patient: A case presentation and review

Surgical Neurology International ◽

10.25259/sni_436_2019 ◽

2019 ◽

Vol 10 ◽

pp. 204

Author(s):

Ioannis D. Siasios ◽

Aggeliki Fotiadou ◽

Kostas Fountas ◽

Vassilios Dimopoulos

Keyword(s):

Epidural Abscess ◽

Mortality Rates ◽

Blood Cultures ◽

Surgical Approaches ◽

Spinal Instability ◽

Laboratory Studies ◽

Resonance Imaging ◽

Case Presentation ◽

Magnetic Resonance Imaging Mri ◽

Catheter Irrigation

Background: Holospinal epidural abscess (HEA) is a rare pathological entity with significant morbidity and mortality rates. Here, we present a 74-year-old male with HEA treated with focal skip laminectomies and catheter irrigation. Case Description: A 74-year-old male presented with fever, neck/back pain, and slight weakness in his legs bilaterally (4/5). The patient underwent a magnetic resonance imaging (MRI) of the entire spine showing an epidural collection extending from C5-C6 to the L4-L5 levels. Laboratory studies revealed a leukocytosis and an elevated C-reaction protein level. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. The patient underwent skip laminectomies at C6 and C7; T2, T3, T5, T6, T8, T9, T10, and T12; and L3, L4, and L5 with catheter irrigation between these levels; this minimized the risk of postoperative kyphosis and instability. His postoperative course was uneventful. Other surgical approaches to HEA described in literature include laminectomy, focal laminectomies, and skip laminectomies. Conclusion: In this case of a holospinal HEA, skip laminectomies and catheter irrigation avoided neurological deterioration and delayed spinal instability in a 74-year-old male.

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Ocular Infection Preceding Major Epidural Abscess

Case Reports in Orthopedics ◽

10.1155/2014/245013 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

Liam Dunbar ◽

Ryan Johnstone

Keyword(s):

Epidural Abscess ◽

Primary Source ◽

Ocular Infection ◽

Resonance Imaging ◽

Radiological Features ◽

Short Course ◽

Intravenous Antibiotics ◽

Magnetic Resonance Imaging Mri ◽

Discharge From Hospital ◽

High Index Of Suspicion

Staphylococcal bacteremia is an important clinical entity. A 74-year-old lady presented with an isolated staphylococcal ocular infection; this was treated with a short course of antibiotics, a prolonged course of steroids, and discharge from hospital with outpatient clinic followup. She represented three weeks later to the emergency department with back pain, raised inflammatory markers, and positive blood cultures. On magnetic resonance imaging (MRI), an extensive epidural collection was seen. This was surgically decompressed, and she was treated with appropriate intravenous antibiotics. Despite a complicated postoperative course, she made an excellent recovery. This case reviews the important clinical and radiological features of the presentation of a major epidural abscess and it also suggests a potentially unusual primary source. The clinician is reminded to always have a high index of suspicion regarding staphylococcal bacteremia and the potential for seeding to the epidural space.

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Osseous Infections Caused by Aspergillus Species

Diagnostics ◽

10.3390/diagnostics12010201 ◽

2022 ◽

Vol 12 (1) ◽

pp. 201

Author(s):

Christos Koutserimpas ◽

Ifigeneia Chamakioti ◽

Konstantinos Raptis ◽

Kalliopi Alpantaki ◽

Georgia Vrioni ◽

...

Keyword(s):

Imaging Techniques ◽

Severe Infection ◽

Axial Skeleton ◽

Surgical Debridement ◽

Resonance Imaging ◽

Chain Reaction ◽

X Ray ◽

Galactomannan Antigen ◽

Polymerase Chain ◽

Magnetic Resonance Imaging Mri

Background: Osteomyelitis caused by Aspergillus spp. is a severe, but rare, clinical entity. However, clear guidelines regarding the most effective medical management have not yet been established. The present study is a literature review of all such cases, in an effort to elucidate epidemiology, as well as the therapeutic management and the infection’s outcome. Methods: A thorough review of all reports of osteomyelitis of the appendicular and the axial skeleton, without the skull and the spine, caused by Aspergillus spp. was undertaken. Data about demographics, imaging techniques facilitating diagnosis, causative Aspergillus, method of mold isolation, antifungal treatment (AFT), surgical treatment, as well as the infection’s outcome were recorded and evaluated. Results: A total of 63 cases of osseous infection due to Aspergillus spp. were identified. The studied population’s mean age was 37.9 years. The most commonly affected site was the rib cage (36.8%). Most hosts suffered immunosuppressive conditions (76.2%). Regarding imaging methods indicating diagnosis, computer tomography (CT) was performed in most cases (42.9%), followed by plain X-ray (41.3%) and magnetic resonance imaging (MRI) (34.9%). The most frequent isolated mold was Aspergillus fumigatus (49.2%). Cultures and/or histopathology were used for definite diagnosis in all cases, while galactomannan antigen test was additionally used in seven cases (11.1%), polymerase chain reaction (PCR) in four cases (6.3%), and beta-d-glucan testing in three cases (4.8%). Regarding AFT, the preferred antifungal was voriconazole (61.9%). Most patients underwent surgical debridement (63.5%). The outcome was successful in 77.5%. Discussion: Osteomyelitis due to Aspergillus spp. represents a severe infection. The available data suggest that prolonged AFT in combination with surgical debridement is the preferred management of this infection, while identification of the responsible mold is of paramount importance.

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Meningioma of the Frontal Sinus

American Journal of Rhinology ◽

10.2500/105065895781873908 ◽

1995 ◽

Vol 9 (2) ◽

pp. 109-114

Author(s):

Michael J. Sillers ◽

Glenn E. Peters

Keyword(s):

Magnetic Resonance Imaging ◽

Frontal Sinus ◽

Epidural Abscess ◽

Bone Erosion ◽

Rare Entity ◽

Resonance Imaging ◽

Meningeal Irritation ◽

Preoperative Magnetic Resonance ◽

Magnetic Resonance Imaging Mri ◽

Sinus Obliteration

Meningioma of the frontal sinus is a rare entity. Only nine cases of primary frontal sinus meningioma are reported in the literature. Two cases of frontal sinus meningioma, one primary and one secondary, are herein described. Each patient presented with headache and a frontal mass. Neither patient had fever or signs of meningeal irritation. Computerized tomography (CT) of the paranasal sinuses demonstrated frontal sinus opacification, posterior table bone erosion, and inferolateral displacement of the orbital contents in both patients. One patient underwent preoperative magnetic resonance imaging (MRI) that was officially interpreted as a frontal sinus mucocele and a small epidural abscess. Patients underwent unsuccessful endoscopic decompression for presumed mucoceles. Subsequent MRI in the second patient showed a large intracranial mass with extension into the frontal sinus. Treatment included frontal sinus obliteration and frontal craniotomy for removal of tumor, respectively. Meningioma was confirmed histologically in each patient. Although meningioma of the frontal sinus is rare, thorough evaluation, including MRI, should be considered for frontal sinus opacification in association with posterior table bone erosion.

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Hematogenous pyogenic facet joint infection of the subaxial cervical spine

Journal of Neurosurgery Spine ◽

10.3171/spi.2001.95.1.0135 ◽

2001 ◽

Vol 95 (1) ◽

pp. 135-138 ◽

Cited By ~ 3

Author(s):

Anthony J. Muffoletto ◽

Remi Nader ◽

Richard M. Westmark ◽

Haring J. W. Nauta ◽

Kim J. Garges ◽

...

Keyword(s):

Epidural Abscess ◽

Facet Joint ◽

Joint Infection ◽

Tissue Formation ◽

Granulation Tissue Formation ◽

Content Type ◽

Joint Infections ◽

Cervical Facet ◽

Cervical Facet Joint ◽

Fine Print

✓ Two cases of hematogenous, pyogenic, subaxial cervical facet joint infection are reported, and the literature is reviewed. Infection of the cervical facet joint is a rarely diagnosed condition; only one case has been reported in the literature. Lumbar facet joint infections are also rare but more commonly reported. Approximately one fourth of facet joint infections in the lumbar spine are complicated by epidural abscess formation, which can lead to a neurological deficit. Because of the paucity of reports on cervical facet joint infections, the clinical characteristics of this entity are not well known. Both patients presented with an acute onset of unilateral neck pain that radiated into the ipsilateral shoulder. Frank radicular pain was initially absent. Unilateral upper-extremity motor weakness that was attributed to associated epidural abscess or granulation tissue formation was also demonstrated in both patients. Leukocyte count and erythrocyte sedimentation rate were elevated in both cases. Magnetic resonance imaging was necessary to obtain an accurate diagnosis. Staphylococcus aureus was identified as the offending pathogen in both cases. Decompressive surgery and antibiotic therapy were required to cure the condition. One patient recovered completely and the other sustained a permanent motor deficit. Hematogenous cervical facet joint infection is a rare clinical entity that has many characteristics in common with the more-common lumbar homolog. All three reported cases, however, have been complicated by epidural abscess or granulation tissue formation that has led to a neurological deficit. This finding suggests that a facet joint infection in the cervical spine may have a less benign clinical course than that in the lumbar spine.

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Hypertrophic Synovitis of the Facet Joint Causing Root Pain

Clinical medicine Arthritis and musculoskeletal disorders ◽

10.4137/cmamd.s411 ◽

2008 ◽

Vol 1 ◽

pp. CMAMD.S411

Author(s):

Koichi Iwatsuki ◽

Toshiki Yoshimine ◽

Masanori Aoki ◽

Kazuhiro Yoshimura

Keyword(s):

Facet Joint ◽

Cauda Equina ◽

Radicular Pain ◽

Leg Pain ◽

Facet Joints ◽

Resonance Imaging ◽

Disc Disease ◽

Articular Surfaces ◽

Synovial Cysts ◽

Magnetic Resonance Imaging Mri

Osteoarthritic changes in the facet joints are common in the presence of degenerative disc disease. Changes in the joint capsule accompany changes in the articular surfaces. Intraspinal synovial cysts that cause radicular pain, cauda equina syndrome, and myelopathy have been reported; however, there have been few reports in orthopedic or neurosurgical literature regarding hypertrophic synovitis of the facet joint presenting as an incidental para-articular mass. Here, we report a case of hypertrophic synovitis causing root pain. We describe the case of a 65-year-old man suffering from right sciatica and right leg pain in the L5 nerve-root dermatome for 1 year; magnetic resonance imaging (MRI) revealed an enhanced mass around the L4–5 facet joint. We investigated this mass pathologically. After right medial facetectomy, the symptoms resolved. Pathological investigation revealed this mass was hypertrophic synovitis. Hypertrophic synovitis of the facet joint might cause root pain.

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