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Spinal cervical infection: a case report and current update
1Chicago Institute of Neurosurgery and Neuroresearch, Silver Cross Hospital Satellite, Joliet 60432, USA.
Abstract:
Cervical spine infection is a term used to encompass osteomyelitis, discitis and epidural abscess. Most cases are caused by Staphylococcus aureus but other organisms have been isolated. The most frequent source is hematogenous spread from a nearby or distant source. Diagnosis is often confusing. The most common symptom is worsening back or neck pain that increases with movement. Patients may have motor or sensory changes if there is compression of the nerve roots or spinal cord. If the condition is not treated promptly, it may progress to irreversible neurologic deficit. Positive blood cultures and an elevated erythrocyte sedimentation rate (ESR) may be seen. Radiologic findings may include a paravertebral swelling, a destruction of the vertebral end plates and adjacent portions of the bodies and disc space and the presence of an epidural mass. Treatment includes radical surgical intervention for debridement and decompression to stabilize the spine in conjunction with 8-12 weeks of intravenous antibiotics. Closed continuous local antibiotic irrigation with a gravity control outflow system has been used.
Insights
Cervical spine infections, including osteomyelitis and discitis, often stem from Staphylococcus aureus and present with worsening neck pain. Prompt diagnosis and treatment with surgery and antibiotics are crucial to prevent irreversible neurological damage.
Area of Science:
- Spinal Surgery
- Infectious Diseases
- Neurosurgery
Background:
- Cervical spine infections encompass osteomyelitis, discitis, and epidural abscesses, frequently caused by Staphylococcus aureus.
- Hematogenous spread is the most common route of infection, originating from local or distant sources.
Observation:
- Diagnosis can be challenging, with worsening neck pain upon movement as the primary symptom.
- Neurological deficits may arise from nerve root or spinal cord compression.
- Elevated erythrocyte sedimentation rate (ESR) and positive blood cultures can be indicative.
Findings:
- Radiographic evidence may include paravertebral swelling, vertebral destruction, and epidural masses.
- Early identification is critical to avert permanent neurological impairment.
Implications:
- Treatment necessitates surgical debridement and decompression for spinal stabilization.
- A course of 8-12 weeks of intravenous antibiotics is standard.
- Local antibiotic irrigation systems offer an adjunctive therapeutic approach.