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12 pages, 584 KiB  
Article
Risk Factors and Outcomes of Surgical Site Infections of the Spine: A Retrospective Multi-Center Analysis
by Bailey D. Lupo, Wesley P. Jameson, Christian J. Quinones, Alexandre E. Malek, Deepak Kumbhare, Bharat Guthikonda and Stanley Hoang
J. Clin. Med. 2025, 14(10), 3520; https://doi.org/10.3390/jcm14103520 - 17 May 2025
Viewed by 982
Abstract
Background/Objectives: Surgical site infections (SSIs) in spine surgery pose significant risks, including neurological deficits, prolonged hospital stays, and increased healthcare costs. SSIs are classified by their location and include superficial, deep, and organ/space (OS) infections. In spine surgery, OS SSIs include osteomyelitis, [...] Read more.
Background/Objectives: Surgical site infections (SSIs) in spine surgery pose significant risks, including neurological deficits, prolonged hospital stays, and increased healthcare costs. SSIs are classified by their location and include superficial, deep, and organ/space (OS) infections. In spine surgery, OS SSIs include osteomyelitis, discitis, and spinal epidural abscess. These infections are difficult to treat with conservative measures, impart significant morbidity, and incur increasing hospital costs. Despite advancements in surgical technique and infection control, the literature is conflicting on which factors are associated with a significant increase in risk of SSIs after spinal surgery. There is also a significant gap in the literature in defining the risk factors specific to OS SSIs. This study aims to identify risk factors associated with SSI after spine surgery at a single institution, as well as provide descriptive characteristics of patients with OS SSIs. Methods: This retrospective study analyzed spinal surgeries performed at a multi-center, single-institution between 1 January 2019 and 9 February 2025. Neurosurgical patients who underwent spine surgery were identified by ICD-10 procedure and diagnosis codes. Surgical infections were classified based on the National Healthcare Safety Network (NHSN) criteria. Univariate and multivariate analyses were performed to assess associations between patient demographics, comorbidities, and infection risk. Results: Of the 2363 unique spinal surgery patients, 39 developed infections, with 14 meeting the NHSN criteria for OS SSI. The overall rate of SSIs at this institution was 1.65%. Significant risk factors for developing an SSI included cardiovascular disease (p = 0.017) and COPD (p = 0.012). Multivariate analysis confirmed both risk factors identified in the univariate analysis as independent risk factors, with adjusted odds ratios of 1.97 (p = 0.033) and 2.072 (p = 0.041), respectively. The commonly cultured pathogens included Staphylococcus aureus, Staphylococcus epidermidis, and methicillin-resistant Staphylococcus aureus. Conclusions: Male sex, diabetes mellitus, gastroesophageal reflux disease, hyperlipidemia, hypertension, hardware placement, and a history of smoking were more common in patients with SSI. In the OS SSI subgroup, cardiovascular disease and COPD were associated with an increased risk of developing an OS SSI. Future research is needed to investigate more detailed risk factors and include mitigating factors of OS infection into the analysis. Full article
(This article belongs to the Special Issue Musculoskeletal Infections: Clinical Diagnosis and Treatment)
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18 pages, 2983 KiB  
Review
Infective Spondylitis in Adults: A Journey Through Diagnosis, Management, and Future Directions
by Woo-Seok Jung, Sung-Ryul Choi, Ji-Won Kwon, Kyung-Soo Suk, Hak-Sun Kim, Seong-Hwan Moon, Si-Young Park, Jae-Won Shin and Byung-Ho Lee
Antibiotics 2025, 14(4), 391; https://doi.org/10.3390/antibiotics14040391 - 9 Apr 2025
Viewed by 1372
Abstract
Infective spondylitis is a rare but potentially devastating spinal infection that requires timely diagnosis and appropriate treatment to prevent severe complications, including neurological deficits and spinal deformity. Despite advancements in diagnostic imaging, microbiological techniques, and antimicrobial therapies, clinical challenges persist because of the [...] Read more.
Infective spondylitis is a rare but potentially devastating spinal infection that requires timely diagnosis and appropriate treatment to prevent severe complications, including neurological deficits and spinal deformity. Despite advancements in diagnostic imaging, microbiological techniques, and antimicrobial therapies, clinical challenges persist because of the disease’s insidious onset, varied etiologies, and increasing antimicrobial resistance. This review article provides a comprehensive analysis of the current literature on the epidemiology, pathophysiology, diagnostic approaches, and treatment strategies for infective spondylitis. Full article
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7 pages, 5266 KiB  
Case Report
The Remote Intradural Migration of Polyethylene Glycol-Based Hydrogel Sealant Following Lumbar Laminectomy: A Case Report
by Barnabas Obeng-Gyasi, Trenton A. Line, Whitney Brown, Anoop S. Chinthala, Nathan J. Kussow and Gordon Mao
J. Clin. Med. 2025, 14(5), 1472; https://doi.org/10.3390/jcm14051472 - 22 Feb 2025
Viewed by 697
Abstract
Background/Objectives: Synthetic polyethylene glycol (PEG)-based hydrogel sealants, such as Adherus, are commonly used in spinal surgeries to achieve watertight dural closure and prevent cerebrospinal fluid (CSF) leaks. This case report describes an unusual instance of suspected hydrogel sealant migration resulting in an [...] Read more.
Background/Objectives: Synthetic polyethylene glycol (PEG)-based hydrogel sealants, such as Adherus, are commonly used in spinal surgeries to achieve watertight dural closure and prevent cerebrospinal fluid (CSF) leaks. This case report describes an unusual instance of suspected hydrogel sealant migration resulting in an intradural collection at a spinal level remote from the original surgery. Methods: A 57-year-old female with a history of osteoarthritis and prediabetes underwent a minimally invasive L5-S1 laminectomy for the removal of an epidural abscess causing cauda equina and S1 nerve root compression. During the procedure, a dural puncture occurred, which was repaired using Duragen (collagen matrix) and Adherus (synthetic PEG hydrogel sealant). Postoperatively, the patient developed urinary retention and new bilateral posterior leg pain. An MRI on postoperative day four revealed a new peripherally enhancing dorsal intradural collection at the L2 level, causing significant thecal sac narrowing and compression of the cauda equina nerve roots, suggestive of migration of the hydrogel sealant used during surgery. Conservative management was adopted. Results: The patients symptoms gradually resolved. Follow-up imaging at five months showed resolution of the intradural collection, with residual intradural inflammatory changes and arachnoiditis. Conclusions: While PEG-based hydrogel sealants like Adherus are effective in preventing CSF leaks, they can, in rare instances, migrate and cause remote intradural collections with neurological symptoms. Surgeons should exercise meticulous application techniques, thoroughly document the use of sealants, and maintain vigilant postoperative monitoring to mitigate these risks. Full article
(This article belongs to the Section Orthopedics)
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4 pages, 893 KiB  
Interesting Images
Spinal Infection with Rare Cervical Epidural Air Bubbles
by Chen-Hao Liao and Tse-Hao Chen
BioMed 2025, 5(1), 2; https://doi.org/10.3390/biomed5010002 - 9 Jan 2025
Viewed by 1263
Abstract
Spinal infections involving gas-forming pathogens are exceedingly rare, particularly in the cervical spine. We report the case of a 63-year-old male with a history of hypopharyngeal cancer who presented with neck pain and right upper limb weakness. Imaging studies revealed cervical epidural air [...] Read more.
Spinal infections involving gas-forming pathogens are exceedingly rare, particularly in the cervical spine. We report the case of a 63-year-old male with a history of hypopharyngeal cancer who presented with neck pain and right upper limb weakness. Imaging studies revealed cervical epidural air bubbles and spinal cord edema at C1–C3. Laboratory findings were indicative of infection, and Streptococcus was identified through blood cultures. Urgent surgical decompression via laminectomy was performed, followed by antibiotic treatment. This case highlights the critical role of multimodal imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), in diagnosing spinal infections, especially when conventional radiographs are inconclusive. CT scans identified gas inclusions and soft tissue changes, while MRI provided superior visualization of spinal edema and complications such as medullary compression. Management requires a multidisciplinary approach combining timely surgical intervention with prolonged antibiotic regimens. Full article
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15 pages, 2131 KiB  
Review
Spondylodiscitis and Its Mimickers: A Pictorial Review
by Claudia Lucia Piccolo, Alberta Villanacci, Federica Di Stefano, Nicoletta Fusco, Davide Roberto Donno, Massimo Cristofaro, Fabrizio Taglietti and Stefania Ianniello
Biomedicines 2024, 12(11), 2566; https://doi.org/10.3390/biomedicines12112566 - 9 Nov 2024
Cited by 5 | Viewed by 5363
Abstract
Spondylodiscitis is an infection of the intervertebral disc, the adjacent vertebral body, and/or contiguous structures due to the introduction of infectious agent, usually by the hematogenous route. Imaging is crucial in assessing bacterial and tubercular spondylodiscitis, as well as their associated complications. Magnetic [...] Read more.
Spondylodiscitis is an infection of the intervertebral disc, the adjacent vertebral body, and/or contiguous structures due to the introduction of infectious agent, usually by the hematogenous route. Imaging is crucial in assessing bacterial and tubercular spondylodiscitis, as well as their associated complications. Magnetic resonance imaging in particular can clearly depict osteo-structural changes in the vertebral body and the associated disc, as well as any soft-tissue complications, such as paravertebral abscess and/or epidural abscess, improving disease characterization and helping to recognize the agent involved. Nevertheless, other non-infectious diseases may mimic imaging appearances of spondylodiscitis and one should be aware of these conditions when interpreting MR images, which include Modic type I degenerative changes, ankylosing spondylitis, acute Schmorl’s node, porotic fractures, and spinal neuropathy arthropathy. This pictorial review aims at describing imaging findings of bacterial and non-bacterial spondylodiscitis, complications, and those pathologies that mimic these infections. Full article
(This article belongs to the Special Issue Musculoskeletal Disease: From Infectious to Neoplastic)
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22 pages, 852 KiB  
Article
Antimicrobial Treatment Challenges in the Management of Infective Spondylodiscitis Associated with Hemodialysis: A Comprehensive Review of Literature and Case Series Analysis
by Ioana A. Ratiu, Corina F. Moisa, Laura Țiburcă, Edy Hagi-Islai, Anamaria Ratiu, Gabriel Cristian Bako, Cristian Adrian Ratiu and Liana Stefan
Antibiotics 2024, 13(3), 284; https://doi.org/10.3390/antibiotics13030284 - 20 Mar 2024
Cited by 3 | Viewed by 3572
Abstract
Infective spondylodiscitis (ISD), the infection of vertebral bodies and surrounding tissues, is a rare complication with major impact on the long-term survival of hemodialysis (HD) patients. Although the most frequent etiology is staphylococcal, identifying these pathogens in blood cultures and biopsy cultures [...] Read more.
Infective spondylodiscitis (ISD), the infection of vertebral bodies and surrounding tissues, is a rare complication with major impact on the long-term survival of hemodialysis (HD) patients. Although the most frequent etiology is staphylococcal, identifying these pathogens in blood cultures and biopsy cultures is often difficult. This paper aims to present suitable antibiotic combinations for the treatment of these patients, which is usually challenging in the case of an unidentified pathogen. We presented the therapies applied for 13 HD patients and 19 patients without chronic kidney disease (CKD), diagnosed with ISD between 2013 and 2023 in Bihor County. The percentage of positive blood cultures was low in both groups (30.78% HD vs. 15.78% non-HD). The average length of antibiotic therapy was 5.15 weeks in HD patients and 6.29 weeks in non-HD patients. The use of Carbapenem alone (e.g., Meropenem) for an average of 19.6 days for patients in HD when the pathogen was not identified has proven to be efficient in most cases, similarly to using Vancomycin and Fluoroquinolone/Cephalosporines in combination. Regarding the non-CKD patients, the use of Clindamycin in various combinations for an average of 30.3 days has proven to be efficient in more than 90% of cases of ISD with a nonidentified pathogen. Within 2 years after ISD was diagnosed, 12 of the 13 HD patients passed away, mainly due to cardiovascular causes. Unfortunately, there are no guidelines in the literature concerning the empiric treatment of ISD in the particular case of HD patients. Upon checking the literature on PubMed and Google Scholar, only 10 studies provided relevant data regarding ISD treatment for HD patients. More data about the treatment and evolution of these patients is needed in order to elaborate a truly relevant metanalysis. Full article
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9 pages, 1536 KiB  
Article
From the Oral Cavity to the Spine: Prevalence of Oral Cavity Infections in Patients with Pyogenic Spinal Infection
by Fatma Kilinc, Florian Gessler, Johanna Kessel, Daniel Dubinski, Sae-Yeon Won, Anna Tanneberger, Shahram Ghanaati, Vincent Prinz, Marcus Czabanka, Matthias Setzer, Thomas Freiman and Bedjan Behmanesh
J. Clin. Med. 2024, 13(4), 1040; https://doi.org/10.3390/jcm13041040 - 11 Feb 2024
Cited by 4 | Viewed by 1772
Abstract
Background incidence of pyogenic spinal infections has increased in recent years. In addition to treating the spinal infection, optimal care also includes identifying the source of the pyogenic spinal infection and the presence of other infections. The aim of this study is to [...] Read more.
Background incidence of pyogenic spinal infections has increased in recent years. In addition to treating the spinal infection, optimal care also includes identifying the source of the pyogenic spinal infection and the presence of other infections. The aim of this study is to elucidate the prevalence of oral cavity infection (OCI) within this patient cohort. Methods As part of a prospective study conducted from 2016 to 2021, the number of patients with dental infections was investigated by means of an orthopantomogram (OPG) and subsequent dental examination. Results The presence of an oral infection was investigated in 55 (47%) of 118 patients by an OPG, 29 (53%) of whom had a corresponding abnormality of the oral cavity. In addition to the spinal infection, patients with an oral cavity infection revealed an increased incidence of endocarditis, sepsis and brain abscess. A spinal epidural abscess, a multilevel affection of the infection, and an elevated CRP value were also found in patients with a co-existing oral cavity infection. Back pain assessed at admission and 3 months after surgery was also more pronounced in patients with an oral cavity infection. Neurological deficits were often present in patients with spinal and oral cavity infection. Conclusions The presence of an oral cavity infection has proven to be one of the important factors in the detection of the source of the pyogenic spinal infection. In addition, a pronounced spinal affection and frequent co-infections were seen in patients with an oral cavity infection. Full article
(This article belongs to the Special Issue Spine Surgery – from Basics to Advances Technology)
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14 pages, 2039 KiB  
Article
Diagnostics, Management, and Outcomes in Patients with Pyogenic Spinal Intra- or Epidural Abscess
by Mido Max Hijazi, Timo Siepmann, Ibrahim El-Battrawy, Assem Aweimer, Kay Engellandt, Dino Podlesek, Gabriele Schackert, Tareq A. Juratli, Ilker Y. Eyüpoglu and Andreas Filis
J. Clin. Med. 2023, 12(24), 7691; https://doi.org/10.3390/jcm12247691 - 14 Dec 2023
Cited by 2 | Viewed by 1690
Abstract
Background: Owing to the lack of evidence on the diagnostics, clinical course, treatment, and outcomes of patients with extremely rare spinal intradural abscess (SIA) and spinal epidural abscess (SEA), we retrospectively analyzed and compared a cohort of patients to determine the phenotyping of [...] Read more.
Background: Owing to the lack of evidence on the diagnostics, clinical course, treatment, and outcomes of patients with extremely rare spinal intradural abscess (SIA) and spinal epidural abscess (SEA), we retrospectively analyzed and compared a cohort of patients to determine the phenotyping of both entities. Methods: Over a period of 20 years, we retrospectively analyzed the electronic medical records of 78 patients with SIA and SEA. Results: The patients with SIA showed worse motor scores (MS scores) on admission (SIA: 20 ± 26 vs. SEA: 75 ± 34, p < 0.001), more often with an ataxic gait (SIA: 100% vs. SEA: 31.8%, p < 0.001), and more frequent bladder or bowel dysfunction (SIA: 91.7% vs. SEA: 27.3%, p < 0.001) compared to the SEA patients. Intraoperative specimens showed a higher diagnostic sensitivity in the SEA patients than the SIA patients (SIA: 66.7% vs. SEA: 95.2%, p = 0.024), but various pathogens such as Staphylococcus aureus (SIA 33.3% vs. SEA: 69.4%) and Streptococci and Enterococci (SIA 33.3% vs. SEA: 8.1%, p = 0.038) were detected in both entities. The patients with SIA developed sepsis more often (SIA: 75.0% vs. SEA: 18.2%, p < 0.001), septic embolism (SIA: 33.3% vs. SEA: 8.3%, p = 0.043), signs of meningism (SIA: 100% vs. 18.5%, p < 0.001), ventriculitis or cerebral abscesses (SIA: 41.7% vs. SEA: 3.0%, p < 0.001), and pneumonia (SIA: 58.3% vs. SEA: 13.6%, p = 0.002). The mean MS score improved in both patient groups after surgery (SIA: 20 to 35 vs. SEA: 75 to 90); however, the SIA patients showed a poorer MS score at discharge (SIA: 35 ± 44 vs. SEA: 90 ± 20, p < 0.001). C-reactive protein (CrP) (SIA: 159 to 49 vs. SEA: 189 to 27) and leukocyte count (SIA: 15 to 9 vs. SEA: 14 to 7) were reduced at discharge. The SIA patients had higher rates of disease-related mortality (SIA: 33.3% vs. SEA: 1.5%, p = 0.002), had more pleural empyema (SIA: 58.3% vs. SEA: 13.6%, p = 0.002), required more than one surgery (SIA: 33.3% vs. SEA 13.6%, p = 0.009), were treated longer with intravenous antibiotics (7 ± 4 w vs. 3 ± 2 w, p < 0.001) and antibiotics overall (12 ± 10 w vs. 7 ± 3 w, p = 0.022), and spent more time in the hospital (SIA: 58 ± 36 vs. SEA: 26 ± 20, p < 0.001) and in the intensive care unit (SIA: 14 ± 18 vs. SEA: 4 ± 8, p = 0.002). Conclusions: Our study highlighted distinct clinical phenotypes and outcomes between both entities, with SIA patients displaying a markedly less favorable disease course in terms of complications and outcomes. Full article
(This article belongs to the Special Issue Spinal Infections: Pathogenesis, Diagnosis, Management and Outcomes)
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14 pages, 772 KiB  
Article
Post-Operative Thoracic Epidural Analgesia and Incidence of Major Complications according to Specific Safety Standardized Documentation: A Large Retrospective Dual Center Experience
by Despoina G. Sarridou, Sophia Anastasia Mouratoglou, Jeremy B. Mitchell, Felicia Cox, Afroditi Boutou, Maria Braoudaki, George I. Lambrou, Maria Konstantinidou, Helena Argiriadou and Christopher P. R. Walker
J. Pers. Med. 2023, 13(12), 1672; https://doi.org/10.3390/jpm13121672 - 29 Nov 2023
Cited by 7 | Viewed by 2666
Abstract
(1) Background: Thoracic epidural analgesia is considered the gold standard in post-operative pain management following thoracic surgery. This study was designed to explore the safety of thoracic epidural analgesia and to quantify the incidence of its post-operative complications and side effects in patients [...] Read more.
(1) Background: Thoracic epidural analgesia is considered the gold standard in post-operative pain management following thoracic surgery. This study was designed to explore the safety of thoracic epidural analgesia and to quantify the incidence of its post-operative complications and side effects in patients undergoing thoracotomy for major surgery, such as resection of lung malignancies and lung transplantation. (2) Methods: This is a retrospective, dual-center observational study including patients that underwent major thoracic surgery including lung transplantation and received concurrent placement of thoracic epidural catheters for post-operative analgesia. An electronic system of referral and documentation of complications was used, and information was retrieved from our electronic critical care charting system. (3) Results: In total, 1145 patients were included in the study. None of the patients suffered any major complication, including hematoma, abscess, or permanent nerve damage. (4) Conclusions: the present study showed that in experienced centers, post-operative epidural analgesia in patients with thoracotomy is a safe technique, manifesting minimal, none-serious complications. Full article
(This article belongs to the Special Issue Personalized Therapy and Clinical Outcomes for Chronic Pain)
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20 pages, 1687 KiB  
Article
Cervical Spinal Epidural Abscess: Diagnosis, Treatment, and Outcomes: A Case Series and a Literature Review
by Stamatios A. Papadakis, Margarita-Michaela Ampadiotaki, Dimitrios Pallis, Konstantinos Tsivelekas, Petros Nikolakakos, Labrini Agapitou and George Sapkas
J. Clin. Med. 2023, 12(13), 4509; https://doi.org/10.3390/jcm12134509 - 5 Jul 2023
Cited by 8 | Viewed by 4417
Abstract
Although recent diagnostic and management methods have improved the prognosis of cervical epidural abscesses, morbidity and mortality remain significant. The purpose of our study is to define the clinical presentation of cervical spinal epidural abscess, to determine the early clinical outcome of surgical [...] Read more.
Although recent diagnostic and management methods have improved the prognosis of cervical epidural abscesses, morbidity and mortality remain significant. The purpose of our study is to define the clinical presentation of cervical spinal epidural abscess, to determine the early clinical outcome of surgical treatment, and to identify the most effective diagnostic and treatment approaches. Additionally, we analyzed studies regarding cervical epidural abscesses and performed a review of the literature. In this study, four patients with spinal epidural abscess were included. There were three men and one woman with a mean age of 53 years. Three patients presented with motor deficits, and one patient was diagnosed incidentally through spinal imaging. All the patients had fever, and blood cultures were positive. Staphylococcus aureus was the most common organism cultured from abscesses. All patients underwent a surgical procedure, and three patients recovered their normal neurological functions, but one remained with mild neurological disability that was resolved two years postoperatively. The mean follow-up period was 12 months, and no deaths occurred in this series. Furthermore, we identified 85 studies in the literature review and extracted data regarding the diagnosis and management of these patients. The timely detection and effective management of this condition are essential for minimizing its associated morbidity and mortality. Full article
(This article belongs to the Special Issue Spinal Infections: Pathogenesis, Diagnosis, Management and Outcomes)
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10 pages, 1333 KiB  
Case Report
Endocarditis with Streptococcus pseudoporcinus Associated with Mastocytosis and Spondylodiscitis—A Coincidental Association? A Case Report
by Victoria Birlutiu, Rares-Mircea Birlutiu, Minodora Teodoru, Alina Camelia Catana and Cristian Ioan Stoica
Trop. Med. Infect. Dis. 2023, 8(5), 247; https://doi.org/10.3390/tropicalmed8050247 - 25 Apr 2023
Cited by 1 | Viewed by 2497
Abstract
Streptococcus pseudoporcinus is a nonmotile Gram-positive, catalase, and benzidine negative, arranged in short chains, isolated from the genitourinary tract group B Streptococcus. S. pseudoporcinus was also identified from blood, urine, skin, cervical area, wounds, rectum, and placenta samples. Two cases of infective endocarditis [...] Read more.
Streptococcus pseudoporcinus is a nonmotile Gram-positive, catalase, and benzidine negative, arranged in short chains, isolated from the genitourinary tract group B Streptococcus. S. pseudoporcinus was also identified from blood, urine, skin, cervical area, wounds, rectum, and placenta samples. Two cases of infective endocarditis have been reported in the literature. Based on these data, the identification of a case of S. pseudoporcinus infective endocarditis associated with spondylodiscitis in a patient with undiagnosed systemic mastocytosis until the age of 63 years is unusual. Two sets of blood specimens were collected, and both sets were positive for S. pseudoporcinus. Transesophageal echocardiography revealed, multiple vegetations on the mitral valve. A lumbar spine MRI revealed L5-S1 spondylodiscitis that associates prevertebral and right paramedian epidural abscesses with compressive stenosis. The performed bone marrow biopsy, and cellularity examination revealed 5–10% mast cells in the areas of medullary tissue, an aspect that is suggestive of mastocytosis. Antibiotic therapy was initiated, under which the patient presented intermittent fever. A second transesophageal echocardiography revealed a mitral valve abscess. A mitral valve replacement with a mechanical heart valve device through a minimally invasive approach was performed, with a favorable evolution under treatment. S. pseudoporcinus can be responsible for infectious endocarditis in certain immunodepressed cases, but also in a profibrotic, proatherogenic field, as shown by the association with mastocytosis in the presented case. Full article
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7 pages, 875 KiB  
Case Report
Epidural Abscesses as a Complication of Interleukin-6 Inhibitor and Dexamethasone Treatment in a Patient with COVID-19 Pneumonia: A Case Report
by Valdis Ģībietis
Medicina 2023, 59(4), 771; https://doi.org/10.3390/medicina59040771 - 16 Apr 2023
Cited by 2 | Viewed by 2160
Abstract
A 66-year-old female patient was hospitalized with severe COVID-19 pneumonia, which led to hypoxia requiring oxygen support with high-flow nasal cannulae. She received anti-inflammatory treatment with a 10-day dexamethasone 6 mg PO course and a single infusion of IL-6 monoclonal antibody tocilizumab 640 [...] Read more.
A 66-year-old female patient was hospitalized with severe COVID-19 pneumonia, which led to hypoxia requiring oxygen support with high-flow nasal cannulae. She received anti-inflammatory treatment with a 10-day dexamethasone 6 mg PO course and a single infusion of IL-6 monoclonal antibody tocilizumab 640 mg IV. Treatment led to gradual reduction of oxygen support. However, on Day 10, she was found to have Staphylococcus aureus bacteremia with epidural, psoas, and paravertebral abscesses as the source. Targeted history taking revealed a dental procedure for periodontitis 4 weeks prior to hospitalization as the probable source. She received an 11-week antibiotic treatment, which led to resolution of the abscesses. This case report highlights the importance of individual infection risk assessment before the initiation of immunosuppressive treatment for COVID-19 pneumonia. Full article
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11 pages, 782 KiB  
Systematic Review
A Systematic Review of Intracranial Complications in Adults with Pott Puffy Tumor over Four Decades
by Giorgos Sideris, Efstathia Davoutis, Evangelos Panagoulis, Pavlos Maragkoudakis, Thomas Nikolopoulos and Alexander Delides
Brain Sci. 2023, 13(4), 587; https://doi.org/10.3390/brainsci13040587 - 30 Mar 2023
Cited by 14 | Viewed by 3059
Abstract
The purpose of this study is to investigate the risk factors of intracranial complications in adult patients with Pott Puffy Tumor (PPT). A systematic review was conducted of clinical studies from January 1983 to December 2022 that reported on PPT adult patients. The [...] Read more.
The purpose of this study is to investigate the risk factors of intracranial complications in adult patients with Pott Puffy Tumor (PPT). A systematic review was conducted of clinical studies from January 1983 to December 2022 that reported on PPT adult patients. The full-text articles were reviewed for the patients’ ages, sex, cultured organisms, surgical procedures, clinical sequalae, and underlying diseases that may affect the onset of intracranial complications in PPT adult patients. A total of 106 studies were included. Medical data were reviewed for 125 patients (94 males, 31 females). The median age was 45 years. A total of 52% had comorbidities, mostly head trauma (24.5%), sinus/neurosurgical operations (22.4%), immunosuppression conditions (13.3%), diabetes mellitus (9.1%), cocaine use (7.1%), or dental infections (6.1%). A total of 28 cultures revealed Streptococcus (22.4%), 24 contained staphylococci (19.2%), and 22 cultures contained other pathogens (17.6%). An amount of 30.4% developed intracranial complications, with the most common being epidural abscesses or empyemas (55.3%), as well as subdural (15.7%) and extradural lesions (13.2%). Age, DM, and immunosuppression conditions are significantly associated with intracranial complications (p < 0.001, p = 0.018 and p = 0.022, respectively). Streptococcus infection is associated with intracranial complications (p = 0.001), although Staphylococcus and other microorganisms are not. Surgical intervention, mainly ESS, and broad-spectrum antibiotics remain the cornerstones of treatment. Full article
(This article belongs to the Section Neurosurgery and Neuroanatomy)
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13 pages, 1492 KiB  
Review
Post-COVID-19 Spondylodiscitis: A Case Study and Review of the Literature
by George-Cosmin Popovici, Costinela-Valerica Georgescu, Anca-Adriana Arbune, Mihaela-Camelia Vasile, Ionut Olteanu and Manuela Arbune
Medicina 2023, 59(3), 616; https://doi.org/10.3390/medicina59030616 - 20 Mar 2023
Cited by 5 | Viewed by 6461
Abstract
COVID-19 is currently a major health problem, leading to respiratory, cardiovascular and neurological complications, with additional morbidity and mortality. Spinal infections are rare, representing around 1% of all bone infections and comprising less than 2 per 10,000 of all hospitalizations in tertiary care [...] Read more.
COVID-19 is currently a major health problem, leading to respiratory, cardiovascular and neurological complications, with additional morbidity and mortality. Spinal infections are rare, representing around 1% of all bone infections and comprising less than 2 per 10,000 of all hospitalizations in tertiary care centers. Spondylodiscitis is a complex disease, with challenging diagnosis and management. We report the case of a 45-year-old man, non-smoker hospitalized for severe COVID-19 disease with respiratory failure. Post-COVID-19, in the 8th week after discharge, he was diagnosed by magnetic resonance imaging with spondylodiscitis, but etiology was not confirmed by microbiological investigations. Antibiotics were used, considering the identification of MRSA from cultures of pleural fluid and nasal swab, but surgical intervention was not provided. Clinic, biologic and imagistic were improved, but rehabilitation and long term follow up are necessary. We concluded that spondylodiscitis with spinal abscess is a rare but severe complication post-COVID-19 disease, due to dysbalanced immune response related to the respiratory viral infection, endothelial lesions, hypercoagulation and bacterial superinfection. Full article
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13 pages, 841 KiB  
Review
Spinal Cord Injury and Complications Related to Neuraxial Anaesthesia Procedures: A Systematic Review
by Daniel H. Pozza, Isaura Tavares, Célia Duarte Cruz and Sara Fonseca
Int. J. Mol. Sci. 2023, 24(5), 4665; https://doi.org/10.3390/ijms24054665 - 28 Feb 2023
Cited by 15 | Viewed by 8185
Abstract
The use of neuraxial procedures, such as spinal and epidural anaesthesia, has been linked to some possible complications. In addition, spinal cord injuries due to anaesthetic practice (Anaes-SCI) are rare events but remain a significant concern for many patients undergoing surgery. This systematic [...] Read more.
The use of neuraxial procedures, such as spinal and epidural anaesthesia, has been linked to some possible complications. In addition, spinal cord injuries due to anaesthetic practice (Anaes-SCI) are rare events but remain a significant concern for many patients undergoing surgery. This systematic review aimed to identify high-risk patients summarise the causes, consequences, and management/recommendations of SCI due to neuraxial techniques in anaesthesia. A comprehensive search of the literature was conducted in accordance with Cochrane recommendations, and inclusion criteria were applied to identify relevant studies. From the 384 studies initially screened, 31 were critically appraised, and the data were extracted and analysed. The results of this review suggest that the main risk factors reported were extremes of age, obesity, and diabetes. Anaes-SCI was reported as a consequence of hematoma, trauma, abscess, ischemia, and infarction, among others. As a result, mainly motor deficits, sensory loss, and pain were reported. Many authors reported delayed treatments to resolve Anaes-SCI. Despite the potential complications, neuraxial techniques are still one of the best options for opioid-sparing pain prevention and management, reducing patients’ morbidity, improving outcomes, reducing the length of hospital stay, and pain chronification, with a consequent economic benefit. The main findings of this review highlight the importance of careful patient management and close monitoring during neuraxial anaesthesia procedures to minimise the risk of spinal cord injury and complications. Full article
(This article belongs to the Special Issue Spinal Cord Injury: From Mechanisms to Therapeutic Approaches)
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