Myelopathy secondary to spinal epidural abscess: case reports and a review.

Spinal epidural abscess (SEA) is a rare disease with an unknown incidence rate. This paper will illustrate that early diagnosis and rehabilitation may result in improved outcomes for patients with neck or back pain presenting with neurological deficits. Three cases of SEA in individuals without the commonly acknowledged risk factors of intravenous drug abuse (IVDA), invasive procedures, or immunosuppression were seen at our institution during a 10-month period between October 1995 and July 1996. The patients presented with neck or thoracic back pain and progressive neurological deficits without a febrile illness. Predisposing factors were thought to be urinary tract infection with underlying untreated diabetes mellitus in the first case, a history of recurrent skin infection in the second, and alcoholism without a definite source of infection in the third. Leukocytosis, elevated sedimentation rate, and confirmatory findings reported on magnetic resonance imaging (MRI) led to the diagnosis of SEA in all three cases. Immediate surgical drainage and decompression followed by proper antibiotic treatment and early aggressive rehabilitation led to good functional outcomes. All the individuals became independent in activities of daily living, wheelchair mobility, and bowel and bladder management. Two eventually became ambulatory.

Pregnancies following ultrasound-guided drainage of tubo-ovarian abscess.

OBJECTIVE: To study fertility among women treated by means of ultrasound-guided drainage and antibiotics for tubo-ovarian abscess (TOA). DESIGN: Retrospective cohort study. SETTING: A tertiary referral center. PATIENT(S): One hundred women of reproductive age treated for TOA between June 1986 and July 2003. INTERVENTION(S): Transvaginal ultrasound-guided drainage of TOA was performed in all patients. The procedure was repeated if a substantial amount of pus was seen using ultrasonography 2-5 days after the initial aspiration, and repeated later if necessary. MAIN OUTCOME MEASURE(S): Frequency of naturally conceived pregnancies. RESULT(S): Twenty of 38 (52.6%; 95% CI 36.5-68.9%) women who intended to have a child achieved pregnancy naturally and became mothers. In addition, 7 (50%) of 14 women who were not on birth control on a regular basis became pregnant. No ectopic pregnancies were registered. CONCLUSION(S): Ultrasound-guided drainage of TOA in combination with antibiotics seems to preserve fertility in approximately half of the patients.

Non-granulomatous spinal epidural abscess: a rehabilitation perspective.

Spinal epidural abscess (SEA) as a cause of back pain, fever, and neurological deficits has been recognised. Reports of this entity have increased in recent years, possibly likely secondary to increasing intravenous drug abuse. Most patients recover without neurological sequelae. Recent reports in fact indicate that those with persistent deficit have a much poorer prognosis for survival. As a result, few patients with SEA are seen in spinal injury rehabilitation programmes. Our 5 years experience with SEA was reviewed. Thirteen patients were admitted with residual neurological deficits following a course of prolonged antibiotic therapy. Of these most had progressive neurological improvement with only 3 of 4 remaining Frankel class A and 3 of 7 Frankel class C. The only mortalities (2) were secondary to the underlying medical problems. Most patients were discharged home.

Predisposing factors of life-threatening deep neck infection: logistic regression analysis of 214 cases.

OBJECTIVE: In the era of antibiotics, most deep neck infections can be cured by conservative treatment, but some still result in life-threatening complications. In this study, we discuss whether or not there are predisposing factors of complicated deep neck infection. DESIGN: A retrospective chart review of patients presenting between 1988 and 1996 was conducted. METHOD: Among 214 deep neck infection patients, 18 cases resulted in lethal complications. We used the "dummy" variable with logistic regression as the statistical analysis method. RESULTS: Patients with an underlying disease, neck swelling, and delay time had a positive correlation that was statistically significance (p < .05). Patients who were older, male, with complete blood count/differential count-positive finding and fever had positive correlation, but this was not statistically significant (p > .05). CONCLUSION: Although complicated deep neck infection is a rapidly progressive disease with a high mortality, we can not thoroughly predict the prognosis or avoid it happening completely. But, if we can detect and pay more attention to the high-risk group of patients with use of aggressive therapy, the incidence of complicated deep neck infection may be reduced.

Management of spinal brucellosis and outcome of rehabilitation.

STUDY DESIGN: Review of cases. OBJECTIVE: To review cases of brucellosis in order to clarify diagnostic guidelines, treatment regimes and prognosis. SETTING: University Hospital, Turkey. METHODS: Study of 11 patients (9 male, 2 female) with either brucellar spondylitis or epidural brucellar abscess. Diagnosis made on clinical presentation, laboratory findings, radiographic evidence and a minimum brucellar anti body of 1 : 160, a positive bacteriological culture and/or histological finding of inflammation of granulomatous tissue. All patients were treated with a combination of oral antibiotics. Surgery was performed in 8 patients. RESULTS: At least 6 months antibiotic therapy using Rifampicin and Doxycycline is recommended. Surgery is indicated in the presence of spinal instability, cord compression or radiculopathy. In our series eight patients required surgery. CONCLUSION: The patients complaining of back pain, particularly in endemic areas should be investigated as possible cases of brucellosis.