Epidural Abscess Caused by Gas-Producing Clostridium Septicum: A Case Report.

CASE: Few cases have reported Clostridium species of bacteria as a source for vertebral osteomyelitis and epidural abscesses. The subspecies of Clostridium septicum has not been described as a cause. This case describes a 69-year-old man who hematogenously spread C. septicum without associated malignancy, subsequently failed conservative management in the form of intravenous antibiotics, and was definitively treated with surgical intervention through a minimally invasive approach. CONCLUSIONS: An epidural abscess occurring in a surgically naive patient is a rare phenomenon. An epidural abscess caused by C. septicum is even rarer. Appropriate imaging, early recognition, and surgical debridement can lead to a favorable outcome.

Focal Correction of Severe Fixed Kyphosis with Single Level Posterior Ponte Osteotomy and Interbody Fusion.

OBJECTIVE: To report the successful correction of a severe, fixed kyphotic deformity utilizing a combination posterior lumbar interbody fusion (PLIF) and Ponte osteotomy at the site of acute kyphosis. SUMMARY OF BACKGROUND DATA: There have been no reports on the experience and surgical strategy of combined one-level focal PLIF and Ponte osteotomy for fixed severe kyphotic deformity. Typically, these corrections would need a pedicle subtraction osteotomy or a vertebrectomy. METHODS: A 24-year-old man presented with progressive back pain and a fixed severe thoracolumbar kyphosis centered at the L2-L3 disc space seven years after removal of instrumentation for intractable infection following correction of Scheuermann's Kyphosis. The patient also demonstrated pseudoarthrosis of the posterior thoracolumbar fusion bed. The original operative plan was to perform a vertebral column resection (VCR) of L2 to correct his severe kyphosis.  During preparation for the VCR, the patient's deformity corrected completely after insertion of blunt distraction paddles for the interbody fusion after the Ponte osteotomy at L2-L3. A VCR was avoided, and the construct was able to be completed with simple rod insertion and posterolateral fusion. RESULTS: The described technique achieved 69 degrees of correction at the L2-L3 disc space without any remodeling of the surrounding vertebrae. The C7 plumb line was normalized, and the patient was able to stand upright with horizontal gaze and without pre-existing discomfort. At the six-month follow-up, the patient reported a significant improvement in pain and was able to resume normal activities.

Validity and reliability of a pad test model using a simulated urine leak and healthy continent females.

The objective of this study was to determine the validity and reliability of a modified pad test to assess urinary incontinence. Urine leakage was simulated using normal saline that was dosed onto super-absorbent incontinence pads, and worn by healthy continent females over two sequential 12-hour time periods. The results indicate that the two x 12-hour pad test provides a reliable assessment of urine leak in female subjects.