Imaging in spinal infections: Current status and future directions

Unusual case of staphylococcus epidermidis-induced spinal epidural abscess in an adolescent: Clinical insights and diagnostic considerations

Spinal epidural abscess (SEA) is an uncommon infection typically caused by Staphylococcus aureus, predominantly affecting older adults with risk factors such as advanced age, comorbidities, and prior surgical interventions. This report details a case involving a 14-year-old male presenting with acute lumbar pain, lower limb weakness, urinary retention, and skin pustules. The patient had no history of immunologic diseases, diabetes, or drug use. Contrast-enhanced magnetic resonance imaging (MRI) with gadolinium demonstrated a peripheral fluid signal surrounding the thoracic spinal cord, consistent with an epidural abscess from T9-T12 to L1, causing spinal cord compression. Cultures from the abscess and skin pustules identified Staphylococcus epidermidis (S. epidermidis). The patient underwent surgical drainage and remained stable postoperatively. This case highlights an unusual SEA presentation in an adolescent without typical risk factors, emphasizing the importance of considering atypical pathogens and further investigation into infection sources.

Imaging clues for the diagnosis of various pathogenic causes of infectious spondylitis

Infectious spondylitis is not a common disease; however, its incidence has increased recently due to the increasing number of older patients with chronic diseases and immunocompromised status globally. The clinical presentation of infectious spondylitis may be non-specific, causing delays in diagnosis and treatment, and leading to significant sequelae. Imaging usually plays a crucial role in characterizing the presence and extent of the disease, leading to proper management, reduced mortality, and long-term neurological morbidity. Many studies have proposed imaging features to distinguish between the common causes of infectious spondylitis, pyogenic or tuberculous infections, while the less common infections, including those caused by fungi or other bacterial organisms such as brucellosis, melioidosis, and actinomycosis, are believed to lack specific imaging characteristics. In this review, we highlight the characteristic imaging findings of both common and uncommon pathogens, which can serve as key clues for accurately diagnosing various pathogenic causes of infectious spondylitis.

Thoracic Pyogenic Spondylitis Misdiagnosed As Osteoporotic Compression Fracture Status Post Vertebral Augmentation With Resultant Paraplegia: A Case Report

This paper describes a case of serious complications following vertebral augmentation resulting from a misdiagnosis of pyogenic spondylitis as osteoporotic compression fracture (OCF). A 56-year-old female with systemic lupus erythematosus underwent vertebral augmentation following a diagnosis of T10 OCF based on plain film analysis. Note that preoperative computed tomography (CT) and magnetic resonance imaging (MRI) were not performed. One day after vertebral augmentation, the patient experienced a recurrence of low back pain with fever and paraplegia. MRI findings revealed paravertebral and epidural soft tissue over T9 and T10 with cord compression. Subsequent laminectomy of T9 and T10 revealed devitalized lamina, epidural abscess, and granulation tissue. Pathological analysis indicated a combination of acute and chronic inflammation. A pus culture identified Staphylococcus aureus, indicative of pre-existing pyogenic spondylitis. Further revision surgery was performed at another hospital. The patient remained in a paraplegic state one year after surgery. Infectious spondylitis often manifests with nonspecific symptoms similar to those of compression fracture, and plain radiographs are insufficient to differentiate between the two, often leading to misdiagnosis and mistreatment. Nonetheless, many practitioners base preoperative planning solely on plain film imaging. We advocate the routine usage of CT and/or MRI for patients diagnosed with compression fractures, particularly for immunocompromised individuals.