Abstract
Spinal infection is a significant cause of morbidity. Despite advances in antibiotic treatment regimens, the incidence is not decreasing. Several factors can make people more vulnerable to spinal infections, including immunodeficiency secondary to human immunodeficiency virus (HIV) infection or intravenous drug abuse, old age, chronically debilitated individuals, the widespread use of broad-spectrum antibiotics, the use of corticosteroids and immunosuppressive drugs and parenteral alimentation. Clinical symptoms most often include back pain, sensory motor deficits, fever, and obtundation. Fever, however, may not be prominent, and body temperature can be normal in patients with chronic infection. Mechanical compression is the most common cause of functional compromise of the spinal cord, and deterioration secondary to ischemic compromise is often seen. Magnetic resonance imaging is the method of choice and gold standard in detecting infectious spine diseases.
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References
Akiguchi I, Fujiwara T, Matsuyama H et al. (1979) Intramedullary cysticercosis. Neurology 29:1531–1534
Alessi G, Lemmerling M, Nathoo N (2003) Combined spinal subdural tuberculous empyema and intramedullary tuebrculoma in an HIV-positive patient. Eur Radiol 13:1899–901
Al-Mulhim FA, Ibrahim EM, el Hassan AY, Moharram HM (1995) Magnetic resonance imaging of tuberculous spondylitis. Spine 20:2287–2292
Andronikou A, Jadwat A, Dois H (2002) Patterns of disease on MRI in 53 children with tuberculous spondylitis and the role of gadolinium. Pediatr Radiol 32:798–805
Artigas J, Grosse G, Niedobitek F (1990) Vacuolar myelopathy in AIDS. A morphologic analysis. Path Res Pract 186:228–237
Babu R, Jafar JJ, Huang PP et al. (1992) Intramedullary cord abscesses associated with spinal cord ependymoma. Neurosurgery 30:121–124
Bass SN, Ailani RK, Shekar R, Gerblich AA (1998) Pyogenic vertebral osteomyelitis presenting as exudative pleural effusion: a series of five cases. Chest 114:642–647
Bazan C III, Jackson C, Jinkins JR, Barohn RJ (1991) Gadolinium-enhanced MRI in a case of cytomegalovirus polyradiculopathy. Neurology 41:1522–1523
Bergmann M, Gulotta F, Kuchelmeister K, Masini T, Angeli G (1993) AIDS-myelopathy. A neuropathological study. Path Res Pract 189:58–65
Bötzel K (1993) Tuberkulöse Radiculomyelitis: gut therapierbar nur bei frühem Erkennen. Nervenarzt 64:281–283
Byrd BF, Weiner MH, McGee ZA (1982) Aspergillus spinal epidural abscess. J Am Med Assoc 248:3138–3139
Candon E, Frerebeau P (1994) Bacterial abscesses of the spinal cord. Review of the literature (73 cases). Rev Neurol 150:370–376
Chan CT, Gold WL (1998) Intramedullary abscess of the spinal cord in the antibiotic era: clinical features, microbial etiologies, trends in pathogenesis, and outcomes. Clin Infect Dis 27:619–626
Chang KH, Han MH, Choi YW et al. (1989) Tuberculous arachnoiditis of the spine: findings on myelography, CT, and MR imaging. Am J Neuroradiol 10:1255–1262
Chi Cy, Fung CP, Liu CY (2003) Aspergillus flavus epidural abscess and osteomyelitis in a diabetic patient. J Microbiol Immunol Infect 36:145–148
Chimelli L, Freitas MRG de, Bazin AR et al. (1990) Encephalo-myelo-radiculite a cytomegalovirus au cours du syndrome dÃmmuno-deficience acquise. Rev Neurol 146:354–360
Citow JS, Ammirati M (1994) Intramedullary tuberculoma of the spinal cord: case report. Neurosurgery 35:327–330
Cross RK Jr, Howell C (2003) Two cases of spontaneous epidural abscess in patient with cirrhosis. South Med J 96:291–293
Dal Pan GJ, Glass JD, McArthur JC (1994) Clinicopathologic correlations of HIV-1-associated vacuolar myelopathy. Neurology 44:2159–2164
Danner RL, Hartmann BJ (1987) Update of spinal epidural abscess: 35 cases and review of the literature. Rev Infect Dis 9:265–274
Devi BI, Chandra S, Mongia S et al. (2002) Spinal intramedullary tuberculoma and abscess: a rare cause of paraparesis. Neurol India 50:494–496
Evangelista E, Itti E, Malek Z et al. (2004) Diagnostic value of 99mTc-HMDP bone scan in atypical osseous tuberculosis mimicking multiple secondary metastases. Spine 1: E85–E87
Fairley CK, Wodak J, Benson E (1992) Spinal cord toxoplasmosis in a patient with human immunodeficiency virus infection. Int J STD AIDS 3:366–368
Farkas V (1986) Morphology and structure of fungi. In: Braude AI, Davis CE, Fierer J (eds) Infectious diseases and medical microbiology, 2nd edn. Saunders, Philadelphia, pp 113–124
Frazier DD, Campell DR, Garvey TA et al. (2001) Fungal infections of the spine. J Bone Joint Surg 83:560–565
Friedman DP, Hills JR (1994) Cervical epidural spinal infection: MR imaging characteristics. Am J Radiol 163:699–704
Friess HM, Wasenko JJ (1997) MR of staphylococcal myelitis of the cervical spinal cord. Am J Neuroradiol 18:455–458
Gero B, Sze G, Sharif H (1991) MR imaging findings of intradural inflammatory diseases of the spine. Am J Neuroradiol 12:1009–1019
Gillams AR, Chaddha B, Carter AP (1996) MR appearance of the temporal evolution and resolution of infectious spondylitis. Am J Roentgenol 166:903–907
Go BM, Ziring DJ, Kountz DS (1993) Spinal epidural abscess due to Aspergillus sp in a patient with acquired immunodeficiency syndrome. South Med J 8:957–960
Gouliamos AD, Kehagias DT, Lahanis S et al. (2001) MR imaging of tuberculous vertebral osteomyelitis: pictorial review. Eur Radiol 11:575–579
Gray F, Gherardi R, Trotot P, fenelon G, Poirier J (1990) Spinal cord lesions in acquired immune deficiency syndrome. Neurosurg Rev 13:189–194
Griffiths P (2004) Cytomegalovirus infection of the central nervous system. Herpes 11:95A–104A
Gupta SK, Pandit A, White DG, Evans PD (2004) Salmonella osteomyelitis of the thoracic spine: an unusual presentation. Postgrad Med J 80:110–111
Harris TM, Smith RR, Bognanno JR, Edwards MK (1990) Toxoplasmic myelitis in AIDS: gadolinium-enhanced MR. J Comput Assist Tomogr 14:809–811
Hoffman EB, Crosier JH, Cremin BJ (1993) Imaging children with spinal tuberculosis. A comparison of radiography, CT and MRI. J Bone Joint Surg Br 75:233–239
Ingwer I, McLeish KR, Tight RR et al. (1978) Aspergillus fumigatus epidural abscess in a renal transplant recipient. Arch Intern Med 138:153–154
Jevtic V (2001) Magnetic resonance imaging appearances of different discovertebral lesions. Eur Radiol 11:1123–1135
Jinkins JR, Gupta R, Chang KH et al. (1995) MR imaging of central nervous system tuberculosis. Radiol Clin North Am 33:771–786
Jung NY, Jee WH, Ha KY, Park CK, Byun JY (2004) Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. Am J Radiol 182:1405–1410
Kayser K, Campbell R, Sartorious C, Bartlett M (1990) Toxoplasmosis of the conus medullaris in a patient with hemophilia A-associated AIDS. J Neurosurg 73:951–953
Kleinschmidt-DeMasters BK (2002) Central nervous system aspergillosis: a 20-year retrospective study. Hum Pathol 33:116–124
Kumar K (1985) A clinical study and classification of posterior spinal tuberculosis. Int Orthop 9:147–152
Leite CC, Jinkins JR, Escobar BE et al. (1997) MR imaging of intramedullary and intradural-extramedullary spinal cysticercosis. Am J Radiol 169:1713–1717
Lindahl S, Nyman RS, Brismar J et al. (1996) Imaging of tuberculosis: spinal manifestations in 63 patients. Acta Radiol 37:506–511
Lindner A, Becker G, Warmuth-Metz M et al. (1995) Magentic resonance imaging findings of spinal intramedullary abscess caused by Candida albicans: case report. Neurosurgery 36:411–412
Liu GC, Chou MS, Tsai TC et al. (1993) MR evaluation of tuberculosis spondylitis. Acta Radiol 34:554–558
Loke TK, Ma HT, Chan CS (1997) MRI of tuberculous spinal infection. Australas Radiol 41:7–12
Longo M, Granata F, Ricciardi GK, Gatea M, Blandino A (2003) Contrast-enhanced MR imaging with fat suppression in adult-onset septic spondylodiscitis. Eur Radiol 13:626–637
Maiuri F, Iaconetta G, Gallicchio B, Manto A, Briganti F (1997) Spondylodiscitis: clinical and magnetic resonance diagnosis. Spine 22:1741–1746
Mahieux F, Gray F, Fenelon G et al. (1989) Acute myeloradiculitis due to cytomegalovirus as the initial manifestation of AIDS. J Neurol Neurosurg Psychiatry 52:270–274
Mehren M, Burns PJ, Mamani F, Levy CS, Laureno R (1988) Toxoplasmic myelitis mimicking intramedullary spinal cord tumor. Neurology 38:1648–1650
Melhem ER, Wang H (1992) Intramedullary spinal cord tuberculoma in a patient with AIDS. Am J Neuroradiol 13:986–988
Morgello S, Cho ES, Nielsen S et al. (1987) Cytomegalovirus encephalitis in patients with acquired immunodeficiency syndrome: an autopsy study of 30 cases and a review of the literature. Hum Pathol 18:289–297
Murphy KJ, Brunberg JA, Quint DJ, Kazanjian PH (1988) Spinal cord infection: myelitis and abscess formation. Am J Neuroradiol 19:341–348
Narlawar RS, Shah JH, Pimple MK et al. (2002) Isolated tuberculosis of posterior elements of spine. Spine 27:275–281
Numaguchi Y, Rigamonti D, Rothman MI et al. (1993) Spinal epidural abscess: evaluation with gadolinium-enhanced MR imaging. RadioGraphics 13:545–559
Palella FJ Jr, Delaney KM, Moorman AC et al. (1998) Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatients Study Investigators. N Engl J Med 338:853–860
Panagiotopoulos V, Konstantinou D, Solomou E et al. (2004) Extended cervicolumbar spinal epidural abscess associated with paraparesis successfully decompressed using a minimally invasive technique. Spine 29:300–303
Park KU, Lee HS, Kim CJ, Kim EC (2000) Fungal discitis due to Aspergillus terreus in a patient with acute lymphoblastic leukemia. J Korean Med Sci 15:704–707
Parmar H, Shah J, Patkar D, Varma R (2000) Intramedullary tuberculomas. MR findings in seven patients. Acta Radiol 41:572–577
Parmar H, Shah, Pathwardhan V et al. (2001) MR imaging in intramedullary cysticercosis. Neuroradiology 43:961–967
Petito CK, Navia BA, Cho ES et al. (1985) Vacuolar myelopathy pathologically resembling combined degeneration in patients with the acquired immunodeficiency syndrome. N Engl J Med 312:874–879
Poon TP, Tchertkoff V, Pares F et al. (1992) Spinal cord toxoplasma lesion in AIDS: MR findings. J Comput Assist Tomogr 16:817–819
Post MJD, Sze G, Quencer RM et al. (1990) Gadolinium-enhanced MR in spinal infection. J Comput Assist Tomogr 14:721–729
Pott P (1997) Remarks of that kind of palsy of the lower limbs which is frequently found to accompany a curvature of the spine. J. Johnson, London
Resnick DK, Comey CH, Welch WC et al. (1995) Isolated toxoplasmosis of the thoracic spinal cord in a patient with acquired immunodeficiency syndrome. J Neurosurg 82:493–496
Rocco A di, Werner P, Bottiglieri T et al. (2004) Treatment of AIDS-associated myelopathy with L-methionine: a placebo-controlled study. Neurology 63:1270–1275
Said G, Lacroix C, Chemouilli P et al. (1991) Cytomegalovirus neuropathy in acquired immunodeficiency syndrome: a clinical and pathological study. Ann Neurol 29:139–146
Saigal G, Post MJD, Kozic D (2004) Thoracic intradural aspergillus abscess formation following epidural steroid injection. Am J Neuroradiol 25:642–644
Sandhu FS, Dillon WP (1991) Spinal epidural abscess: evaluation with contrast-enhanced MR imaging. Am J Neuroradiol 12:1087–1093
Sartoretti-Schefer S, Blättler T, Wichmann W (1997) Spinal MRI in vacuolar myelopathy, and correlation with histopathological findings. Neuroradiology 39:865–869
Sharif HS, Morgan JL, Al Shahed MS, Al Thagafi MYA (1995) Role of CT and MRI in the management of tuberculous spondylitis. Radiol Clin N Am 33:787–804
Skendros P, Kamaria F, Knotopoulos V, Tsitouridis I, Sidiropoulos L (2003) Intradural, extramedullary tuberculoma of the spinal cord as a complication of tuberculous meningitis. Infection 31:115–117
Sklar EM, Post MJD, Lebwohl NH (1993) Imaging of infection of the lumbosacral spine. Neuroimaging Clin North Am 3:577–590
Smith AS, Blaser SI (1991) Infectious and inflammatory processes of the spine. Radiol Clin N Am 29:809–827
Stäbler A, Doma AB, Baur A, Krüger A, Reiser MF (2000) Reactive bone marrow changes in infectious spondylitis: quantitative assessment with MR imaging. Radiology 217:863–868
Sundaram M, Seelig R, Pohl D (1987) Vertebral erosions in patients undergoing maintenance hemodyalisis for chronic renal failure. Am J Roentgenol 149:323–327
Talpos D, Tien RD, Hesselink JR (1991) Magnetic resonance imaging of AIDS-related polyradiculopathy. Neurology 41:1996–1997
Tan SV, Guiloff RJ (1998) Hypothesis on the pathogenesis of vacuolar myelopathy, dementia, and peripheral neuropathy in AIDS. J Neurol Neurosurg Psychiatry 65:23–28
Tins BJ, Cassar-Pullicino VN (2004) MR imaging in spinal infection. Semin Musculoskelet Radiol 3:215–229
Thurnher MM, Jinkins RJ, Post MJD (1997) Diagnostic imaging of infections and neoplasms affecting the spine in patients with AIDS. Neuroimaging Clin North Am 7:341–357
Thurnher MM, Post MJD, Jinkins JR (2000) MRI of infections and neoplasms of the spine and spinal cord in 55 patients with AIDS. Neuroradiology 42:551–563
Tins BJ, Cassar-Pullicino VN (2004) MR imaging in spinal infection. Semin Musculoskelet Radiol 8:215–229
Torri H, Takahashi T, Shimizu H, Watanabe M, Tominaga T (2004) Intramedullary spinal tuberculoma: case report. Neurol Med Chir 44:266–268
Tsui EYK, Ng SH, Chow L et al. (2002) Syphilitic myelitis with diffuse spinal cord abnormality on MR imaging. Eur Radiol 12:2973–2976
Vaishya S, Sharma MS (2004) Spinal Aspergillus vertebral osteomyelitis with extradural abscess: case report and review of literature. Surg Neurol 61:551–555
Van Tassel P (1994) Magnetic resonance imaging in spinal infections. Top Magn Reson Imaging 6:69–81
Villoria MF, Fortea F, Moreno S, Munoz L, Manero M, Benito C (1995) MRI and CT of CNS tuberculosis in the patients with AIDS. Radiol Clin N Am 33:805–819
Whiteman ML, Dandapari BK, Shebert RT, Post MJD (1994) MRI of AIDS-related polyradiculomyelitis. J Comput Assist Tomogr 18:7–11
Whiteman M, Espinoza L, Post MJ et al. (1995) Central nervous system tuberculosis in HIV-infected patients: clinical and radiographic findings. Am J Neuroradiol 16:1319–1327
Williams RL, Fukui MB, Meltzer CC et al. (1999) Fungal spinal osteomyelitis in the immunocompromised patient: MR findings in three cases. Am J Neuroradiol 20:381–385
Woods GL, Goldsmith JC (1990) Aspergillus infection of the central nervous system in patients with acquired immunodeficiency syndrome. Arch Neurol 47:181–184
Yu AW, Chen WJ, Lin WC et al. (2004) Serious pyogenic spondylitis following vertebroplasty: a case report. Spine 10:209–211
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Thurnher, M.M. (2007). Spinal Infections. In: Van Goethem, J.W.M., van den Hauwe, L., Parizel, P.M. (eds) Spinal Imaging. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-68483-1_22
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DOI: https://doi.org/10.1007/978-3-540-68483-1_22
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