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Title: Re: Ivo R, Sobottke R, Seifert H,et al. Tuberculous spondylitis and paravertebral abscess
formation after kyphoplasty: a case report. Spine 2010;35:E559-63.
Article Type: Letter to the Editor
Corresponding Author: Dr. Yen-Jen Chen, MD
Corresponding Author's Institution: China Medical University Hospital, Taiwan
First Author: Yen-Jen Chen, MD
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To the Editor:
Re: Ivo R, Sobottke R, Seifert H,et al. Tuberculous spondylitis and paravertebral
abscess formation after kyphoplasty: a case report. Spine 2010;35:E559-63.
Dr. Ivo et al
1reported a patient with spinal tuberculosis (TB) and paravertebral
abscess formation after kyphoplasty. The authors mentioned that magnetic resonance
imaging (MRI) scan revealed a subacute compression fracture of L1 without any
radiologic sign of infection. However, after reviewing with our radiologist, some
clues of infection were found.
Ivo et al mentioned that according to rapid worsening of infection after kyphoplasty,
it may be postulated that kyphoplasty acted as a trigger of spinal tuberculosis
infection. According to the diagnostic criteria of Vaccaro et al,
2tuberculous infections
often show soft-tissue masses dissecting beneath the anterior longitudinal ligament. In
figure 2, blurring and disruption of anterior cortical line with hyper-intensity soft
tissue mass is noted at the pre-vertebral area of L1 and extended to T12. In addition,
loss of intra-nuclear cleft and increased signal intensity within the disc of T12-L1
suggests a pathological process, such as inflammation or infection. From above
findings, infection should be highly suspected. So this case should be a pre-existed
TB spondylitis exacerbated by kyphoplasty.
Manuscript Text (must include page numbers)
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Actually, two important things should be learned from this case. First, it is
important to rule out the presence of vertebral osteomyelitis before proceeding with
any cement injection procedure; and pre-procedure MRI with contrast should be
performed when infection is suspected. Second, if infection can’t be completely ruled
out, cement-injection procedure should not be performed.
Yen-Jen Chen, MD
1,3Hui-Yi Chen, MD
2Horng-Chaung Hsu, MD
1,3 1Orthopedic Department
2Radiologic Department
China Medical University Hospital
3
School of Medicine
China Medical University
Taichung, Taiwan
References:
1.
Ivo R, Sobottke R, Seifert H, et al. Tuberculous spondylitis and paravertebral
abscess formation after kyphoplasty: a case report. Spine 2010;35:E559-63.
2.
Vaccaro AR, Shah SH, Schweitzer ME, et al. MRI description of vertebral
osteomyelitis, neoplasm, and compression fracture. Orthopedics
1999;22:67-73.
References (cited in order of appearance)
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