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Re: Ivo R, Sobottke R, Seifert H, et al. Tuberculous spondylitis

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Editorial Manager(tm) for Spine Journal

Manuscript Draft

Manuscript Number:

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

1

reported 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,

2

tuberculous 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

1,3

Hui-Yi Chen, MD

2

Horng-Chaung Hsu, MD

1,3 1

Orthopedic Department

2

Radiologic Department

China Medical University Hospital

3

School of Medicine

China Medical University

Taichung, Taiwan

(4)

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)

(5)

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