title: Pyogenic cervical spondylitis with quadriplegia as a complication of severe burns: Report of a case.
abstract: We report a case of cervical pyogenic spondylitis complicated by epidural abscess with quadriplegia during treatment of severe burns. The patient was a 49-year-old man with 3rd-degree burns to 20% of his body, involving the lower extremities. We performed escharectomy of the 3rd-degree necrosis on days 7 and 16, followed by the first skin graft on day 23. Pseudomonas aeruginosa was detected in the postoperative graft wound culture. On day 23 after the skin graft, he became febrile and began to experience cervical pain and muscle weakness of the extremities. By day 24, quadriplegia had developed. A cervical vertebral magnetic resonance imaging (MRI) scan showed pyogenic spondylitis with an epidural abscess, which was causing the quadriplegia. We treated the patient by performing curettage of the pyogenic lesion and anterior fixation of the cervical vertebral bodies. The fact that P. aeruginosa was detected in the pyogenic focus culture indicated that burn wound sepsis was responsible for the infection. This case reinforces that acting on a strong suspicion helps to establish a diagnosis and initiate appropriate treatment early.
authors.affiliation: Surgical Department, Urayasu City Hospital, 3-4-23 Toudaijima, Urayasu, Chiba, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Asakage
authors.forename: Atsuo
authors.initials: A
authors.lastname: Katami
authors.forename: Satoru
authors.initials: S
authors.lastname: Takekawa
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Suzuki
authors.forename: Michitoshi
authors.initials: M
authors.lastname: Goto
authors.forename: Ryuta
authors.initials: R
authors.lastname: Fukai
mesh_terms: D002056:Burns / Q000150:complications* / Q000175:diagnosis; D002574:Cervical Vertebrae; D003937:Diagnosis, Differential; D004322:Drainage; D020802:Epidural Abscess / Q000150:complications*; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D011782:Quadriplegia / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods; D013166:Spondylitis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D015599:Trauma Severity Indices