Takahiro Furukawa1, Keisuke Masuda2, Hideki Shigematsu1, Masato Tanaka1, Akinori Okuda3, Sachiko Kawasaki1, Yuma Suga1, Yusuke Yamamoto1, Yasuhito Tanaka1. 1. Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, 6348522, Nara, Japan. 2. Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, 6348522, Nara, Japan. masudash@gmail.com. 3. Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-cho, Kashihara City, 6348522, Nara, Japan.
Abstract
BACKGROUND: An important complication of pyogenic spondylitis is aneurysms in the adjacent arteries. There are reports of abdominal aortic or iliac aneurysms, but there are few reports describing infected aneurysms of the vertebral artery. Furthermore, there are no reports describing infected aneurysms of the vertebral arteries following cervical pyogenic spondylitis. We report a rare case of an infected aneurysm of the vertebral artery as a complication of cervical pyogenic spondylitis, which was successfully treated by endovascular treatment. CASE PRESENTATION: Cervical magnetic resonance imaging (MRI) of a 59-year-old man who complained of severe neck pain showed pyogenic spondylitis. Although he was treated extensively by antibiotic therapy, his neck pain did not improve. Follow-up MRI showed the presence of a cyst, which was initially considered an abscess, and therefore, treatment initially included guided tapping and suction under ultrasonography. However, under ultrasonographic examination an aneurysm was detected. The contrast-enhanced computed tomography (CT) scan showed an aneurysm of the vertebral artery. Following endovascular treatment (parent artery occlusion: PAO), the patient's neck pain disappeared completely. CONCLUSION: Although there are several reports of infected aneurysms of the vertebral arteries, this is the first report describing an infected aneurysm of the vertebral artery as a result of cervical pyogenic spondylitis. Whenever a paraspinal cyst exist at the site of infection, we recommend that clinicians use not only X-ray, conventional CT, and MRI to examine the cyst, but ultrasonography and contrast-enhanced CT as well because of the possibility of an aneurysms in neighboring blood vessels. It is necessary to evaluate the morphology of the aneurysm to determine the treatment required.
BACKGROUND: An important complication of pyogenic spondylitis is aneurysms in the adjacent arteries. There are reports of abdominal aortic or iliac aneurysms, but there are few reports describing infected aneurysms of the vertebral artery. Furthermore, there are no reports describing infected aneurysms of the vertebral arteries following cervical pyogenic spondylitis. We report a rare case of an infected aneurysm of the vertebral artery as a complication of cervical pyogenic spondylitis, which was successfully treated by endovascular treatment. CASE PRESENTATION: Cervical magnetic resonance imaging (MRI) of a 59-year-old man who complained of severe neck pain showed pyogenic spondylitis. Although he was treated extensively by antibiotic therapy, his neck pain did not improve. Follow-up MRI showed the presence of a cyst, which was initially considered an abscess, and therefore, treatment initially included guided tapping and suction under ultrasonography. However, under ultrasonographic examination an aneurysm was detected. The contrast-enhanced computed tomography (CT) scan showed an aneurysm of the vertebral artery. Following endovascular treatment (parent artery occlusion: PAO), the patient's neck pain disappeared completely. CONCLUSION: Although there are several reports of infected aneurysms of the vertebral arteries, this is the first report describing an infected aneurysm of the vertebral artery as a result of cervical pyogenic spondylitis. Whenever a paraspinal cyst exist at the site of infection, we recommend that clinicians use not only X-ray, conventional CT, and MRI to examine the cyst, but ultrasonography and contrast-enhanced CT as well because of the possibility of an aneurysms in neighboring blood vessels. It is necessary to evaluate the morphology of the aneurysm to determine the treatment required.
Authors: David O Wiebers; J P Whisnant; J Huston; I Meissner; R D Brown; D G Piepgras; G S Forbes; K Thielen; D Nichols; W M O'Fallon; J Peacock; L Jaeger; N F Kassell; G L Kongable-Beckman; J C Torner Journal: Lancet Date: 2003-07-12 Impact factor: 79.321