J Korean Neurosurg Soc.  2012 Jun;51(6):383-387. 10.3340/jkns.2012.51.6.383.

Surgical Management of Cervical Spinal Epidural Abscess Caused by Brucella Melitensis : Report of Two Cases and Review of the Literature

• Ekici MA
• Ozbek Z
• Gokoglu A
• Menku A

• KMID: 2190497
• DOI: http://doi.org/10.3340/jkns.2012.51.6.383

Abstract

Spinal epidural abscess, if especially caused by Brucellosis is a very rare disease which is usually a consequence of spondylodiscitis. The spinal column can be affected at any joint; however, the lumbar spine is the most common region, especially at the level of the L4-5 and L5-S1. The frequency of spinal involvement usually seen at the lumbar, thoracic and cervical spine respectively. As an occupational disease in farmers, veterinaries, butchers, laboratory staff and shepherds, brucellosis can also occur by direct contact to animals and infected materials or ingestion of raw cheese, milk or unpasteurized milk products. In this study, we presented two cases with cervical spinal epidural abscess caused by brucella melitensis, which was successfully treated by surgical approach. Initial treatment was combined with antibiotic therapy after the surgery for 3 months.

Keyword

Cervical epidural abscess; Brucella melitensis; Spondylodiscitis; Spinal cord compression; Surgical treatment

MeSH Terms

Animals
Brucella
Brucella melitensis
Brucellosis
Cheese
Discitis
Eating
Epidural Abscess
Milk
Occupational Diseases
Rare Diseases
Spinal Cord Compression
Spine

Figure

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  Fig. 1 A : Sagittal T1 weighted magnetic resonance imging (MRI) of Case1 revealing spinal cord compression at the C4-5 disc level (arrow). B : Sagittal T2 weighted MRI of Case 1 revealing hyperintense epidural lesion and spinal cord compression at C4-5 disc level (arrow). C : The abscess is seen intraoperatively after insertion of needle into C4-5 disc space.

• 

  Fig. 2 A :Brucella melitensis' colony appearance is also seen with the eosin methylene blue agar. B : Gram negative cocobacillus is being seen at the photomicroscope (H.E×100).

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  Fig. 3 A : Sagittal T1 weighted magnetic resonance imging (MRI) of Case 1 demonstrates complete disappearance of epidural abscess at the end of postoperative third month (arrow). B : Sagittal T2 weighted MRI of Case 1 revealing complete recovery at the end of postoperative 3rd month (arrow).

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  Fig. 4 A : Sagittal T2 weighted magnetic resonance imging (MRI) of Case 2 revealing hyperintense lesion and spinal cord compression due to epidural abscess at C3-4 level (arrow). B : Axial T2 weighted MRI of Case 2 reveals hyperintense lesion and spinal cord compression due to epidural abscess (arrow).

• 

  Fig. 5 Sagittal T2 weighted magnetic resonance imging of Case 2 demonstrating complete disappearance of epidural abscess at the end of postoperative 3rd month (arrow).

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