Introduction: This study aimed to investigate the clinical features of spondylodiscitis by affected sites.

Methods: Fifty-eight patients (24 females and 34 males) with spondylodiscitis who were treated at our hospital between January 2018 and June 2023 were retrospectively reviewed. The mean age of patients was 71 years. The most common site for spondylodiscitis was the lumbar spine, followed by the cervical spine and thoracic spine. The ratio of epidural abscess, neurological disorders, and emergency operation by affected sites was examined.

Results: Among the 58 patients, 51 patients were cured, one patient remained unchanged, and six patients died at discharge. Methicillin-susceptible Staphylococcus aureus was the most common causative microorganism identified. Epidural abscesses occurred in 21 patients, with a higher rate in the cervical spine. An emergency operation was performed in seven patients, with a lower rate in the lumbar spine. Among 21 patients with epidural abscesses, neurological disorder was less common in the lumbar spine, and emergency operation was performed more frequently in the thoracic spine. Among 13 patients with neurological disorders, almost all patients had epidural abscesses, and emergency operation was performed in all thoracic spine cases.

Conclusion: Epidural abscesses in the cervical or thoracic spine were associated with a higher risk of neurological disorders.

Objective: This study aimed to retrospectively evaluate the treatment and outcomes of patients with acute spinal epidural abscess.

Subjects: Twelve patients with acute cervical and thoracic spinal epidural abscesses who presented with neurological symptoms and were treated at our institution between January 2018 and March 2023 were included. The average age of patients was 62 years (range: 39-85 years). The affected levels included the cervical spine in six cases and the thoracic spine in six cases. The treatment methods and outcomes were retrospectively analyzed.

Results: Neurological symptoms were observed in all six cervical spine cases (100%), including one case of complete motor paralysis, one case of severe to incomplete paralysis, three cases of upper limb motor dysfunction, and one case of upper limb numbness. Among the six thoracic spine cases, neurological symptoms were observed in four patients (77%), including two cases of complete paralysis and two cases of severe incomplete paralysis. Two patients with cervical lesions and five patients with thoracic lesions were unable to walk independently. Emergency surgery was performed in seven patients (three cervical and four thoracic cases). Anterior fixation surgery was performed in one cervical case, whereas posterior decompression was performed in the remaining six cases. Moreover, all three thoracic cases underwent subsequent posterior fixation surgery. At the final follow-up, among the seven patients who were unable to walk independently at admission, two patients with cervical spine involvement regained their ability to walk independently, whereas all five patients with thoracic spine involvement remained unable to walk independently.

Conclusion: Early surgical intervention should be considered in cases of severe neurological impairment. In the present study, although early surgical intervention resulted in relatively favorable neurological outcomes for cervical spine involvement, the prognosis for thoracic spine involvement remained poor.

A woman in her 70s was transported for the traffic accident. The patient had multiple traumatic injuries including fractures of the pelvis. All fractures were treated conservatively.

Transcatheter arterial embolization (TAE) was performed for active hemorrhage in peri-fracture soft tissue and subcutaneous tissue, but TAE was re-performed the next day due to rapid increase in hematoma and progression of anemia. Five days after injury, the patient complained of muscle weakness in both legs. Paraparesis in both legs of L1 level and below was observed. Based on various test and data, we diagnosed her subacute spinal cord infarction. The patient had been rehabilitated with a lower limb orthosis, her lower limb paraparesis gradually improved, and she was discharged home 4 months later.

Introduction: Osteoporotic vertebral fractures of the mid-to-lower lumbar spine can present with neurological symptoms in the legs and may be challenging to treat. In this case report, PLIF using the modified CBT method following BKP resulted in a favorable outcome.

Case report: An 86-year-old male developed lower back pain and right lower limb pain after undergoing manual massage therapy. At another hospital, he was diagnosed with an L4 vertebral fracture and L4/5 lateral recess stenosis, for which BKP for L4 and L4/5 laminectomy were performed. While the leg symptoms initially improved postoperatively, right leg pain recurred on postoperative day 4. Since his symptoms did not improve, he was referred to our department two months after surgery. Exacerbation of right L4 foraminal stenosis due to the caudal endplate of L4 was observed. A right L4 nerve block was performed, leading to the disappearance of leg pain. L4/5 PLIF and bone fragment removal using the modified CBT method were performed and the leg pain disappeared.

Conclusion: In osteoporotic vertebral fractures of the middle and lower lumbar spine with neurologic symptoms in the legs, the lumbar intervertebral foramen containing the fracture fragments near the caudal endplate of the vertebral body should be evaluated to determine the treatment strategy.

If PLIF is selected to widen the intervertebral foramen following revision surgery after BKP, the modified CBT method is a useful technique that allows for firm fixation without interference between the screw trajectory and the cement.

A false localizing sign refers to a situation where the lesion location inferred from neurological signs does not match that found on imaging. Foot drop occurs because of weakness of the tibialis anterior muscle (TA), which is innervated by the L4 or L5 nerves. To date, few studies have reported cases of foot drop caused by upper lumbar spine lesions as a false localizing sign. Herein, we report a case of acute foot drop caused by upper lumbar disk herniation, which was surgically treated. A 51-year-old man complained of left lower limb pain and left foot drop. He visited our emergency department because of pain in his left lower limb, which had started three days earlier, and left foot drop, which had started that morning. Pain and numbness were observed in the left L5 region. The result of manual muscle testing was grade 0 for the left TA and extensor hallucis longus. Magnetic resonance imaging revealed spinal canal compression because of a herniated disk at L1/2. This area was determined to be the responsible lesion. On the same day, emergency surgery was performed to remove the L1/2 hernia. On the day after surgery, the patient started getting out of bed, and his lower limb pain improved, with gradual improvement in foot drop. Six months after surgery, his muscle strength had completely recovered, and no pain was observed in the lower limbs. We experienced a case of upper lumbar disk herniation presenting with foot drop as a false localizing sign. Early surgical intervention yielded favorable results.