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What are the main claims of the paper and how important are they?
The authors describe two patients with bi-level vertebral osteomyelitis without concominant epidural abscess secondary to spinal and epidural anesthesia.
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Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.
NA
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Are the claims properly placed in the context of the previous literature?
Yes
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Do the results support the claims? If not, what other evidence is required?
Yes
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If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?
This is a two case report study.
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Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?
This is a two case report study.
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Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?
NA.
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Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?
It's an interesting paper and I would present it at my institution.
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Other Comments:
The authors describe two patients with bi-level (two-level) vertebral osteomyelitis without concomitant epidural abscess secondary to spinal and epidural anesthesia. Epidural-spinal analgesia and anesthesia techniques are quite frequent and seem to be used with more and more popularity. Fortunately, infectious complications are rare (although most of us are quite aware of the recent fungal meningitis outbreak in the USA following contaminated medication used for epidural injections: Fungal infections associated with contaminated methylprednisolone in Tennessee. N Engl J Med. 2012 Dec 6;367(23):2194-203.) Although spinal epidural abscess has been reported following these percutaneous interventional procedures, vertebral osteomyelitis is much less frequent. This in an interesting case report on two patients with nice imaging. The authors state: “Previously reported vertebral osteomyelitis cases had occurred after the epidural anesthesia with catheter use or epidural injection. This is the first case of vertebral osteomyelitis after spinal anesthesia without catheter use.” While this may be true for case 1, please note that in case 2 the epidural catheter was left postoperatively two days for pain control. Even without the catheter, there is some literature demonstrating this rare complication (as the authors correctly reference): Distant skip level discitis and vertebral osteomyelitis after caudal epidural injection: a case report of a rare complication of epidural injections. Spine (Phila Pa 1976). 2003 Jun 1;28(11):E209-11. There are a few grammatical errors. Otherwise a fine article.
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Competing interests:
No
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Invited by the author to review this article? :
No -
Have you previously published on this or a similar topic?:
No
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References:
None -
Experience and credentials in the specific area of science:
General Neurology
- How to cite: Rison R A.Vertebral Osteomyelitis[Review of the article 'Two Level Vertebral Osteomyelitis Without Spinal Epidural Abscess Secondary to Spinal and Epidural Anesthesia: Two Case ' by Eser O].WebmedCentral 2013;4(1):WMCRW002440
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The authors describe an interesting case of vertebral osteomyelitis and spinal
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Yes
Yes
This study is a case report
This study is a case report
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Yes, Is a very interesting case.
The infectious complications in spinal anesthesia are rare but with serious consequences. Among the complications are epidural abscess and meningitis. Furthermore regional anesthesia has been described at times as a cause of vertebral osteomyelitis. The authors describe an interesting case of vertebral osteomyelitis and spinal anesthesia. In the context of a patient with fever, back pain and a history of spinal anesthesia, we always exclude an infectious disease. Vertebral osteomyelitis may be associated with epidural abscess but not always and can have a picture very similar to epidural abscess and regional anesthesia.
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Neurosurgery, Spine Surgery