Antibiotic-Resistant Spondylodiscitis With Canal Invasion and Aggressive Evolution to Epidural Abscess: A Case Series of Spontaneous Occurrence in 16 Patients

Bilateral psoas abscesses. This patient initially presented with fever and back pain with discitis on computed tomography scan. Culture-specific intravenous antibiotics were initiated, with an initial improvement of systemic signs, only to be followed by sudden appearance of paraparesis and bladder incontinence. Magnetic resonance imaging at this stage revealed extensive vertebral osteomyelitis and discitis (black dashed arrow) with posterior extension of the infection through the posterior annulus into the epidural space (white dashed arrow). Note also the multiple bilateral psoas abscesses (black arrows).

Kyphotic deformity. A 78-year-old healthy woman with 2 weeks of lower back pain. Her computed tomography revealed destruction of the T11 to T12 disc space and adjacent endplates (a) and, upon standing lateral radiograph, a kyphotic deformity of 75° (b) accompanied by bilateral lower extremity weakness.

Fulminant spondylodiscitis. A healthy 55-year-old man with spondylodiscitis of L1 to L2 (black dashed arrow in a and b) that was cultured via computed tomography–guided biopsy. Note the inferior vena cava septic thrombi (white arrows in a). While under culture-specific IV antibiotic treatment, an extension through the posterior annulus and posterior longitudinal ligament to the epidural space occurred, essentially evolving into an unusual type of spinal epidural abscess, which is anterior to the dura, as shown on magnetic resonance imaging (white dashed arrows in b).

Bacteria distribution. When considering only positive cultures, Staphylococcus aureus represents approximately 60% of cases, which is comparable to previous reports in large series.