A Pyogenic Discitis at C3–C4 With Associated Ventral Epidural Abscess Involving C1–C4 After Intradiscal Oxygen-Ozone Chemonucleolysis
Bibliographic record
Abstract
STUDY DESIGN: A case report and clinical discussion. OBJECTIVE: To describe an unique case of purulent discitis at C3-C4 and an anterior C1-C4 epidural abscess secondary to oxygen-ozone therapy for the herniated cervical discs. SUMMARY OF BACKGROUND DATA: Previously reported complications secondary to ozone therapy are rarely documented. No cases of pyogenic discitis with associated epidural abscess after oxygen-ozone therapy have been reported to date. To our knowledge, this is the first such case reported in literature. METHODS: A 57-year-old female patient with nuchal stiffness was previously treated with ozone therapy at the discs of C3-C4, C4-C5, and C6-C7. Five days later, she presented with an attack of neck pain and fever followed by progressive quadriplegia with sudden onset of dyspnea and was referred to our hospital. On admission, physical examination revealed a temperature of 38.8 degrees C, evident neck tenderness, marked global weakness (grade 1-2/5 MRC) in bilateral upper-limb, and a modest global weakness in bilateral lower-limb (grade 4/5 MRC). Laboratory findings showed a significantly elevated WCC, ESR, and CRP. Blood culture was negative. Enhanced-MR imaging demonstrated a purulent discitis at C3-C4 and a ventral C1-C4 epidural abscess with homogenous enhancement indicative of a solid phlegmonous granulation tissue. RESULTS: We formulated a 3-stage treatment involving C1-C4 multilevel decompressive laminectomies, subtotal unilateral C3-C4 facetectomies, and tissue sampling for culture with application of a corset after surgery, followed by a delayed secondary posterior thorough drainage of epidural liquid pus using a suction-irrigation drainage, after the abscess had turned to a necrotic liquid abscess, on the basis of findings of enhanced-MR imaging, by 10-day duration of intravenously antibiotic therapy tailored to Streptococcus bovis isolated from infected tissue. Over the next few weeks, the patient made an excellent neurologic recovery. However, she did not consent to undergo further occipitocervical fusion until the follow-up MR imaging at 8 months demonstrated postlaminectomy kyphosis. After surgery, the patient remained clinically satisfactory in neurology without evidence of a recurrence of spinal infection. A slight improvement in the cervical spine curve was demonstrated in the follow-up radiograph at nearly 4-month postoccipitocervical fusion. CONCLUSION: This case report illustrates a rare but life-threatening complication of oxygen-ozone therapy for the cervical disc herniation. Infection is a common risk for any invasive spinal techniques involving puncture, so attention should be paid to the sterility during the procedures. A high index of suspicion along with reliance on enhanced-MRI is essential to diagnose the condition and institute appropriate treatment on an individual basis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".