General Spine

Jagan, D, Gupta, MD
Neel, D, Gupta, MD, Non ASSR Member
Enrique, Palacios, MD, Non ASSR Member
Paul, Friedlander, MD, Non ASSR Member
Jorge, Alvernia, MD, Non ASSR Member

Poster

Purpose

The purpose of the study is to present 6 cases of nontraumatic retropharyngeal abscesses complicated with cervical discitis, osteomyelitis, and epidural abscess in post-Katrina New Orleans which struck the U.S. Gulf Coast in August 2005. All cases were directly related to the adverse sanitary and health conditions that existed in the hurricane’s aftermath. We hope to capture the presenting symptoms, imaging findings, and detail the management options and outcomes of our patients. In addition we hope to provide an educational overview of retropharyngeal abscesses, cervical discitis, cervical osteomyelitis, and epidural abscesses focusing on exquisiite anatomy, imaging characteristics, and treatment options (medical and surgical) with close collaboration of results and input from our Otolaryngology colleagues.

Methods & Materials

Our study includes 6 patients who presented to Tulane University Health Sciences Center ER post Hurricane Katrina (August 2005) with a combination of the following symptoms: neck pain and stiffness, new onset weakness, headaches, SOB, dysphagia, and odynophagia . Our patients were between 35 and 60 year old, a mixture of male and female patients, from low socioeconomic background, engaged in alcohol and IV drug abuse, were homeless, and many patients lived in FEMA trailers. Our patients experienced some of the following comorbidities:diabetes, immunocompromised, HIV, Hepatitis C, MRSA abscesses, recent surgery.

Results

Patients presented with retropharyngeal abscesses with complicated discitis, osteomyelitis, and epidural abscesses due to MSSA or MRSA infections and superinfections. Marked skeletal deformity resulted from osseous and disc destruction and soft tissue inflammation. Bacteremia from distant sites of infection may lead to cervical osteomyelitis and associated complications. The incidence of epidural abscesses has increased over the past 20 years with risk factors including IV drug use, diabetes, recent spinal intervention or trauma, and the presence of a nidus of localized infection .

Conclusion

MSSA and MRSA infections may have been exacerbated by the poor sanitation and disrupted water and sewage systems experienced in the aftermath of Hurricane Katrina. In addition, poor personal hygeine and limited access to healthcare in post Katrina
New Orleans may have initiated and further complicated MSSA and MRSA infections. Crowded evacuation centers provided breeding grounds for infections and a large number of MRSA wound infections were noted by the CDC. Concomittant comorbidities and known demographics of our local population contributed to the development of such extensive soft tissue and osseous infections.

References/Financial Disclosures

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No Financial Disclosures