scholarly journals Just the Facts: Risk stratifying non-traumatic back pain for spinal epidural abscess in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 753-755
Author(s):  
Zoe Polsky ◽  
Shawn K. Dowling ◽  
W. Bradley Jacobs
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Thoracic Spinal ◽  
Life Threatening ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Whole Spine ◽  
Spinal Epidural

A 65-year-old male with a history of hypertension presents to the emergency department (ED) with new onset of non-traumatic back pain. The patient is investigated for life-threatening diagnoses and screened for “red flag symptoms,” including fever, neurologic abnormalities, bowel/bladder symptoms, and a history of injectiondrug use (IVDU). The patient is treated symptomatically and discharged home but represents to the ED three additional times, each time with new and progressive symptoms. At the time of admission, he is unable to ambulate, has perineal anesthesia, and 500 cc of urinary retention. Whole spine magnetic resonance imaging (MRI) confirms a thoracic spinal epidural abscess. This case, and many like it, prompts the questions: when should emergency physicians consider the diagnosis of a spinal epidural abscess, and what is the appropriate evaluation of these patients in the ED? (Figure 1).

scholarly journals Spinal Epidural Abcess

2018 ◽  
Vol 21 (1) ◽  
pp. 60-63
Author(s):  
Douglas Serra Vasconcelos ◽  
Lucas Crociati Meguins ◽  
Domingos Edno Castro Ribeiro ◽  
Giselle Da Silva Mello ◽  
Dicla Caroline Hartuique Rodrigues ◽  
...  
Keyword(s):  
Back Pain ◽  
Hospital Admissions ◽  
Epidural Abscess ◽  
Thoracolumbar Spine ◽  
Surgical Decompression ◽  
Spinal Epidural Abscess ◽  
Neurologic Deficits ◽  
Life Threatening ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Epidural

Spinal epidural abscess (SEA) is an extremely rare life-threatening infectious disorder. It accounts for 0.2-2.0/10,000 hospital admissions per year. We report on a young man with a recent history of furunculosis that evolved febrile back pain associated with triparesia with right upper extremity paresis and crural paraplegia. He referred also symptoms of urinary incontinency. Magnetic resonance imaging (MRI) of the thoracolumbar spine showed an epidural mass compressing two thoracic vertebras, from T4 to T5. The patient underwenturgent surgical decompression of the epidural abscess and culture of the purulent collection grew Methicillin-sensitive Staphylococcus aureus. Postoperative combined intravenous antibiotic treatment was instituted with metronidazole, oxacilin and gentamicin during 30 days. The patient had anuneventful recovery without any residual neurologic deficits. This report highlights the importance of an early suspicion of SEA in patients with febrile back pain and initial neurologic deficits with known risk factors for epidural abscess. Aggressive treatment with surgical decompression and systemicantibiotics seems to be an appropriate approach to prevent permanent neurologic deficits.

scholarly journals Spinal epidural abscess: a rare complication of olecranon bursitis

2009 ◽  
Vol 1 (1) ◽  
pp. 1 ◽  
Author(s):  
Rhys D.R. Evans ◽  
Moe Thaya ◽  
Ne Siang Chew ◽  
Charles E.R. Gibbons
Keyword(s):  
Back Pain ◽  
Epidural Abscess ◽  
Rare Complication ◽  
Complete Recovery ◽  
Acute Onset ◽  
Spinal Epidural Abscess ◽  
Good Resolution ◽  
Olecranon Bursitis ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Epidural

Spinal epidural abscess is a rare but potentially fatal condition if left untreated. We report the case of a 67-year old man who presented to the Accident and Emergency department complaining of acute onset of inter-scapular back pain, left leg weakness and loss of sensation in the left foot. On examination he was found to be pyrexial with long tract signs in the left lower leg. In addition he had a left sided olecranon bursitis of three weeks duration. Blood tests revealed raised inflammatory markers and a staphylococcal bacteremia. Magnetic resonance imaging (MRI) confirmed the diagnosis of spinal epidural abscess and he subsequently underwent a three level laminectomy with good resolution of his back pain and neurological symptoms. He has made a complete recovery with a prolonged course of intravenous antibiotics.

scholarly journals Rapidly Progressive Spontaneous Spinal Epidural Abscess

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Abdurrahman Aycan ◽  
Ozgür Yusuf Aktas ◽  
Feyza Karagoz Guzey ◽  
Azmi Tufan ◽  
Cihan Isler ◽  
...  
Keyword(s):  
Epidural Abscess ◽  
Delayed Diagnosis ◽  
Clinical Findings ◽  
Neurological Deficits ◽  
Spinal Epidural Abscess ◽  
Low Back ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Paraspinal Abscess ◽  
Spinal Epidural

Spinal epidural abscess (SEA) is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI) remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

scholarly journals Community-Acquired MRSA Pyomyositis: Case Report and Review of the Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Douglas P. Olson ◽  
Sarita Soares ◽  
Sandhya V. Kanade
Keyword(s):  
Epidural Abscess ◽  
Surgical Intervention ◽  
Cauda Equina ◽  
Spinal Epidural Abscess ◽  
Paraspinal Muscles ◽  
Sensory Deficits ◽  
Antibiotic Management ◽  
History Of ◽  
Spinal Epidural ◽  
Repeat Imaging

Community-acquired methicillin-resistantStaphylococcus aureus(CA-MRSA) is responsible for a broad range of infections. We report the case of a 46-year-old gentleman with a history of untreated, uncomplicated Hepatitis C who presented with a 2-month history of back pain and was found to have abscesses in his psoas and right paraspinal muscles with subsequent lumbar spine osteomyelitis. Despite drainage and appropriate antibiotic management the patient's clinical condition deteriorated and he developed new upper extremity weakness and sensory deficits on physical exam. Repeat imaging showed new, severe compression of the spinal cord and cauda equina from C1 to the sacrum by a spinal epidural abscess. After surgical intervention and continued medical therapy, the patient recovered completely. This case illustrates a case of CA-MRSA pyomyositis that progressed to lumbar osteomyelitis and a spinal epidural abscess extending the entire length of the spinal canal.

Brain Abscess and Spinal Epidural Abscess

2019 ◽  
pp. 642-648
Author(s):  
Selby G. Chen
Keyword(s):  
Magnetic Resonance Imaging ◽  
Brain Abscess ◽  
Hospital Admissions ◽  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Early Management ◽  
Brain Abscesses ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Epidural ◽  
The Brain

Two infections of the brain are relatively common. Patients with brain abscess are often critically ill and have a high mortality rate. The reported incidence of brain abscesses ranges from 0.4 to 0.9 per 100,000 people. In contrast, spinal epidural abscess (SEA), an infection of the epidural space, has increased in incidence from approximately 0.2 to 1.2 per 10,000 hospital admissions in the mid-1970s to a currently estimated 2.0 to 12.5 per 10,000 admissions. Both disorders are now more easily detected with magnetic resonance imaging (MRI), and this has improved early management, but clinical recognition is still a challenge for many physicians.

scholarly journals Recurrence of spinal epidural abscess after inadequate antibiotic dosage regimen

2019 ◽  
Vol 1 (1) ◽  
pp. 66-69
Author(s):  
Ram Krishna Dahal ◽  
Javad Ahmad Khan ◽  
Binod Bijukachhe
Keyword(s):  
Back Pain ◽  
Neurological Deficit ◽  
Epidural Abscess ◽  
Blood Parameters ◽  
Surgical Decompression ◽  
Clinical Suspicion ◽  
Spinal Epidural Abscess ◽  
Threatening Condition ◽  
Clinical Triad ◽  
Spinal Epidural

Introduction: Spinal epidural abscess (SEA) is a potentially life threatening condition which can present with a clinical triad of fever, back pain and neurological deficit. It is more common in elderly population with risk factors like immunocompromised status, diabetes mellitus and alcoholism. High index of clinical suspicion of SEA warrants prompt investigated and treatment. Immediate surgical decompression along with antibiotic is recommended for better outcome. Case Presentation : A 16 years old boy presented with complaints of fever, upper back pain which had developed gradually over a period of 10 days. He had history of furuncle in perineal region 3 weeks prior to his symptoms, which was drained. With high clinical suspicion of SEA, Contrast enhanced Magnetic Resonance Imaging (CEMRI) was done along with blood parameters and was diagnosed as SEA D3-D6 level. He underwent immediate surgical decompression and was given 3 weeks of antibiotics. Post-operative period was uneventful with clinical improvement of the symptoms. He again presented to us with relapse of the infection on 28th post-operative day with similar fever and back pain. He was reinvestigated with MRI and blood investigations which revealed relapse of the infection. He was then managed with intravenous (IV) Vancomycin for 2 weeks and oral Erythromycin for another 6 weeks. He did not require any surgical intervention in his later presentation. Conclusion: Spinal epidural abscess is a surgical emergency and prompt diagnosis with surgical drainage is recommended for better outcome even when there is no neurological deficit. Abscess drainage should be adjunct with longer duration of antibiotics for at least 6 weeks for optimum results.

scholarly journals Cervical, Thoracic, and Lumbar Spine Epidural Abscess: Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Bohdan Baralo ◽  
Mrunal Kulkarni ◽  
Rithikaa Ellangovan ◽  
Robert Selko ◽  
Ajinkya Kulkarni ◽  
...  
Keyword(s):  
Back Pain ◽  
Epidural Abscess ◽  
Significant Risk ◽  
Needle Aspiration ◽  
Outpatient Setting ◽  
Spinal Epidural Abscess ◽  
Lumbar Region ◽  
Ct Guided ◽  
Low Incidence ◽  
Spinal Epidural

We report a case of a spinal epidural abscess (SEA) in a patient without significant risk factors. The patient was treated in an outpatient setting for one week for worsening back pain and subsequently admitted to the hospital for the treatment of sepsis and suspected SEA. An MRI obtained on admission showed an epidural abscess extending from the lower cervical to the upper lumbar region and accompanying paraspinal cervical and psoas abscesses. The patient was successfully treated with antibiotics based on the sensitivity of the surgical cultures received from a needle aspiration of the abscess. SEA has a low incidence; however, the number of cases is consistently rising over the last two decades. The outcome of SEA treatment is related to the duration of the process prior to intuition of the treatment. Patients with no neurological symptoms, or with symptoms lasting less than 36 h, have the best recovery rate. As the typical symptoms of SEA are seen in only 13% of cases, physicians should have a low threshold to order MRI in patients with back pain that is new or changed from the baseline. With the help of CT-guided aspiration for culture analysis, patients can be successfully treated conservatively using antibiotics in cases where neurological signs are absent.

scholarly journals Spinal Epidural Abscess in a Child with Eczema: A Case Report and Literature Review

2012 ◽  
Vol 19 (6) ◽  
pp. 411-416 ◽  
Author(s):  
YP Tsang ◽  
MY Sy ◽  
TW Wong
Keyword(s):  
Computed Tomography ◽  
Epidural Abscess ◽  
Early Recognition ◽  
Emergency Operation ◽  
Neurological Complications ◽  
Uneventful Recovery ◽  
Spinal Epidural Abscess ◽  
History Of ◽  
Spinal Epidural ◽  
Chronic Eczema

Spinal epidural abscess is rare in children. Early recognition is important to prevent or minimise neurological complications. We report a case of paediatric spinal epidural abscess. An 8-year-old girl, with a history of poorly controlled atopic eczema over the back of neck, presented with back pain and subsequently fever and worsening backache. Diagnosis was made only after computed tomography. Emergency operation with drainage of the abscess was done and vancomycin was given for 5 weeks. The patient made an uneventful recovery with no neurological complications. Bacteraemia from skin excoriation due to chronic eczema was the presumed aetiology.

Tuberculous spinal epidural abscess (case report and literature review)

MedAlliance ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 57-63
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Thoracic Spinal ◽  
Treat Ment ◽  
Tuberculous Abscess ◽  
Progressive Neurological Deficit ◽  
Spinal Epidural

Tuberculous spinal epidural abscess (SEA) is an uncom-mon pathology, which presents is only 2% of all SEA ca-ses. We report a rare cases of cervical-lumbar and thoracic spinal epidural tuberculous abscess occupying the spinal canal from C2–L3 and Th8–Th9 vertebrae with progressive neurological deficit. Clinical features, diagnostic and treat-ment challenges and follow-up results were presented

Midline trough corpectomies for the evacuation of an extensive ventral cervical and upper thoracic spinal epidural abscess

2010 ◽  
Vol 13 (2) ◽  
pp. 229-233 ◽  
Author(s):  
Vinay R. Deshmukh
Keyword(s):  
High Speed ◽  
Epidural Abscess ◽  
Kyphotic Deformity ◽  
Spinal Epidural Abscess ◽  
Disc Space ◽  
Thoracic Epidural ◽  
Slow Development ◽  
Thoracic Spinal ◽  
Upper Thoracic ◽  
Spinal Epidural

The author reports on a 59-year-old woman with a history of a chronic, nonhealing skin ulcer who presented with sepsis, neck pain, and rapidly progressive quadriparesis. Precontrast and postcontrast MR imaging studies revealed a multifocal ventral cervical and upper thoracic spinal epidural abscess. Compression of the spinal cord from the abscess was greatest behind the disc space of C2–3 and C7–T1. Because of the patient's tenuous medical status, the author elected to apply a technique that would allow expeditious decompression without necessitating concomitant fusion and instrumentation. Multilevel, contiguous trough corpectomies were performed for evacuation of the compressive lesions. A high-speed matchstick bur was used to create a 5- to 7-mm midline trough in the vertebrae and intervening disc spaces from C-2 to T-3. Rapid and successful decompression of the entire ventral cervical and upper thoracic epidural space was achieved using this technique. Understanding that the surgical treatment of discitis or osteomyelitis can often result in a kyphotic deformity or frank instability, the patient was immobilized in a cervical collar following surgery and underwent vigilant monitoring with serial plain radiographs, CT scans, and MR images. These neuroimaging studies confirmed complete resolution of the abscess and the slow development of a mild, stable kyphotic deformity. At the 1-year follow-up, the patient was ambulating and had returned to work. A trough corpectomy is a viable surgical approach that allows for rapid decompression of ventral cervical and upper thoracic epidural abscesses while obviating the need for same-setting fusion and fixation.

Sign in / Sign up

Export Citation Format

Share Document