scholarly journals Spinal Epidural Abscess: A Review with Special Emphasis on Earlier Diagnosis

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Allison Bond ◽  
Farrin A. Manian
Keyword(s):  
Epidural Abscess ◽  
Significant Proportion ◽  
Simple Algorithm ◽  
Neurological Deficits ◽  
Spinal Epidural Abscess ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation ◽  
Objective Evidence ◽  
Spinal Epidural

Spinal epidural abscess (SEA) is an uncommon but serious condition with significant morbidity and mortality. The prognosis of SEA is highly dependent on the timeliness of its diagnosis before neurological deficits develop. Unfortunately, often due to its nonspecific presentation, such as back pain, the diagnosis of SEA may be delayed in up to 75% of cases. Although many risk factors for SEA can be found in the published literature, their utility is limited by their frequent lack of objective evidence, numerousness, and absence in a significant proportion of cases. In this review, we call for a more discriminate evidence-based use of the term “risk factor” when discussing SEA and explore several approaches to its earlier diagnosis, including a simple algorithm based on its pathophysiology and serum C-reactive protein or erythrocyte sedimentation rate.

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 Spinal Epidural Abscess İn An Adolescent (Case Report)

2021 ◽  
Author(s):  
Meryem Badem ◽  
Serpil Ugur Baysal ◽  
İlknur Karyağdı ◽  
Nusret Oren ◽  
Hamit Selim Karabekir ◽  
...  
Keyword(s):  
Medical Literature ◽  
Epidural Abscess ◽  
Surgical Intervention ◽  
Neurological Deficits ◽  
Spinal Epidural Abscess ◽  
Spinal Magnetic Resonance Imaging ◽  
Serious Infection ◽  
English Medical Literature ◽  
Spinal Epidural ◽  
Systemic Antibiotics

Spinal infections in immunocompetent children are very rare. But it is a serious infection in the epidural space along the spinal cord. It should be considered in patients with backache, fever, neurological deficits and/or spinal tenderness. There are cases which an etiology could not determined. In the English medical literature, there are only 31 reported pediatric cases in the last two decades. In children with neurologic deficits, surgery combined with systemic antibiotics constitutes the optimal therapy. We report a case of thoracal spinal epidural abscess in a 12-year-old adolescent boy who was immunocompetent and presented with spinal tenderness, back pain and four days of fever. A spinal magnetic resonance imaging demonstrated an epidural abscess between T2 and T10 level. An emergent surgical intervention was applied. Cultures remained negative. He was given systemic antibiotics for six weeks. He recovered without any sequelae.

scholarly journals An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

2014 ◽  
Vol 37 (2) ◽  
pp. E9 ◽  
Author(s):  
Faris Shweikeh ◽  
Kashif Saeed ◽  
Laura Bukavina ◽  
Stephanie Zyck ◽  
Doniel Drazin ◽  
...  
Keyword(s):  
Literature Search ◽  
Epidural Abscess ◽  
Early Recognition ◽  
Thoracolumbar Spine ◽  
Signs And Symptoms ◽  
Neurological Deficits ◽  
Current Status ◽  
Spinal Epidural Abscess ◽  
Presenting Symptoms ◽  
Spinal Epidural

Object Over the past decade, the incidence of bacterial spinal epidural abscess (SEA) has been increasing. In recent years, studies on this condition have been rampant in the literature. The authors present an 11-year institutional experience with SEA patients. Additionally, through an analysis of the contemporary literature, they provide an update on the challenging and controversial nature of this increasingly encountered condition. Methods An electronic medical record database was used to retrospectively analyze patients admitted with SEA from January 2001 through February 2012. Presenting symptoms, concurrent conditions, microorganisms, diagnostic modalities, treatments, and outcomes were examined. For the literature search, PubMed was used as the search engine. Studies published from January 1, 2000, through December 31, 2013, were critically reviewed. Data from articles on methodology, demographics, treatments, and outcomes were recorded. Results A total of 106 patients with bacterial SEA were identified. The mean ± SD age of patients was 63.3 ± 13.7 years, and 65.1% of patients were male. Common presenting signs and symptoms were back pain (47.1%) and focal neurological deficits (47.1%). Over 75% of SEAs were in the thoracolumbar spine, and over 50% were ventral. Approximately 34% had an infectious origin. Concurrent conditions included diabetes mellitus (35.8%), vascular conditions (31.3%), and renal insufficiency/dialysis (30.2%). The most commonly isolated organism was Staphylococcus aureus (70.7%), followed by Streptococcus spp. (6.6%). Surgery along with antibiotics was the treatment for 63 (59.4%) patients. Surgery involved spinal fusion for 19 (30.2%), discectomy for 14 (22.2%), and corpectomy for 9 (14.3%). Outcomes were reported objectively; at a mean ± SD follow-up time of 8.4 ± 26 weeks (range 0–192 weeks), outcome was good for 60.7% of patients and poor for 39.3%. The literature search yielded 40 articles, and the authors discuss the result of these studies. Conclusions Bacterial SEA is an ominous condition that calls for early recognition. Neurological status at the time of presentation is a key factor in decision making and patient outcome. In recent years, surgical treatment has been advocated for patients with neurological deficits and failed response to medical therapy. Surgery should be performed immediately and before 36–72 hours from onset of neurological sequelae. However, the decision between medical or surgical intervention entails individual patient considerations including age, concurrent conditions, and objective findings. An evidence-based algorithm for diagnosis and treatment is suggested.

scholarly journals Pneumorachis from the cervical to the sacral spinal canal with spinal epidural abscess by gas gangrene

2019 ◽  
Vol 27 (2) ◽  
pp. 230949901986007
Author(s):  
Tomoki Matsuo ◽  
Atsushi Tanji ◽  
Koichi Tateyama ◽  
Yuhei Yoda ◽  
Yusaku Kamata ◽  
...  
Keyword(s):  
Spinal Canal ◽  
Epidural Abscess ◽  
Rare Condition ◽  
Gas Gangrene ◽  
Neurological Deficits ◽  
Spinal Epidural Abscess ◽  
Laboratory Findings ◽  
Severe Diabetes ◽  
Spinal Epidural

We present a 70-year-old woman with severe diabetes mellitus, who experienced low back pain and left lower leg paralysis. Computed tomography showed air in the spinal canal from C4 to S5, and magnetic resonance imaging revealed an epidural abscess from Th11 to L1. Laboratory findings showed increases in inflammatory indicators and blood culture indicated the presence of Escherichia coli. The patient was treated conservatively with antibiotics. Neurological deficits and inflammatory data improved during the course. Follow-up imaging studies showed the disappearance of gas and epidural abscess. The existence of air in the spinal canal is a rare condition known as pneumorachis. To the best of our knowledge, such a long pneumorachis ranging from the cervical to the sacral spinal canal with epidural abscess caused by gas gangrene has not yet been described. We should therefore realize the possibility of epidural abscess produced by gas gangrene and treat it appropriately.

Spinal Epidural Abscesses: Clinical Manifestations, Prognostic Factors, and Outcomes

Neurosurgery ◽  
2002 ◽  
Vol 51 (1) ◽  
pp. 79-87 ◽  
Author(s):  
Martin Soehle ◽  
Thomas Wallenfang
Keyword(s):  
Prognostic Factors ◽  
Clinical Manifestations ◽  
Neurological Deficits ◽  
Motor Deficits ◽  
C Reactive Protein ◽  
Computed Tomographic ◽  
Protein Levels ◽  
Reactive Protein ◽  
Outcome Group ◽  
Spinal Epidural

Abstract OBJECTIVE This study was performed to evaluate the clinical manifestations and prognostic factors for outcomes among patients with nontuberculous spinal epidural abscesses. METHODS The records and magnetic resonance imaging/computed tomographic results for patients treated between 1994 and 2000 were retrospectively evaluated. Outcomes were assessed after 11 months, using scores ranging from 0 (dead) to 4 (no neurological deficits). RESULTS All 25 patients (mean age, 62 yr) underwent surgery and subsequently received antibiotics. Back/neck pain (72% of patients), leukocytosis (64%), fever (60%), and motor deficits (56%) were the most common symptoms at admission. Outcomes were assessed as poor for 40% of the patients and as good (no deficit or independently ambulatory) for 60%. Low leg muscle strength grades (r = 0.68, P < 0.001) and high white blood cell (WBC) counts (r = −0.56, P = 0.006) at admission were significantly correlated with low outcome scores. From the time of admission until 14 days after surgery, the poor-outcome group exhibited significantly (P < 0.005) higher WBC counts, compared with the good-outcome group. The same was true for C-reactive protein levels, with the exception that no differences between groups were observed until 8 days after surgery. Factors such as cervicothoracic abscess locations (P = 0.041), lower limb motor deficits (P = 0.005), complete paralysis (P = 0.005), and WBC counts of more than 14,000 cells/μl (P = 0.049) at admission were observed to be prognostic for poor outcomes. CONCLUSION Surgical decompression combined with antimicrobial therapy remains the recommended treatment. In addition to abscess locations and motor deficits, inflammatory markers such as WBC counts and C-reactive protein levels are prognostic for outcomes.

scholarly journals A rare case of spinal epidural abscess: diagnostic challenges and rehabilitation outcomes

2020 ◽  
Vol 11 (Vol.11, no.3) ◽  
pp. 288-293
Author(s):  
Vitalie VĂCĂRAȘ ◽  
Cristian ABRUDAN ◽  
Silvina ILUȚ ◽  
Imelda RAHOVAN ◽  
Ronela POPA ◽  
...  
Keyword(s):  
Rare Case ◽  
Epidural Abscess ◽  
Rehabilitation Program ◽  
Neurological Deficits ◽  
Lumbar Pain ◽  
Spinal Epidural Abscess ◽  
Rehabilitation Outcomes ◽  
Rehabilitation Programs ◽  
Considerable Morbidity ◽  
Spinal Epidural

Introduction: Spinal epidural abscess is a rare clinical entity with considerable morbidity. Even with prompt diagnosis and treatment, many patients are left with persistent residual neurological deficits. Case report: The purpose of this article is to report a rare case of primary pyogenic spinal epidural abscess. The patient admitted to our clinic because of lumbar pain of increasing severity and fever. Case management consisted of surgical and medical treatment with antibiotics. Postoperatively, with proper rehabilitation program, he markedly improved. Conclusions: Despite a correct management, spinal epidural abscess is associated with a high degree of morbidity and mortality. Proper treatment, rehabilitation programs and long-term follow-up is critical for a better outcome.

Surgical Treatment of Patients With Spondylodiscitis and Neurological Deficits Caused by Spinal Epidural Abscess (SEA) is a Predictor of Clinical Outcome

2014 ◽  
Vol 27 (7) ◽  
pp. 395-400 ◽  
Author(s):  
Björn P. Robach ◽  
Thomas R. Niethammer ◽  
Alexander C. Paulus ◽  
Carolin Melcher ◽  
Christof Birkenmaier ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcome ◽  
Epidural Abscess ◽  
Neurological Deficits ◽  
Spinal Epidural Abscess ◽  
Spinal Epidural

Minimally invasive transpedicular approach for evacuation of epidural abscess and debridement of disc space in a patient with discitis in the thoracic spine

2013 ◽  
Vol 35 (v2supplement) ◽  
pp. Video6
Author(s):  
Lee A. Tan ◽  
Ippei Takagi ◽  
Harel Deutsch
Keyword(s):  
Minimally Invasive ◽  
Anterior Approach ◽  
Epidural Abscess ◽  
Symptomatic Improvement ◽  
Neurological Deficits ◽  
Spinal Epidural Abscess ◽  
Surgical Morbidity ◽  
Disc Space ◽  
Transpedicular Approach ◽  
Spinal Epidural

Spinal epidural abscess (SEA) often requires prompt surgical decompression to prevent potential devastating neurological deficits. Dorsally located SEA usually can be evacuated via simple laminectomies. Ventral SEA often requires an anterior approach such as thoracotomy to achieve adequate exposure and decompression. We report a case of ventral thoracic SEA associated with discitis and osteomyelitis that was successfully treated via minimally invasive transpedicular approach. The patient had immediate and dramatic symptomatic improvement and was ambulatory on post-operative Day 1. The minimally invasive transpedicular approach avoids the surgical morbidity associated with anterior approach and is effective surgical alternative to treat ventral SEA.The video can be found here: http://youtu.be/do-K1VWYhi4.

scholarly journals Pus in Spinal Needle: Diagnosis and Management of a Long-Segment Spinal Epidural Abscess

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
B. M. Munasinghe ◽  
N. Pathirage ◽  
M. S. Hameed ◽  
C. T. Hapuarachchi
Keyword(s):  
Early Diagnosis ◽  
Epidural Abscess ◽  
Spinal Needle ◽  
Neurological Deficits ◽  
Spinal Epidural Abscess ◽  
Neuraxial Blockade ◽  
Diagnosis And Management ◽  
Neurological Outcomes ◽  
Spinal Epidural

Spinal-epidural abscess (SEA) is believed to be primarily of haematogenous origin and very rarely as a consequence of central neuraxial blockade. Early diagnosis and pertinent management invariably improve neurological outcomes. We report a case of long-segment SEA, which was suspected during subarachnoid anaesthesia, subsequently diagnosed and managed appropriately, averting irreversible neurological deficits.

Spinal epidural abscess in a juvenile dog

2005 ◽  
Vol 18 (03) ◽  
pp. 186-188 ◽  
Author(s):  
W. B. Thomas ◽  
C. W. Schmiedt
Keyword(s):  
Epidural Space ◽  
Rectal Temperature ◽  
Epidural Abscess ◽  
Spinal Pain ◽  
Neurological Deficits ◽  
Spinal Epidural Abscess ◽  
Intact Female ◽  
Haemolytic Streptococcus ◽  
Spinal Epidural

SummaryA six-month-old, intact female, Miniature Pinscher was admitted with signs of progressive neurological deficits in the hind legs, an elevated rectal temperature, and spinal pain of 48 hours duration. A myelogram was performed which demonstrated a dorsal, left sided compressive lesion extending from T11-T13. A leftsided hemilaminectomy was performed from T11-T13. A friable, poorly organized, pale tan and red mass was identified within the epidural space. Cytopathological and histopathological analyses of the mass demonstrated marked, subacute, suppurative cellulitis. A culture of the purulent material revealed beta haemolytic Streptococcus sp.

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