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 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).

Acute Spinal Epidural Abscess—A Cause of Meningism

1981 ◽  
Vol 26 (4) ◽  
pp. 348-349 ◽  
Author(s):  
I. C. Stewart ◽  
M. J. Ford ◽  
R. C. Heading ◽  
A. D. Mendelow ◽  
P. Harris
Keyword(s):  
Epidural Abscess ◽  
Rare Condition ◽  
Spinal Epidural Abscess ◽  
Lumbar Region ◽  
Neurological Sequelae ◽  
Spinal Epidural ◽  
Prompt Diagnosis ◽  
Neurosurgical Intervention

Spinal epidural abscess is a rare condition requiring prompt diagnosis and neurosurgical intervention if permanent neurological sequelae are be avoided. A patient is described who presented with meningism due to an acute spinal epidural abscess extending from the cervical to the lumbar region and which was managed non-operatively.

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 Predictors of Failure for Nonoperative Management of Spinal Epidural Abscess

2019 ◽  
Vol 11 (1) ◽  
pp. 6-12
Author(s):  
Sarah Hunter ◽  
Robert Cussen ◽  
Joseph F. Baker
Keyword(s):  
Cell Count ◽  
Failure Rate ◽  
Epidural Abscess ◽  
Nonoperative Management ◽  
White Cell Count ◽  
White Cell ◽  
Spinal Epidural Abscess ◽  
Lumbar Region ◽  
Risk Of Failure ◽  
Spinal Epidural

Study Design: Retrospective cohort study. Objectives: The aim of this study is to identify predictive factors associated with failure of nonoperative management of spinal epidural abscess (SEA). Methods: Between January 2007 and January 2017, there were 97 patients 18 years or older treated for SEA at a tertiary referral center. Of these, 58 were initially managed nonoperatively. Details on presenting complaint, laboratory parameters, radiographic evaluation, demographics, comorbidities, and neurologic status (Frankel grades A-E) were collected. Success of treatment was defined as eradication of infection with no requirement for further antimicrobial therapy. Diagnosis of SEA was made via evaluation of imaging and intraoperative findings. Patients with repeat presentation of SEA, children, and those who were transferred for immediate surgical decompression were excluded. Results: Fifty-eight patients initially treated nonoperatively were included. Of these, 21 failed nonoperative management and required surgical intervention. The mean age was 60 years, 66% male, and 19% of Maori ethnicity. Abscess location was predominantly dorsal, and in the lumbar region (53%). Multivariate analysis identified Maori ethnicity, multifocal sepsis, and elevated white cell count as predictors of failure of nonoperative management. With 1 predictor the risk of failure was 44%. In the presence of 2 predictive variables, failure rate increased to 60%, and if all 3 variables were present, patients had a 75% risk of failure. Conclusion: Thirty-six percent of patients treated nonoperatively failed nonoperative management—the failure rate was significantly increased in patients with multifocal sepsis, in patients with elevated white cell count, and in patients of Maori ethnicity.

scholarly journals Spontaneous spinal epidural abscess in patients 50 years of age and older: a 15-year institutional perspective and review of the literature

2014 ◽  
Vol 20 (3) ◽  
pp. 344-349 ◽  
Author(s):  
Owoicho Adogwa ◽  
Isaac O. Karikari ◽  
Kevin R. Carr ◽  
Max Krucoff ◽  
Divya Ajay ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Epidural Abscess ◽  
Clinical Status ◽  
Spinal Instrumentation ◽  
Multivariate Logistic Regression Model ◽  
Spinal Epidural Abscess ◽  
Ct Guided ◽  
Presenting Symptoms ◽  
The Past ◽  
Spinal Epidural

Object A spinal epidural abscess (SEA) is a rare but severe infection requiring prompt recognition and management. The incidence of SEA has doubled in the past decade, owing to an aging population and to increased use of spinal instrumentation and vascular access. The optimal management of SEAs in patients 50 years of age and older remains a matter of considerable debate. In an older patient population with multiple comorbidities, whether intravenous antibiotics alone or in combination with surgery lead to superior outcomes remains unknown. The present study retrospectively analyzes cases of SEAs, in patients 50 years of age and older, treated at Duke University Medical Center over the past 15 years. Methods Eighty-two patients underwent treatment for a spinal epidural abscess between 1999 and 2013. There were 46 men and 36 women, whose overall mean age (± SD) was 65 ± 8.58 years (range 50–82 years). The mean duration of clinical follow-up was 41.38 ± 86.48 weeks. Thirty patients (37%) underwent surgery for removal of the abscess, whereas 52 (63%) were treated more conservatively, undergoing CT-guided aspiration or receiving antibiotics alone based on the results of blood cultures. The correlation between pretreatment variables and outcomes was evaluated in a multivariate regression analysis. Results Back pain and severe motor deficits were the most common presenting symptoms. Compared with baseline neurological status, the majority of patients (68%) reported being neurologically “better” or “unchanged.” Twelve patients (15%) had a good outcome (7 [23%] treated operatively vs 5 [10%] treated nonoperatively, p = 0.03), while clinical status in 41 patients (50%) remained unchanged (10 [33%] treated operatively vs 31 [60%] treated nonoperatively, p = 0.01). Overall, 20 patients (25%) died (9 [30%] treated operatively vs 11 [21%] treated nonoperatively, p = 0.43). In a multivariate logistic regression model, an increasing baseline level of pain, the presence of paraplegia or quadriplegia on initial presentation, and a dorsally located SEA were independently associated with poor outcomes. Conclusions The results of the study suggest that in patients 50 years of age and older, early surgical decompression combined with intravenous antimicrobial therapy was not associated with superior clinical outcomes when compared with intravenous antimicrobial therapy alone.

CT guided aspiration of a cervical spinal epidural abscess

2005 ◽  
Vol 12 (4) ◽  
pp. 453-456 ◽  
Author(s):  
T.M. Rust ◽  
S. Kohan ◽  
T. Steel ◽  
R. Lonergan
Keyword(s):  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Ct Guided ◽  
Spinal Epidural

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.

Epidural Abscess

2016 ◽  
Author(s):  
David Mabey
Keyword(s):  
Back Pain ◽  
Surgical Treatment ◽  
Early Diagnosis ◽  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Surgical Drainage ◽  
Stable Patient ◽  
Common Presentation ◽  
Spinal Epidural

An epidural abscess is a collection of pus that has accumulated between the dura and the calvarium or spine. It is rare but can lead to severe neurologic dysfunction or death. There are two main subsets of epidural abscess: spinal epidural abscess (SEA) and intracranial epidural abscess (ICEA). Early diagnosis is key to minimizing complications. Back pain is the most common presentation of SEA, along with spinal tenderness. Treatment requires prolonged hospitalization, surgical drainage in most cases, and long-term antibiotics. Except in rare cases, patients with SEA and ICEA will require hospital admission. In the stable patient, antibiotics should be withheld until culture data can be obtained. If surgical treatment is not readily available, biopsy is often performed to obtain samples for culture before starting antibiotics.

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