Nonoperative Management of Spinal Epidural Abscess

2018 ◽  
Vol 100 (7) ◽  
pp. 546-555 ◽  
Author(s):  
Akash A. Shah ◽  
Paul T. Ogink ◽  
Sandra B. Nelson ◽  
Mitchel B. Harris ◽  
Joseph H. Schwab
Keyword(s):  
Epidural Abscess ◽  
Nonoperative Management ◽  
Spinal Epidural Abscess ◽  
Spinal Epidural

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.

Nonoperative Management of Spinal Epidural Abscess

Neurosurgery ◽  
1998 ◽  
Vol 43 (3) ◽  
pp. 716-716
Author(s):  
Kathryn Beauchamp ◽  
Bryan J. Duke ◽  
Ronald N. Baxter ◽  
Kerry E. Brega ◽  
Anna Cajade-Law ◽  
...  
Keyword(s):  
Epidural Abscess ◽  
Nonoperative Management ◽  
Spinal Epidural Abscess ◽  
Spinal Epidural

Comparison of operative and nonoperative management of spinal epidural abscess: a retrospective review of clinical and laboratory predictors of neurological outcome

2013 ◽  
Vol 19 (1) ◽  
pp. 119-127 ◽  
Author(s):  
David E. Connor ◽  
Prashant Chittiboina ◽  
Gloria Caldito ◽  
Anil Nanda
Keyword(s):  
Blood Culture ◽  
Peripheral Blood ◽  
Epidural Abscess ◽  
Nonoperative Management ◽  
Spinal Epidural Abscess ◽  
Patient Age ◽  
Focal Neurological Deficit ◽  
Radiology Reports ◽  
Patient Âgé ◽  
Spinal Epidural

Object Spinal epidural abscess (SEA), once considered a rare occurrence, has showed a rapid increase in incidence over the past 20–30 years. Recent reports have advocated for conservative, nonoperative management of this devastating disorder with appropriate risk stratification. Crucial to a successful management strategy are decisive diagnosis, prompt intervention, and consistent follow-up care. The authors present a review of their institutional experience with operative and nonoperative management of SEA to assess morbidity and mortality and the accuracy of microbiological diagnosis. Methods A retrospective analysis of patient charts, microbiology reports, operative records, and radiology reports was performed on all cases involving patients admitted with the diagnosis of SEA between July 1998 and May 2009. Results Seventy-seven cases were reviewed (median patient age 51.4 years, range 17–78 years). Axial pain was the most common presenting symptom (67.5% of cases). Presenting signs included focal weakness (55.8%), radiculopathy (28.6%), and myelopathy (5.2%). Abscesses were localized to the lumbar, thoracic, and cervical spine, respectively, in 39 (50.6%), 20 (26.0%), and 18 (23.4%) of the patients. Peripheral blood cultures were negative in 32 (45.1%) of 71 patients. Surgical site or interventional biopsy cultures were diagnostic in 52 cases (78.8%), with concordant blood culture results in 36 (60.0%). Methicillin-resistant Staphylococcus aureus (MRSA) was the most frequent isolate in 24 cases (31.2%). The mean time from admission to surgery was 5.5 days (range 0–42 days; within 72 hours in 66.7% of cases). Outcome data were available in 72 cases. At discharge, patient condition had improved or resolved in 57 cases (79.2%), improved minimally in 6 (8.3%), and showed no improvement or worsening in 9 (12.5%). Patient age and premorbid weakness were the only factors found to be significantly associated with outcome (p = 0.04 and 0.012, respectively). Conclusions These results strongly support immediate surgical decompression combined with appropriately tailored antibiotic therapy for the treatment of symptomatic SEA presenting with focal neurological deficit. The nonsuperiority discovered in other patient subsets may be due to allocation biases between surgically treated and nonsurgically treated cohorts. The present data demonstrate the accuracy of peripheral blood culture for the prediction of causative organisms and confirm patient age as a predictor of outcomes.

scholarly journals The indications and timing for operative management of spinal epidural abscess: literature review and treatment algorithm

2014 ◽  
Vol 37 (2) ◽  
pp. E8 ◽  
Author(s):  
Alexander Tuchman ◽  
Martin Pham ◽  
Patrick C. Hsieh
Keyword(s):  
Literature Review ◽  
Medical Management ◽  
Epidural Abscess ◽  
Nonoperative Management ◽  
Treatment Algorithm ◽  
Case Series ◽  
Spinal Epidural Abscess ◽  
Pubmed Database ◽  
Cord Injury ◽  
Spinal Epidural

Object Delayed or inappropriate treatment of spinal epidural abscess (SEA) can lead to serious morbidity or death. It is a rare event with significant variation in its causes, anatomical locations, and rate of progression. Traditionally the treatment of choice has involved emergency surgical evacuation and a prolonged course of antibiotics tailored to the offending pathogen. Recent publications have advocated antibiotic treatment without surgical decompression in select patient populations. Clearly defining those patients who can be safely treated in this manner remains in evolution. The authors review the current literature concerning the treatment and outcome of SEA to make recommendations concerning what population can be safely triaged to nonoperative management and the optimal timing of surgery. Methods A PubMed database search was performed using a combination of search terms and Medical Subject Headings, to identify clinical studies reporting on the treatment and outcome of SEA. Results The literature review revealed 28 original case series containing at least 30 patients and reporting on treatment and outcome. All cohorts were deemed Class III evidence, and in all but two the data were obtained retrospectively. Based on the conclusions of these studies along with selected smaller studies and review articles, the authors present an evidence-based algorithm for selecting patients who may be safe candidates for nonoperative management. Conclusions Patients who are unable to undergo an operation, have a complete spinal cord injury more than 48 hours with low clinical or radiographic concern for an ascending lesion, or who are neurologically stable and lack risk factors for failure of medical management may be initially treated with antibiotics alone and close clinical monitoring. If initial medical management is to be undertaken the patient should be made aware that delayed neurological deterioration may not fully resolve even after prompt surgical treatment. Patients deemed good surgical candidates should receive their operation as soon as possible because the rate of clinical deterioration with SEA is notoriously unpredictable. Although patients tend to recover from neurological deficits after treatment of SEA, the time point when a neurological injury becomes irreversible is unknown, supporting emergency surgery in those patients with acute findings.

Development of a machine learning algorithm for prediction of failure of nonoperative management in spinal epidural abscess

2019 ◽  
Vol 19 (10) ◽  
pp. 1657-1665 ◽  
Author(s):  
Akash A. Shah ◽  
Aditya V. Karhade ◽  
Christopher M. Bono ◽  
Mitchel B. Harris ◽  
Sandra B. Nelson ◽  
...  
Keyword(s):  
Machine Learning ◽  
Epidural Abscess ◽  
Nonoperative Management ◽  
Learning Algorithm ◽  
Spinal Epidural Abscess ◽  
Machine Learning Algorithm ◽  
Spinal Epidural

Aggregatibacter aphrophilus spinal epidural abscess

2020 ◽  
Vol 13 (7) ◽  
pp. e235320
Author(s):  
Antoine Altdorfer ◽  
Pierre Gavage ◽  
Filip Moerman
Keyword(s):  
Risk Factors ◽  
Lower Limb ◽  
Rare Case ◽  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Surgical Drainage ◽  
Eikenella Corrodens ◽  
Aggregatibacter Aphrophilus ◽  
Progressive Neurological Deficit ◽  
Spinal Epidural

A 76-year-old woman with a rare case of spinal epidural abscess (SEA) that had no risk factors for such type of infection, presented symptoms of back pain, progressive neurological deficit of the lower limb and loss of sphincter control. A gadolinium-enhanced MRI confirmed the diagnosis of an SEA. The patient underwent laminectomy with surgical drainage, where cultures showed the presence of Aggregatibacter aphrophilus, a bacterium of the HACEK group (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species), rarely involved in SEA. Following surgery, the patient was treated with intravenous ceftriaxone for 6 weeks, and this gave excellent results.

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.

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