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 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 A Predictive Clinical Model to Facilitate Early Recognition of Spinal Epidural Abscess in Adults

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Andrew Artenstein ◽  
Jennifer Friderici ◽  
Adam Holers ◽  
Deirdre Lewis ◽  
Jan Fitzgerald ◽  
...  
Keyword(s):  
Epidural Abscess ◽  
Early Recognition ◽  
Spinal Epidural Abscess ◽  
Clinical Model ◽  
Spinal Epidural

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.

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 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.

Spinal Epidural Abscess in Children

Neurosurgery ◽  
1981 ◽  
Vol 9 (3) ◽  
pp. 257-260 ◽  
Author(s):  
Edwin G. Fischer ◽  
Clarence S. Greene ◽  
Ken R. Winston
Keyword(s):  
Spinal Deformity ◽  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Presenting Symptoms ◽  
Spinal Epidural

Abstract This is a report of three children with spinal epidural abscess. The literature is reviewed and the features of this condition in children are noted. Because of the nonspecificity of presenting symptoms in children, the diagnosis may be delayed. resulting in a worse outcome, especially in children under I year of age. The extensive laminectomy advised for the treatment of spinal epidural abscesses in adults is undesirable in children because of the risk of spinal deformity and in most cases is probably not necessary.

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 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.

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.

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.

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