scholarly journals Surgical management of an extensive spinal epidural abscess: illustrative cases

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Aleksey Eroshkin ◽  
Dmytro Romanukha ◽  
Serhiy Voitsekhovskyi
Keyword(s):  
Neurological Deficit ◽  
Spinal Canal ◽  
Surgical Trauma ◽  
Spinal Epidural Abscess ◽  
Abscess Drainage ◽  
Access Method ◽  
Silicone Catheter ◽  
Minimal Trauma ◽  
Spinal Epidural ◽  
Purulent Drainage

BACKGROUNDExtensive spinal epidural abscesses (SEAs) occupying three or more spinal regions are rare. This study aimed to address the key dilemma of surgical treatment for holospinal epidural abscesses, i.e., to determine the required scope of surgery and minimize surgical trauma with adequate purulent drainage.OBSERVATIONSTwo patients with extensive SEAs were treated at the Neurosurgery Department of the Central Hospital of Ministry of Internal Affairs of Ukraine from 2018 to 2020. Both patients had a neurological deficit and general inflammatory response syndrome. Spinal magnetic resonance examinations were performed, showing that the first and second patients had extensive SEAs at T11/S1 and C2/L1, respectively. Both underwent minimally invasive abscess drainage via intra- and translaminar access at the most caudal point using an epidural silicone catheter in the cranial direction along the entire length of the abscess.LESSONSTo achieve the key goal of extensive SEA treatment, i.e., to prevent the development of a persistent neurological deficit, immediate effective spinal canal decompression should be performed. Access method and scope should meet the requirements of spinal canal decompression and purulent content aspiration to the greatest possible extent while inducing minimal trauma.

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 Case report (precis): Atypical delayed presentation of cervical spinal epidural abscess

2020 ◽  
Vol 11 ◽  
pp. 332
Author(s):  
Nancy E. Epstein
Keyword(s):  
Case Report ◽  
Upper Extremity ◽  
Neurological Deficit ◽  
Older Patients ◽  
Spinal Epidural Abscess ◽  
Delayed Presentation ◽  
Laboratory Studies ◽  
Cortical Irregularity ◽  
Spinal Epidural ◽  
Ct Studies

Background: Older patients with spinal epidural abscesses (SEA) may present in an atypical fashion, failing to exhibit the classical triad of pain, fever, and a neurological deficit. Rather, they may be less aware of pain, fail to develop a fever, and attribute their neurological deficit to “old age.” Further, their laboratory studies may not be abnormal, and critical findings on MR (i.e., more so than CT studies) may be overlooked. Here, we present an elderly patient with severe upper extremity monoparesis whose cervical SEA was overlooked for months. Case Description: Over 10 months, and 6 months ago respectively, the patient had two successive MR scans ordered due to falls; both were interpreted as normal. Within the past few months, a third cervical MR, and an initial CT scan were performed; they both showed “questionable” changes (e.g. cortical irregularity/epidural air) that were largely ignored. When the patient presented to a spine surgeon with severe upper extremity monoparesis, the fourth MR clearly demonstrated a high cervical SEA. Of interest, laboratory findings were normal (e.g. white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP)). The patient successfully underwent an anterior cervical discectomy/and fusion (ACDF); cultures grew Staphylococcus aureus, and he was appropriately managed with intravenous antibiotic therapy. Conclusion: This case report (precis) highlights three “teaching” points. First, elderly immunologically compromised patients may not develop the classical SEA triad of pain, fever, and a neurological deficit. Second, laboratory studies may remain normal. Third, it may take longer for abnormal findings to develop on MR/CT studies consistent with SEA in immunocompromised older patients, thus resulting in very delayed surgery.

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 Our institutional experience with Spinal Epidural Abscess

2019 ◽  
Vol 16 (2) ◽  
pp. 16-19
Author(s):  
Y. Joulali ◽  
F. Lakhdar ◽  
M. Benzagmout ◽  
K. Chakour ◽  
M. F. Chaoui
Keyword(s):  
Neurological Deficit ◽  
Epidural Abscess ◽  
Cord Compression ◽  
University Hospital ◽  
Initial Assessment ◽  
Spinal Epidural Abscess ◽  
Point Of Entry ◽  
Institutional Experience ◽  
Spinal Epidural ◽  
Peripheral Enhancement

CorrigendumThe article published in Nepal Journal of Neurosciences 2019;16:16-19 by Joulali Youssef etal was mistakenlypublished with a wrong co-author.The corresponding author has submitted following authors as responsible for the article, Y. Joulali, F. Lakhdar,M. Benzagmout, K. Chakour and M.F. Chaoui. Bipin Chaurasia was added in error.Please cite this article as Joulali Y, Lakhdar F, Benzagmout M, Chakour K, Chaoui MF. Our institutionalexperience with Spinal Epidural Abscess. Nepal Journal of Neurosciences 2019 ; 16:16-19 in future citations. Abstract: Spinal epidural abscess is a rare pathology which is manifested by a classic triad of pain, fever and neurological deficit. In most cases, the clinical picture is incomplete which makes its diagnosis difficult. In this retrospective study, we report five cases of spinal epidural abscess treated in the neurosurgery department of Hassan II University Hospital of Fez. Four of our patients were admitted due to spinal cord compression, while one patient was admitted for isolated spinal syndrome without neurological deficit. Fever was present in all our patients, nevertheless no point of entry was identified in the initial assessment. MRI was performed on emergency basis in all of our patients which demonstrated an extra-dural hypo intensity on T1WI, hyper intensity on T2WI. It also showed lesions with peripheral enhancement after contrast with gadolinium. Four of our patients underwent surgical treatment which involved performing alaminectomy/laminotomy with drainage of the abscess, while one patient received medical treatment alone. The evolution was favorable in 4 of our patients while one patient died post operatively due to severe sepsis.

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.

Spinal Epidural Compression Secondary to Osteoblastic Metastatic Vertebral Expansion

Neurosurgery ◽  
1988 ◽  
Vol 23 (5) ◽  
pp. 662-665 ◽  
Author(s):  
Alan Hirschfeld ◽  
William Beutler ◽  
Juliet Seigle ◽  
Herbert Manz
Keyword(s):  
Computed Tomography ◽  
Radiation Therapy ◽  
Spinal Canal ◽  
Surgical Decompression ◽  
The Other ◽  
Precise Nature ◽  
Osteoblastic Metastasis ◽  
Neurological Improvement ◽  
Epidural Compression ◽  
Spinal Epidural

Abstract We present two cases in which spinal epidural compression was caused by the expansion of bony elements into the spinal canal as a result of osteoblastic metastases. The precise nature of the compression was appreciated only on computed tomography. One patient had immediate and sustained neurological improvement after laminectomy. The other benefited temporarily, but widespread involvement of his spine ultimately led to paraplegia despite two more decompressive procedures. We think that bony expansion of the spine secondary to osteoblastic metastasis is not reversible with radiation therapy alone and is, therefore, an absolute indication for surgical decompression.

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