Spinal epidural abscess: clinical presentation, management, and outcome (original) (raw)
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European Spine Journal, 2011
Spinal epidural abscess (SEA) is a rare, but serious, condition with multiple causes. We prospectively studied the aetiology, predisposing factors, and clinical outcomes of SEA in all patients with SEA treated in our hospital's neurosurgical service from 2004 to 2008. For each patient, we recorded the medical history, comorbidities, focus of infection, pathogen(s), and outcome. The 36 patients (19 women and 17 men) ranged in age from 34 to 80 years old (mean 57; median 56). The SEA was primary (i.e., due to haematogenous spread) in 16 patients (44%); it was secondary to elective spinal procedures, either injections or surgery, in 20 patients (56%). The duration of follow-up was 12-60 months (mean 36; median 37.5). The most common pathogen, Staphylococcus aureus, was found in 18 patients (50%). Patients with primary SEA had different underlying diseases and a wider range of pathogens than those with secondary SEA. Only five patients (14%) had no major comorbidity; 16 of the 20 patients with secondary SEA (44% of the overall group) had undergone spinal surgery before developing the SEA; the treatment of the SEA involved multiple surgical operations in all 16 of these patients, and spinal instrumentation in 5 (14%); 22 patients (61% of the overall group) recovered fully.
Spinal Epidural Abscess: Diagnosis and Treatment
Operative Techniques in Neurosurgery, 2004
Spinal epidural abscess (SEA) is an uncommon entity, with an incidence of 0.2 to 2 per 10,000 hospital admissions. It is associated with potentially devastating neurological consequences. The incidence is increasing with the increase in intravenous drug use and increasing spinal procedures. SEA is classically described as presenting with fever, focal back pain, and progressive neurological symptoms. However, patients rarely fulfill all the characteristics of this pathognomonic triad. The key in diagnosis is a high level of suspicion when patients present with back pain. MRI is highly accurate in the evaluation. Empiric antibiotics for SEA must include coverage for staphylococci (vancomycin pending organism identification and susceptibility testing) and gram-negative bacilli (e.g., ceftazidime, cefepime, or meropenem), and antibiotics should continue for at least 8 weeks. Surgical evacuation remains the standard treatment in patients who present with neurologic signs on physical examination or who have failed medical management. The prognosis depends on the presenting neurologic status. Despite recent efforts, SEA is associated with a high mortality rate, most likely a result of delayed diagnosis and poor neurologic status at presentation. Therefore, high suspicion and early diagnosis remain the most important factors in the management of SEA. Oper Tech Neurosurg 7: [188][189][190][191][192]
Journal of Neurosurgery: Spine, 2013
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 si...
Spinal epidural abscess: A report of 40 cases and review
Surgical Neurology, 1992
Despite modern medical advances, the morbidity and mortality rates associated with spinal epidural abscess remain significant, and the diagnosis often is elusive. A retrospective study was undertaken to define better the incidence and clinical features of this infection, and to establish current diagnostic and therapeutic guidelines. Forty cases of spinal epidural abscess were encountered at our institution between July 1979 and March 1991. All medical records and radiological images were reviewed. We report a significant increase in the incidence of epidural abscess after June 1988 (p = 0 .0195). Sixteen patients used drugs intravenously, and six had undergone spinal procedures. Twelve patients were misdiagnosed in various emergency rooms or clinics and discharged. Localized back pain, fever, and neurological deficit remained the typical clinical manifestations. Erythrocyte sedimentation rate was elevated uniformly when measured (21 cases). Magnetic resonance imaging was diagnostic specifically in 23 of 24 instances. The majority of patients underwent surgical drainage, but five selected patients were managed nonoperatively. The highly variable presentation of spinal epidural abscess may confuse the diagnosis and delay indicated surgical intervention. Localized back pain in a febrile patient at significant risk for epidural abscess warrants erythrocyte sedimentation rate measurement. The presence of erythrocyte sedimentation rate elevation or evidence of spinal cord compression on physical examination are indications for immediate magnetic resonance imaging examination with contrast enhancement. Surgical drainage with sustained intravenous antibiotic treatment remains the cornerstone of therapy. Nonoperative management may be considered in selected cases .
Spinal epidural abscess in clinical practice
QJM, 2007
Spinal epidural abscess (SEA) is a rare but severe infection requiring prompt recognition. The major prognostic factor for a favourable outcome is early diagnosis, leading to appropriate treatment. In clinical practice, a diagnosis of SEA is often not considered, particularly in the early stages of the disease when neurological symptoms are not apparent. Knowledge of persons at risk, clinical features and the required diagnostic procedures may decrease the number of initially misdiagnosed cases. Clinical signs, duration of symptoms and the rate of neurological deterioration show a high interindividual variability, and the classic triad (spinal pain, fever and neurological deficit) is often not found, especially not at first presentation to a physician. However, most patients complain of severe localized back pain. Inflammatory parameters in the blood are generally elevated, but not specific. Gadolinium-enhanced magnetic resonance imaging is the most sensitive, specific and accurate imaging method. Although neurosurgical decompression is still the treatment of choice in the majority of cases, less invasive procedures (e.g. computed tomography-guided needle aspiration) or antimicrobial treatment alone can be applied in selected cases. The choice of the most appropriate therapy should be discussed immediately after a confirmed diagnosis in consultation with infectious disease, radiology and spinal surgery specialists. The outcome of SEA is largely influenced by the severity and duration of neurological deficits prior to surgery, stressing the importance of early recognition.
Spinal Epidural Abscess: A Review of Presentation, Management, and Medicolegal Implications
Asian Spine Journal
Spinal epidural abscess (SEA) is a rare condition associated with significant morbidity and mortality. Despite advances in diagnostic medicine, early recognition of SEAs remains elusive. The vague presentation of the disease, coupled with its numerous risk factors, the diagnostic requirement for obtaining advanced imaging, and the necessity of specialized care constitute extraordinary challenges to both diagnosis and treatment of SEA. Once diagnosed, SEAs require urgent or emergent medical and/or surgical management. As SEAs are a relatively rare pathology, high-quality data are limited and there is no consensus on their optimal management. This paper focuses on presenting the treatment modalities that have been successful in the management of SEAs and providing a critical assessment of how specific SEA characteristics may render one infection more amenable to primary surgical or medical interventions. This paper reviews the relevant history, epidemiology, clinical presentation, rad...
Management of spontaneous spinal epidural abscess: A case report
World Journal of Advanced Research and Reviews
Background: Spinal epidural abscess (SEA) is a rare but severe pyogenic infection of the epidural space. Case presentation: A 60-year-old female with a history High Blood Pressure, Chronic Renal Failure and the non-surgical descending aortic aneurysm was hospitalized 10 days before its symptoms in the intensive care unit for treatment of acute infective endocarditis caused by Staphococcus aureus. She presented 24 hours before a lower limb motor weakness, bladder and bowel dysfunction (urinary and anal incontinence).MRI spine with gadolinium demonstrating an epidural contrast-enhancing mass extending from mid Th10 to Th12 left-side with infiltration of the pedicles and extension to the soft tissues and is most consistent with epidural abscess. Within the next few hours the patient underwent decompressive laminectomy (level Th10-Th12) and surgical evacuation of the abscess. The post-operative cultures from the abscess were positive for Staphylococcus- aureus. Intravenous antibiotics w...
Recent Developments in the Treatment of Spinal Epidural Abscesses
Orthopedic reviews, 2017
Spinal epidural abscess (SEA) is a serious condition that can be challenging to diagnose due to nonspecific symptomology and delayed presentation. Despite this, it requires prompt recognition and management in order to prevent permanent neurologic sequelae. Several recent studies have improved our understanding of SEA. Herein, we summarize the recent literature from the past 10 years relevant to SEA diagnosis, management and outcome. While surgical care remains the mainstay of treatment, a select subset of SEA patients may be managed without operative intervention. Multidisciplinary management involves internal medicine, infectious disease, critical care, and spine surgeons in order to optimize care.
Spinal epidural abscess: Report on 27 cases
Surgical Neurology International, 2017
Background: Spinal epidural abscess, although an uncommon disease, often correlates with a high morbidity owing to significant delay in diagnosis. Methods: In a prospective 5-year study, the clinical and magnetic resonance (MR) findings, treatment protocols, microbiology, and neurological outcomes were analyzed for 27 patients with spinal epidural abscess. Results: Patients were typically middle-aged with underlying diabetes and presented with lumbar abscesses. Those undergoing surgical intervention >36 h after the onset of symptoms had poor neurological outcomes. Conclusion: Early recognition and timely evacuation of spinal abscesses minimized neurological morbidity and potential mortality.