Acute Lumbar Epidural Abscess

Sarrell, Warren G.; LaFia, David J.

doi:10.1056/nejm195402252500804

Cited by 5 publications

(2 citation statements)

References 7 publications

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“…(A) LP can cause intradural contamina tion, as clearly demonstrated by the present series and the experience of others [27][28][29], However, suboccipital or high cervical lateral puncture can reasonably be assumed to over come this risk.…”

Section: Discussionmentioning

confidence: 78%

“…in acute and subacute cases, also a moderate increase in cell content, reasonably due to slight meningeal reaction in the presence of epidural pus. The hazard of spinal puncture in epidural abscesses is widely recognized [9,10,[26][27][28], In 3 of the present cases, ab scesses resulted from previous intraspinal in jections. In a further case, LP was the likely cause of subdural spreading of pus.…”

Section: Discussionmentioning

confidence: 99%

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Spinal Epidural Abscesses

Ravicovitch¹,

Spallone²

1982

Eur Neurol

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42 cases of spinal epidural abscesses were operated on in the years 1957–1980, among approximately 8.000 spinal operations. Staphylococcus aureus was the microorganism most commonly isolated from infected material and the primary source of infection was in most cases cutaneous and/or subcutaneous lesions. Typical clinical history included back pain and fever, with progressive nerve root and spinal cord involvement. The cases were divided into three groups according to the operative findings: (a) acute abscesses; (b) chronic abscesses, and (c) mixed or subacute abscesses. These three groups differed as to duration of illness, incidence of meningeal signs, white blood cell concentration and lumbar puncture results. Plain X-rays were positive in 20% of cases. Myelography, whose indications were maximally restricted, gave in some instances inaccurate results. Treatment consisted of extensive laminectomy of all the affected spinal segments, and drainage of infected material. Local and systemic appropriate antibiotic therapy was also given. An average of 16 daily sessions of barotherapy, consisting of 1.7–2.0 atm given in 40–60 min, were administered in the last 9 cases. When compared with the patients to which barotherapy was not given, these cases showed a lower rate of permanent disability (11 vs. 21%), even if they were managed under less favorable clinical and neurological conditions. These results seem to support a favorable role of hyperbaric treatment in the management of spinal epidural abscesses. Early diagnosis and appropriate management remain essential in order to have satisfactory treatment results.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Spinal Epidural Abscesses

Ravicovitch¹,

Spallone²

1982

Eur Neurol

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Acute Spinal Epidural Abscess vs Acute Transverse Myelopathy

Altrocchi¹

1963

Arch Neurol

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Spinal epidural abscess: a meta-analysis of 915 patients

Waldbaur²,

2000

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Spinal epidural abscess (SEA) was first described in the medical literature in 1761 and represents a severe, generally pyogenic infection of the epidural space requiring emergent neurosurgical intervention to avoid permanent neurologic deficits. Spinal epidural abscess comprises 0.2 to 2 cases per 10,000 hospital admissions. This review intends to offer detailed evaluation and a comprehensive meta-analysis of the international literature on SEA between 1954 and 1997, especially of patients who developed it following anesthetic procedures in the spinal canal. In this period, 915 cases of SEA were published. This review is the most comprehensive literature analysis on SEA to date. Most cases of SEA occur in patients aged 30 to 60 years, but the youngest patient was only 10 days old and the oldest was 87. The ratio of men to women was 1:0.56. The most common risk factor was diabetes mellitus, followed by trauma, intravenous drug abuse, and alcoholism. Epidural anesthesia or analgesia had been performed in 5.5% of the patients with SEA. Skin abscesses and furuncles were the most common source of infection. Of the patients, 71% had back pain as the initial symptom and 66% had fever. The second stage of radicular irritation is followed by the third stage, with beginning neurological deficit including muscle weakness and sphincter incontinence as well as sensory deficits. Paralysis (the fourth stage) affected only 34% of the patients. The average leukocyte count was 15,700/microl (range 1,500-42,000/microl), and the average erythrocyte sedimentation rate was 77 mm in the first hour (range 2-50 mm). Spinal epidural abscess is primarily a bacterial infection, and the gram-positive Staphylococcus aureus is its most common causative agent. This is true also for patients who develop SEA following spinal anesthetics. Magnetic resonance imaging (MRI) displays the greatest diagnostic accuracy and is the method of first choice in the diagnostic process. Myelography, commonly used previously to diagnose SEA, is no longer recommended. Lumbar puncture to determine cerebrospinal fluid protein concentrations is not needed for diagnosis and entails the risk of spreading bacteria into the subarachnoid space with consequent meningitis; therefore, it should not be performed. The therapeutic method of choice is laminectomy combined with antibiotics. Conservative treatment alone is justifiable only for specific indications. Laminotomy is a therapeutic alternative for children. The mortality of SEA dropped from 34% in the period of 1954-1960 to 15% in 1991-1997. At the beginning of the twentieth century, almost all patients with SEA died. Parallel to improvements in the mortality rate, today more patients experience complete recovery from SEA. The prognosis of patients who develop SEA following epidural anesthesia or analgesia is not better than that of patients with noniatrogenic SEA, and the mortality rate is also comparable. The essential problem of SEA lies in the necessity of early diagnosis, because only timely treatment is able to av...

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Acute Lumbar Epidural Abscess

Cited by 5 publications

References 7 publications

Spinal Epidural Abscesses

Spinal Epidural Abscesses

Acute Spinal Epidural Abscess vs Acute Transverse Myelopathy

Spinal epidural abscess: a meta-analysis of 915 patients

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