Adult spinal epidural abscess: clinical features and prognostic factors

Lu, Cheng-Hsien; Chang, Wen-Neng; Lui, Chen-Chung; Lee, Ping-Yu; Chang, Hsueh‐Wen

doi:10.1016/s0303-8467(02)00020-3

Cited by 103 publications

(63 citation statements)

References 15 publications

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“…4,28 However, presentation is variable and can be ambiguous, leading to delayed diagnosis. 7,12,14,18,27,37,41 Reportedly, SEA usually occurs in the thoracolumbar spine, dorsally. 19,30,31 In one study, systemic symptoms were more common among those with ventral lesions, and focal deficits were more common among those with dorsal lesions.…”

Section: 10mentioning

confidence: 99%

An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

Shweikeh

Saeed

Bukavina

et al. 2014

FOC

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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.

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Section: 10mentioning

confidence: 99%

An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

Shweikeh

Saeed

Bukavina

et al. 2014

FOC

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“…5 The most important predictor of neurological outcome is preoperative neurological status. 2,4,7 Early surgical intervention before deterioration of neurological function is needed to improve patient outcomes. [4][5][6][7] As for the operative indications for SEA, another study reported that diabetes, (A) (B) (C) Fig.…”

Section: Discussionmentioning

confidence: 99%

A case of panspinal epidural abscess that presented with meningeal irritation

Okada

Nishiyama

Kurihara

et al. 2017

Acute Medicine & Surgery

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Case:In rare cases, spinal epidural abscess involves the entire spine and can lead to neurological deficits and sepsis if treatment is delayed or suboptimal. A 65-year-old man was admitted with a diagnosis of bacterial meningitis. After admission, magnetic resonance imaging showed a spinal epidural abscess from the cervical to lumbar spine. Blood culture revealed Staphylococcus aureus. The patient was initially treated medically because he had no neurological deficits. Repeat blood culture remained positive and abscesses were found in the mediastinum and bilateral psoas muscles.Outcome: Surgery was carried out and the patient's postoperative course was satisfactory. Conclusion: Spinal epidural abscess can extensively affect the spine and may present with the symptoms of bacterial meningitis. It is essential to examine the entire spine and paraspinal regions and to treat early in cases of spinal epidural abscess.

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“…Patients who have been paralyzed for more than 24 to 36 hours tend to recover some neurologic function. 4,5,11,12,18,19 Immediate surgical decompression with appropriate choice of antibiotics remains the optimal therapy. 11 Our patient consumed alcohol occasionally, and had a source of infection in the form of thrombophlebitis leading to SEA.…”

Section: Discussionmentioning

confidence: 99%