Cervical epidural analgesia complicated by epidural abscess

Zhang, Junhui; Wang, Zhili; Wan, Li

doi:10.1097/md.0000000000007789

Cited by 13 publications

(26 citation statements)

References 15 publications

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“…[ 1 , 4 , 5 , 13 , 19 , 29 ] Nevertheless, as noted here, there are serious complications of ESIs that include spinal epidural and subdural hematomas, brain/cord infarctions (cervical ESI), and spinal epidural/subdural abscesses. [ 3 , 11 , 24 , 37 , 42 ]…”

Section: Discussionmentioning

confidence: 99%

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All that glitters is not gold: A spinal epidural empyema following epidural steroid injection

Brunasso

Basile

Iacopino

et al. 2020

Surgical Neurology International

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Background: Therapeutic epidural spinal injections (ESIs) of steroids are one of the most common nonsurgical management modalities employed for alleviating pain due to chronic persistent lumbar spinal disease. However, it is well documented that they have significant risks and complications without any long-term efficacy. ESI may result in epidural empyema which may be difficult to diagnose with delays resulting in significant permanent neurological sequelae. Case Description: A 45-year-old female presented with a lumbar spinal epidural empyema after receiving ESI for low back and right leg pain due to a lumbar disc herniation. Laboratory studies showed elevations of multiple inflammatory markers, and the MR documented a significant lumbar epidural empyema contributing to significant thecal sac compression. Clinically, the patient had an acute cauda equina syndrome warranting emergency surgery consisting of a laminectomy for debridement/decompression followed by long-term antibiotic treatment. Conclusion: Epidural empyema is a major potential complication of lumbar ESI. Multiple markedly elevated inflammatory markers (WBC, ESR, CRP, and procalcitonin) and MRI evidence of an epidural empyema necessitates emergent surgical intervention to limit morbidity, neurological sequelae, and mortality.

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Section: Discussionmentioning

confidence: 99%

“…[ Table 1 ] summarizes reported reviewed cases of extradural abscess following extradural analgesic injection for low back and radiculopathies to our knowledge. [ 4 , 14 , 20 , 23 , 27 , 40 , 42 ]…”

Section: Discussionmentioning

confidence: 99%

All that glitters is not gold: A spinal epidural empyema following epidural steroid injection

Brunasso

Basile

Iacopino

et al. 2020

Surgical Neurology International

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“…Carpenter et al [ 14 ] reported a case of spinal epidural abscess with discitis and vertebral osteomyelitis that was successfully treated with 6-week administration of intravenous antibiotics. Zhang et al [ 15 ] reported a case of cervical epidural abscess with a combination of intravenous vancomycin and imipenem/cilastatin.…”

Section: Discussionmentioning

confidence: 99%

Preliminary clinical study: percutaneous lumbar discectomy combined with external drainage for treatment of intervertebral disc infections with epidural abscess.

Quanping

Niu

2020

Videosurgery and Other Miniinvasive Techniques

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Introduction: Percutaneous lumbar discectomy (PLD) combined with external drainage (ED) is a new technique for the treatment of intervertebral disc infection with epidural abscess. Aim: To discuss the feasibility, safety and efficacy of PLD and ED for the treatment of intervertebral disc infections with epidural abscess. Material and methods: We enrolled 12 patients who underwent intervertebral disc infections with epidural abscess. The clinical efficacy was evaluated by visual analog scale (VAS) and standard Macnab's evaluation. Postoperative computed tomography and magnetic resonance imaging were also used to evaluate the clinical efficacy. Result: The technical success rate is 100%.

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“…(2017) noted that CESI rarely result in cervical epidural abscess (CEA). [ 13 ] In some cases they may be effectively treated with antibiotic therapy alone, but in others, they may warrant operative debridement [ Table 2 ]. [ 13 ] Their patient had a CESI, and later developed a C6-T8 CEA on MR.…”

Section: Cervical Epidural Abscess Due To Cesimentioning

confidence: 99%

“…[ 13 ] In some cases they may be effectively treated with antibiotic therapy alone, but in others, they may warrant operative debridement [ Table 2 ]. [ 13 ] Their patient had a CESI, and later developed a C6-T8 CEA on MR. The patient was effectively treated with 4 weeks of intravenous vancomycin, imipenem, and cilastatin.…”

Section: Cervical Epidural Abscess Due To Cesimentioning

confidence: 99%

Major risks and complications of cervical epidural steroid injections: An updated review

Epstein¹

2018

Surg Neurol Int

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Background:Too many patients, with or without significant cervical disease, unnecessarily undergo cervical epidural steroid injections (CESIs). These include interlaminar (ICESI) and transforaminal ESI (TF-CESI) injections that are not Food and Drug Administration (FDA) approved, have no documented long-term efficacy, and carry severe risks and complications.Methods:Here we reviewed recent reports of morbidity and mortality attributed to the various types of CESIS. Major complications included; epidural hematomas, infection (abscess/meningitis), increased neurological deficits due to intramedullary (quadriparesis/quadriplegia), and intravascular injections (e.g., vertebral artery injections leading to cord, brain stem, and cerebellar strokes). The latter injections leading to strokes were typically attributed to the particulate steroid matter (e.g., within the methylprednisolone injection solution) that embolized into the distal arterial branches.Results:Complications of cervical CESI/TF-CESI injections producing epidural hematoma, new neurological deficits (intramedullary injections), or intravascular injections resulting in strokes to the cord, brain stem, and cerebellum are often underreported. Interestingly, several other cases involving adverse events of CESI/TF-CESI may now be found in the medicolegal literature.Conclusions:Cervical epidural injecions (e.g., CESI, ICESI, and TF-CESI) which are not FDA approved, provide no long-term benefit, and are being performed for minimal to no indications. They contribute to significant morbidity and mortality, including; epidural hematomas, infection, inadvertent intramedullary cord injections or cord, brain stem, and cerebellar strokes. Furthermore, these injections are increasingly required by insurance carriers prior to granting permission for definitive surgery, thus significantly delaying in some cases necessary operative intervention, while also subjecting patients at the hands of the insurance companies, to the additional hazards of these procedures.

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Cervical epidural analgesia complicated by epidural abscess

Cited by 13 publications

References 15 publications

All that glitters is not gold: A spinal epidural empyema following epidural steroid injection

All that glitters is not gold: A spinal epidural empyema following epidural steroid injection

Preliminary clinical study: percutaneous lumbar discectomy combined with external drainage for treatment of intervertebral disc infections with epidural abscess.

Major risks and complications of cervical epidural steroid injections: An updated review

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