Computed Tomography of Nontuberculous Spinal Infection

Whelan, Margaret; Schonfeld, Steven A.; Post, Judith D.; Svigals, Paul; Meisler, William J.; Weingarten, Karen; Kricheff, Irvin I.

doi:10.1097/00004728-198503000-00010

Cited by 33 publications

(15 citation statements)

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“…The lowest age was reported by Dei-Anang et al [80], who found a mean age of only 34 years in a group of 15 patients. Maslen et al [231] reported a mean of 67 years of age in a group of 28 patients with SEA, which represents the highest average age in all published case series [16,31,73,74,80,81,98,141,154,172,177,189,201,212,213,231,235,253,283,297,300,306,316,370,391,401]. However, Dei-Anang et al [80] included in their patient group four children aged 2 to 6 as well as five patients from 19 In this review, articles published between 1954 and 1997 concerning a total of 915 patients with SEA were statistically analyzed [1, 3-5, 11-14, 16, 17, 24, 31-33, 35-40, 43-46, 50, 55, 57-61, 63, 65, 66, 70, 71, 73, 74, 77, 79-81, 84-86, 89, 92-94, 96-100, 103-108, 110, 115-117, 121-124, 126-128, 133, 134, 137, 138, 141-143, 146-149, 152, 154, 156, 158, 160, 161, 166, 168, 170, 172, 176-178, 180-182, 184-189, 191, 193, 194, 198-202, 204, 206, 208, 211-217, 220, 222-227, 229, 231-233, 235, 237, 240-242, 244, 245, 250, 253, 254, 256, 259, 260, 264-266, 269-271, 273, 276-278, 280, 283, 293, 294, 297-300, 303-306, 308, 311, 315-318, 321, 324, 326-328, 330, 332, 335, 336, 339, 341-343, 345-348, 351, 352, 354, 357-359, 362, 365, 370, 372, 373, 379-385, 388, 390, 391, 395, 397-399, 401, 403].…”

Section: Epidemiologymentioning

confidence: 98%

“…All large case series observed a preference for the male gender in the development of SEA [31,73,74,80,81,98,141,154,172,177,189,201,212,213,231,235,253,283,297,300,316,370,391,401]. Only one article on a series of 39 patients with SEA [16] reports a male:female ratio of 0.5:1.…”

Section: Epidemiologymentioning

confidence: 99%

“…Other gramnegative bacteria were identified in individual cases. Spinal epidural abscess due to Escherichia coli and Pseudomonas aeruginosa was described in case series that did not undertake differentiated analysis of infection sources or risk factors [16,74,81,98,154,172,177,189,213,235,300,391]. There are only five published case reports that allow such an analysis; SEA due to Escherichia coli was identified in two diabetic patients, one of whom was also alcoholic and underwent several endoscopic investigations because of pancreatitis [148,327] and the other three case reports described Pseudomonas aeruginosa as the infectious agent [24,278,351].…”

Section: Causative Organismsmentioning

confidence: 99%

“…The introduction of CT into routine clinical use at the beginning of the 1980s replaced myelography as the diagnostic method of first choice for patients with SEA [41,52,181,211,270,354,391]. Computed tomographic imaging enables axial tomographs of the spine with high resolution and reproducibility.…”

Section: Diagnosismentioning

confidence: 99%

“…In one of the patients reported by O'Sullivan et al, only the use of myelo-CT enabled a definitive diagnosis, which had not been possible with CT alone [270]. The diagnostic value of CT in patients with SEA can also be increased by the application of intravenous contrast medium [354,391]. Spinal radiograph 53 34 142 31 90 17 Myelography 104 66 104 23 112 21 Computed tomography --33 7 56 11 Myelography and computed tomography --89 20 96 18 MRI --38 8 90 17 Gadolinium-enhanced MRI ----57 11 Isotopic examinations* --50 11 28 5 Total 157 100 456 100 529 100 *Includes radioisotope bone scan, 111 indium scan, 67 gallium, and 99m technetium scan.…”

Section: Diagnosismentioning

confidence: 99%

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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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Section: Epidemiologymentioning

confidence: 98%

Section: Epidemiologymentioning

confidence: 99%

Section: Causative Organismsmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

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Spinal epidural abscess: a meta-analysis of 915 patients

Waldbaur²,

2000

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Vertebral osteomyelitis with a rare etiology diagnosed by fine‐needle aspiration cytology

Bn¹,

Kini²,

Berndt³

2010

Diagnostic Cytopathology

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Invasive fungal infections are rare in immunocompromised individuals, but are not uncommon in immunologically compromised patients. Bone involvement by these infections, though exceedingly rare, may occur due to direct extension of the infection from a neighboring organ or due to hematogenous dissemination in critically ill patients. Still rarer is the invasive aspergillosis involving either the vertebral body or the intervertebral disc with extension into the extradural space as an abscess. We report one such case of vertebral osteomyelitis due to Aspergillus diagnosed by FNAC in a well-controlled diabetic patient who presented with nonspecific symptoms and in whom a clinical and radiological diagnosis of Pott's spine was considered. The present case stresses the importance of early cytologic diagnosis of vertebral Aspergillus osteomyelitis, which in conjunction with appropriate timely medical and surgical treatment, offers good recovery without much sequelae or threat to life.

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Diagnostic Imaging of CNS Infection and Inflammation

Bowen¹,

Post²

1990

Infections of the Nervous System

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Computed Tomography of Nontuberculous Spinal Infection

Cited by 33 publications

References 0 publications

Spinal epidural abscess: a meta-analysis of 915 patients

Spinal epidural abscess: a meta-analysis of 915 patients

Vertebral osteomyelitis with a rare etiology diagnosed by fine‐needle aspiration cytology

Diagnostic Imaging of CNS Infection and Inflammation

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