CT guided aspiration of a cervical spinal epidural abscess

Rust, T.M.; Kohan, S.; Steel, Timothy; Lonergan, Roisin

doi:10.1016/j.jocn.2004.08.009

Cited by 19 publications

(4 citation statements)

References 26 publications

(54 reference statements)

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“…In the more recent literature less invasive techniques have been suggested. Recently, a case was presented where a cervical epidural abscess at the C2level was treated with CT-guided aspiration and antibiotic therapy [7]. In conclusion the complication we described is exceptional for hip fracture surgery; however, the possibly serious Fig.…”

Section: Discussionmentioning

confidence: 72%

Epidural Metastatic Abscess from an Infected Femoral Head Prosthesis Presenting with Hemiplegia

Roemeling¹,

Elst²

2005

Osteosynthesis and Trauma Care

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Section: Discussionmentioning

confidence: 72%

Epidural Metastatic Abscess from an Infected Femoral Head Prosthesis Presenting with Hemiplegia

Roemeling¹,

Elst²

2005

Osteosynthesis and Trauma Care

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“…Both minimally invasive and open approaches have been described in the literature. Less invasive techniques include the use of CT guided percutaneous drainage, and the use of microsurgical tubular retractor systems [4,18,19] . Open access to the spinal abscess collection may be attained via a laminectomy, laminotomy or inter-laminar approach.…”

Section: Discussionmentioning

confidence: 99%

Holospinal epidural abscess: An unexpected find

Calderón¹,

Haralsingh²,

Ramnarine³

2020

Int. J. Orthop. Sci.

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Introduction: Spinal epidural abscesses present infrequently in surgical practice resulting in neurological morbidity, and mortality. A rare find is the presence of an abscess involving the entire cervical, thoracic and lumbosacral regions of the spine, with limited reported cases in literature. When this is encountered urgent neurosurgical intervention is required to improve patient prognosis. Case Description: A 58-year-old, poorly controlled type II diabetic male, presented with a 3-week history of lower back pain and progressive limitation in ambulation. Further deterioration was observed in-hospital, with a sudden decline in power of the lower limbs from a Medical Research Council (MRC) grade 5 to 2. This prompted urgent magnetic resonance imaging of the whole spine, which depicted an epidural abscess extending from the cervical vertebrae -C3, to the sacrum -S1, with resulting compression of the spinal cord. An emergency multi-level laminectomy was performed with drainage of the epidural space. There was resolution of his sensory deficits and objective improvement in power of the lower limbs post-operation. Culture reports showed the culprit organism to be Escherichia coli. Conclusion:Severe back pain in the diabetic patient requires careful assessment and monitoring. Emergency surgical decompression within 72 hours of neurological symptoms improves prognostic outcomes in patients with spinal epidural abscesses. We contend that performing a multi-level laminectomy procedure is the best option for an extensive posterior spinal epidural abscesses without bony involvement. Other methods such as image-guided percutaneous drainage, catheter procedures and intermediate level fenestration procedures, while less invasive, may be more likely to fail.

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“…The white blood cell count is normal in half of the SEA cases, and if elevation is present, it is usually a moderate one and does not contribute to the SEA diagnosis. Blood cultures may grow the infecting organism, especially in those with hematogenous spread and in intravenous drug abusers [8]. The most frequently grown organism in cultures is Staphylococcus aureus [9].…”

Section: Discussionmentioning

confidence: 99%

“…But in cases of spontaneous abscess formation, in the absence of predisposing factors or when clinical and laboratory findings are not suggestive of an abscess, like it was in our case, diagnosis may be a real challenge. Early diagnosis and treatment are of utmost importance in decreasing the mortality and morbidity risks of SEA considering its high mortality (5-31%) and morbidity rates [8]. Cases of misdiagnosed spontaneous epidural abscesses showing significant contrast enhancement in the routine MR images have been reported in the medical literature [10].…”

Section: Discussionmentioning

confidence: 99%

A posterior epidural mass causing paraparesis in a 20-year-old healthy individual

2009

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We present a case of a posterior epidural abscess at the thoracic vertebral level causing paraparesia in a young, healthy individual with no otherwise predisposing factors, with normal laboratory findings, as diagnosed using fat-suppressed MR imaging. Spinal epidural abscess is a rare condition, encountered mostly in the midthoracic or lower lumbar vertebral levels of elderly patients, that has a high mortality and morbidity (18-31%) when diagnosis and treatment is delayed. It is rarely spontaneous and is usually accompanied by spinal osteomyelitis. Diagnosis is rather easy in cases of vertebral osteomyelitis or when classical clinical, laboratory and imaging findings are present. However, cases of spontaneous development, with no predisposing factors, and lack of abscess suggesting clinical and laboratory findings may be a diagnostic challenge. In such cases, other posterior epidural masses such as schwannoma, neurofibroma, meningioma and hematoma should be considered in the differential diagnosis. Both the clinician and the radiology physician should have a high suspicion of epidural abscesses, because their early diagnosis and treatment is important. In addition to routine MR images, fat-suppressed MR images prove helpful in the diagnosis of spontaneous epidural abscesses by showing the inflammatory changes in the paraspinal area.

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CT guided aspiration of a cervical spinal epidural abscess

Cited by 19 publications

References 26 publications

Epidural Metastatic Abscess from an Infected Femoral Head Prosthesis Presenting with Hemiplegia

Epidural Metastatic Abscess from an Infected Femoral Head Prosthesis Presenting with Hemiplegia

Holospinal epidural abscess: An unexpected find

A posterior epidural mass causing paraparesis in a 20-year-old healthy individual

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