Der akute spinale Epiduralabszeß

Abstract

An acute spinal epidural abscess is a rare cause of paraplegia, seen in seven patients over a period of ten years. All patients had fever and severe localized back-pain. Unless treated, within hours or a few days, there will be root defects and rapidly progressive paraplegia. Staphylococcus is the most frequent causative organism and clinically manifest septicaemia is common. Rapid diagnosis and treatment are essential in deciding the patient's fate. Myelography is an important additional examination as it demonstrates the abscess in 96% of cases. Non-contrast radiology is of little value. High-dosage antibiotics and surgical spinal decompression are the cardinal treatment procedures. Antibiotics alone are justified only so long as there are no neurological deficits and neurosurgical intervention, if needed, is immediately available.

Spinal epidural abscess in clinical practice

“…The current annual incidence is estimated to be 2.5-3 per 10 000 hospital admissions. [2][3][4][5][6][7][8][9][10] This trend can be partly explained by the growing number of patients with predisposing conditions or risk factors, such as diabetes mellitus, higher age or intravenous drug use. Instrumentation of the vertebral canal by anaesthetic interventions is also a risk factor contributing to the incidence rate of SEA.…”

“…SEA occurs in all age groups. 11 However, a greater prevalence between the fifth and seventh decade of life [3][4][5][6][7][8]12 and a male predominance 4,[6][7][8]11 have been described in many studies. This might be due to the fact that the reported predisposing conditions and risk factors are more prevalent in older people.…”

“…As the abscess increases in size, it extends along the dural sheath, and therefore usually involves several segments. [3][4][5][6][7]13,14 SEA is typically located in the 'true' posterior space. Abscesses located anterior of the spinal cord are frequently but not exclusively associated with vertebral osteomyelitis.…”

Epidural infection: Is it really an abscess?

“…[2] Since then, numerous reports document an increasing incidence: reports between 1992 and 2006 state an incidence of 2.5-3 per 10,000 hospital admissions. [712–142335424347] The increased recognition of this infection likely relates to the improved accuracy in diagnoses imparted by magnetic resonance imaging (MR). [1618] This trend in the United States is also reflective of an aging population with predisposing conditions or risk factors, such as diabetes mellitus, immunosuppressive therapy, cancer, human immunodeficiency virus (HIV), intravenous drug use, and renal failure.…”

“…[1618] This trend in the United States is also reflective of an aging population with predisposing conditions or risk factors, such as diabetes mellitus, immunosuppressive therapy, cancer, human immunodeficiency virus (HIV), intravenous drug use, and renal failure. [2121423354147] Additionally, the increased use of epidural procedures for anesthesia or pain control likely contributes to these overall numbers despite the low 0.001% incidence of epidural abscess following catheter insertion. [51] Lastly, there are reports documenting occurrence at any age, however, the greatest prevalence occurs in the fifth to seventh decade of life, with a male-to-female ratio of 1:1.…”