Diagnosis and results of different treatment regimes in patients with spinal abscesses

Lange, Manfred; Tiecks, Frank P.; Schielke, Eva; Yousry, Tarek; Haberl, Ralph; Oeckler, R.

doi:10.1007/bf01401836

Cited by 51 publications

(57 citation statements)

References 39 publications

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“…Fatsuppressed sequences are recommended by Ruiz et al [23] to adequately evaluate enhancement of the vertebral body. In agreement with the literature [5,7,13,23], we performed T1 sequences with and without contrast, as well as T2 sequences. The extent of bony destruction can be demonstrated by computed tomography [9,11].…”

Section: Discussionsupporting

confidence: 67%

“…b ap and lateral X-ray of the patient preoperatively c ap and lateral X-ray of the patient after operative treatment with a combined approach; complete bony fusion was achieved 6 months post operatively patients of our population and a combination of two in one case (Table 1). Comparable data on predisposing factors are reported in studies regarding spinal abscesses [13,22]. Thirteen patients had additional concomitant diseases, as shown in Table 2.…”

Section: Discussionmentioning

confidence: 68%

“…This helps to exclude mainly differential diagnoses like erosive osteochondrosis and tumors [10]. Epidural abscesses found in up to onethird of the cases can be visualized just as reliably by MR imaging as paraspinal abscesses [12,13,20]. T1-sequences with contrast are helpful to evaluate abscess formation in the soft tissue [7,23].…”

Section: Discussionmentioning

confidence: 99%

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Surgical treatment of spondylodiscitis in the cervical spine: a minimum 2-year follow-up

et al. 2006

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Cervical spine spondylodiscitis is a rare, but serious manifestation of spinal infection. We present a retrospective study of 20 consecutive patients between 01/1994 and 12/1999 treated because of cervical spondylodiscitis. Mean age at the time of treatment was 59.7 (range 34-81) years, nine of them female. In all cases, diagnosis had been established with a delay. All patients in this series underwent surgery such as radical debridement, decompression if necessary, autologous bone grafting and instrumentation. Surgery was indicated if a neurological deficit, symptoms of sepsis, epidural abscess formation with consecutive stenosis, instability or severe deformity were present. Postoperative antibiotic therapy was carried out for 8-12 weeks. Follow-up examinations were performed a mean of 37 (range 24-63) months after surgery. Healing of the inflammation was confirmed in all cases by laboratory, clinical and radiological parameters. Spondylodesis was controlled radiologically and could be achieved in all cases. One case showed a 15°kyph-otic angle in the proximal adjacent segment. Spontaneous bony bridging of the proximal adjacent segment was observed in one patient. In the other cases the adjacent segments radiologically showed neither fusion nor infection related changes. Preoperative neurological deficits improved in all cases. Residual neurological deficits persisted in three of eight cases. The results indicate that spondylodiscitis in cervical spine should be treated early and aggressive to avoid local and systemic complications.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 68%

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Surgical treatment of spondylodiscitis in the cervical spine: a minimum 2-year follow-up

et al. 2006

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“…18 For one patient, a conventional suction drain was changed to a suction/irrigation system with closure of the wound and a very satisfactory result. 19,28,30,31 Lange et al 31 claimed signi®cantly better survival rates and neurological outcome in patients treated with suction/irrigation systems compared to conventional drainage systems. We were unable to substantiate such a di erence in outcome.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Extradural infections of the spine

Klekamp

Samii

1999

Spinal Cord

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Objectives:We have observed a recent increase in the incidence of spinal extradural infections. To determine postoperative outcome and prognosis we have undertaken a retrospective study on patients with spinal extradural abscesses between 1978 and 1996 treated in the Department of Neurosurgery at the Nordstadt Hospital in Hannover, Germany. Methods: Case records, outpatient ®les, operation notes, neuroradiological examinations and pathological reports were analysed. Neurological function was documented using a score system for each symptom. Results: Twenty-two patients underwent 24 operations during the study period. Staphylococcus aureus was the organism most commonly isolated. Patients presented after a mean history of 1.8+2.6 months with acute development of severe para-or tetraparesis and were followed up for an average period of 6+7 months. Two groups were distinguished. One group was characterized by epidural collections of pus (14 patients). Two patients in this group were not operated due to their moribund state and died from uncontrollable septicemia. Two of the remaining 12 operated patients died within 30 days after surgery due to generalized septicemia or other medical problems unrelated to the spinal involvement. Of the ten surviving patients, ®ve sustained major neurological de®cits, whereas the remaining ®ve patients made an incomplete recovery. The second group consisted of eight patients in a signi®cantly better pre-operative health condition in whom granulomatous material was obtained during the operation and the outcome was considerably better. No patient in this group died. Six patients recovered with no or mild neurological de®cits. Conclusion: Spinal extradural infections require immediate surgical intervention. Neurological outcome depends on the pre-operative neurological status. Survival is determined by the general health condition of the patient.

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“…Intradural abscess, similarly to epidural abscess, has a poor prognosis due to accumulation of purulent material, compressing the spinal cord and compromising its vascular supply, although reports of a good treatment outcome have been described [4,6,17,19]. The most effective treatment of spinal intradural abscess is an immediate surgical evacuation followed by a long-term antimicrobial therapy, which may be adjusted according to the results of antibiogram [7,15,17]. From our experience, we agree that a prompt surgical treatment should be performed particularly in cases with severe neurologic deficits.…”

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confidence: 99%