Epidural Spinal Infection in Intravenous Drug Abusers

Koppel, Barbara S.; Tuchman, Alan J.; Mangiardi, John R.; Daras, Michael; Weitzner, Imre

doi:10.1001/archneur.1988.00520360049011

Cited by 92 publications

(31 citation statements)

References 12 publications

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“…Bacteremia is also an important predisposing factor because the incidence of SEA is increased in patients who use injection drugs and in those who have intravenous catheters or infective endocarditis (2,3).…”

Section: Discussionmentioning

confidence: 99%

Spinal Epidural Abscess in Hemodialysis Patients

Wong

Daka²,

Pastewski

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummarySpinal epidural abscess (SEA) is a rare but potentially devastating condition. We noticed an increase in the number of cases of SEA, with the majority in hemodialysis (HD) patients. This prompted a retrospective chart review of all cases of SEA admitted from 2000 to 2005 and a literature search of similar cases. We identified 19 SEA cases treated at Long Island College Hospital during this 6-year period, of which six were on HD: four were dialyzed via catheter, one via arteriovenous fistula, and in one the method of dialysis was not documented. Four patients had bacteremia with Staphylococcus aureus. Four patients presented with paresis or paralysis; only one improved. The mortality rate was 33% (2/6). We found 30 other cases of SEA in patients on HD from the literature. These 36 HD cases were compared with 85 SEA cases that were not on HD (13 from our study and 72 described in two large case series). The mortality rate was noted to be much higher in HD patients (23% [6/26] versus 7% [6/85]). Neurologic deficit at presentation was noted in 47% (17/36) of HD patients versus 69% (59/85) of non-HD patients, but neurologic improvement was higher in non-HD patients (71% [42/59] versus 29% [5/17]). This is the largest literature review of SEA in patients on HD. When compared with non-HD patients, HD patients had a higher mortality rate and were less likely to improve neurologically.

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Section: Discussionmentioning

confidence: 99%

Spinal Epidural Abscess in Hemodialysis Patients

Wong

Daka²,

Pastewski

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…Mild left leg weakness, diminished deep tendon reflexes, lumbosacral tenderness, paraspinous muscle spasm, and urinary retention in the presence of sepsis, increased the possibility of an epidural space infection. 3 Contrast-enhanced CT scan of the lumbar spine and pelvis was initially normal, but one week later showed swelling of the left iliacus and piriformis muscles. The diagnosis was therefore compatible with inflammatory myositis, probably pyogenic in nature, a The source of the infection could have been acquired by direct extension from her perineal laceration (forceps trauma) or from a transient bacteraemia arising from the 'genitourinary or gastrointestinal tracts.…”

Section: Discussionmentioning

confidence: 99%

Piriformis pyomyositis mimicking epidural abscess in a parturient

et al. 1995

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“…Almost all reviews and case series on spinal epidural abscess emphasize this point [8,16,31,67,80,82,98,154,158,164,179,189,195,201,213,214,230,232,235,262,264,283,297,300,306,309,314,316,330,350,366,378,401]. Immediate therapy is necessary to prevent compression of the spinal cord and cauda equina, with the corresponding neurological lesions (Fig.…”

Section: Introductionmentioning

confidence: 99%

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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Epidural Spinal Infection in Intravenous Drug Abusers

Cited by 92 publications

References 12 publications

Spinal Epidural Abscess in Hemodialysis Patients

Spinal Epidural Abscess in Hemodialysis Patients

Piriformis pyomyositis mimicking epidural abscess in a parturient

Spinal epidural abscess: a meta-analysis of 915 patients

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