High risk and low prevalence diseases: Spinal epidural abscess

Long, Brit; Carlson, Jestin N.; Montrief, Tim; Koyfman, Alex

doi:10.1016/j.ajem.2022.01.008

Cited by 13 publications

(13 citation statements)

References 77 publications

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“…SEA, also known as a spinal epidural infection, is a rare but serious condition that carries with it a high rate of mortality and associated factors, including immunocompromise, bacteremia, and adjacent infection, 6 characterized by insidious manifestations and variable progression that can cause serious neurological complications. Streptococcus constellatus is an extremely rare SEA pathogen with only a few cases.…”

Section: Discussionmentioning

confidence: 99%

Acute Spinal Epidural Abscess of the Cervical Spine Caused by Streptococcus constellatus Leads to Paraplegia in an Adult: A Case Report

Zhang¹,

Lai²,

Li³

et al. 2023

IDR

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The incidence of a spinal epidural abscess (SEA), which can cause serious neurological complications, is low; however, the incidence of SEA caused by Streptococcus is even lower, most of which are reported in the thoracolumbar spine and lumbosacral segment. We reported a case of cervical SEA caused by Streptococcus constellatus infection, resulting in paralysis of the patient. The acute onset of SEA in a 44-year-old male led to decreased upper limb muscle strength, lower limb paralysis, and loss of bowel and bladder function, and imaging and blood tests suggested pyogenic spondylitis. Emergency decompression surgery and antibiotic therapy were given, the patient gradually recovered, and the muscle strength of the lower limbs gradually improved. This case report suggests the importance of early decompressive surgery and effective antibiotic therapy.

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Section: Discussionmentioning

confidence: 99%

Acute Spinal Epidural Abscess of the Cervical Spine Caused by Streptococcus constellatus Leads to Paraplegia in an Adult: A Case Report

Zhang¹,

Lai²,

Li³

et al. 2023

IDR

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“…SEA can be secondary to bacteremia caused by any factor ( 15 ), of which diabetes is a common complication, occurring in 21%–43% of patients with SEA ( 8 ). The placement of an epidural catheter is also an important risk factor for SEA, with an incidence rate of 0.5%–3.0% ( 23 , 24 ).…”

Section: Discussionmentioning

confidence: 99%

“…The classic triad of diagnostic significance is fever, back pain, and neurological dysfunction ( 9 ). Unfortunately, <8% patients exhibit these three manifestations simultaneously ( 8 ). For severe localized back pain and fever, SEA or spinal osteomyelitis should be considered.…”

Section: Discussionmentioning

confidence: 99%

“…This trend may be due to the growing population of immunocompromised patients with cancer and diabetes, and the increasing number of invasive spinal surgeries. The mean age of SEA is 50 years with most cases occurring between the ages of 30 and 70 years, though children may be rarely affected ( 1 , 2 , 7 , 8 ). Although typical SEA symptoms include fever, back pain, and progressive neurological dysfunction ( 9 ), approximately 50% of patients have either back pain or other non-specific manifestations ( 10 , 11 ), leading to a high rate of misdiagnosis and inevitably missed diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Extensive spinal epidural abscess caused by Staphylococcus epidermidis: A case report and literature review

Gong

Jiang

et al. 2023

Front. Surg.

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BackgroundExtensive spinal epidural abscess (SEA) is an exceptional and threatening condition that requires prompt recognition and proper management to avoid potentially disastrous complications. We aimed to find key elements of early diagnosis and rational treatments for extensive SEA.Case presentationA 70-year-old man complained of intense pain in the cervical-thoracic-lumbar spine that radiated to the lower extremity. Laboratory test results revealed a marked increase in all indicators of infection. The spinal magnetic resonance imaging (MRI) revealed a ventral SEA extending from C2 to L4. Owing to the patient's critical condition, laminectomy, drainage, and systemic antibiotic therapy were administered. And the multidrug-resistant Staphylococcus epidermidis was detected in the purulent material from this abscess.ResultsPostoperative MRI revealed diminished epidural abscess, and the clinical symptoms were dramatically and gradually relieved after two rounds of surgery and systemic antibiotic therapy involving the combination of ceftriaxone, linezolid, and rifampicin.ConclusionsA comprehensive emergency assessment based on neck or back pain, neurological dysfunctions, signs of systemic infection, and MRI are important for early diagnosis of extensive SEA. Further, the combination of laminectomy, drainage, and systemic antibiotic therapy may be a rational treatment choice for patients with SEA, especially for extensive abscess or progressive neurological dysfunction.

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“…Diagnostic delays occur in up to 75% of cases and increase risks for permanent neurological deficits by sixfold. 1 Early SEA presentations are difficult to distinguish from other back pain etiologies. The classic triad (back pain, fever, neurologic deficit) occurs in <8% of cases.…”

Section: Introductionmentioning

confidence: 99%

Implementation of an emergency department back pain clinical management tool on the early diagnosis and testing of spinal epidural abscess

Cai

Zocchi

Carlson

et al. 2023

Academic Emergency Medicine

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BackgroundSpinal epidural abscess (SEA) is a rare, catastrophic condition for which diagnostic delays are common. Our national group develops evidence‐based guidelines, known as clinical management tools (CMT), to reduce high‐risk misdiagnoses. We study whether implementation of our back pain CMT improved SEA diagnostic timeliness and testing rates in the emergency department (ED).MethodsWe conducted a retrospective observational study before and after implementation of a nontraumatic back pain CMT for SEA in a national group. Outcomes included diagnostic timeliness and test utilization. We used regression analysis to compare differences before (January 2016–June 2017) and after (January 2018–December 2019) with 95% confidence intervals (CIs) clustered by facility. We graphed monthly testing rates.ResultsIn 59 EDs, pre versus post periods included 141,273 (4.8%) versus 192,244 (4.5%) back pain visits and 188 versus 369 SEA visits, respectively. After implementation, SEA visits with prior related visits were unchanged (12.2% vs. 13.3%, difference +1.0%, 95% CI –4.5% to 6.5%). Mean number of days to diagnosis decreased but not significantly (15.2 days vs. 11.9 days, difference −3.3 days, 95% CI −7.1 to 0.6 days). Back pain visits receiving CT (13.7% vs. 21.1%, difference +7.3%, 95% CI 6.1% to 8.6%) and MRI (2.9% vs. 4.4%, difference +1.4%, 95% CI 1.0% to 1.9%) increased. Spine X‐rays decreased (22.6% vs. 20.5%, difference 2.1%, 95% CI –4.3% to 0.1%). Back pain visits receiving erythrocyte sedimentation rate or C‐reactive protein increased (1.9% vs. 3.5%, difference +1.6%, 95% CI 1.3% to 1.9%).ConclusionsBack pain CMT implementation was associated with an increased rate of recommended imaging and laboratory testing in back pain. There was no associated reduction in the proportion of SEA cases with a related prior visit or time to SEA diagnosis.

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High risk and low prevalence diseases: Spinal epidural abscess

Cited by 13 publications

References 77 publications

Acute Spinal Epidural Abscess of the Cervical Spine Caused by Streptococcus constellatus Leads to Paraplegia in an Adult: A Case Report

Acute Spinal Epidural Abscess of the Cervical Spine Caused by Streptococcus constellatus Leads to Paraplegia in an Adult: A Case Report

Extensive spinal epidural abscess caused by Staphylococcus epidermidis: A case report and literature review

Implementation of an emergency department back pain clinical management tool on the early diagnosis and testing of spinal epidural abscess

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