<p>Studies on 11 Cases of Spinal Epidural Abscess and Literature Review</p>

Abstract

In the present study, we aimed to describe the clinical features, diagnosis, treatment, and prognosis of spinal epidural abscess (SEA). Methods: The complete clinical data of 11 SEA patients who were treated in our hospital system from January 2015 to June 2018 were retrospectively analyzed. Moreover, the clinical features, diagnosis, treatment, and prognosis of 642 SEA cases collected from the foreign literature from 2010 to 2019 were also investigated. Results: Among our 11 SEA patients, nine cases had purulent inflammation, two cases had tuberculosis, two cases had infection caused by Staphylococcus aureus, one case had infection caused by Streptococcus constellatus, one case had infection caused by Klebsiella pneumoniae, five cases showed negative bacterial culture, and two cases had Mycobacterium tuberculosis. All 11 cases showed focal spinal pain, eight cases exhibited neurological deficits, and six cases experienced fever. Nine of the 11 cases involved the lumbosacral spine, one case involved the thoracic spine, and one case involved the cervical spine. Eight patients had a longer course of disease (>2 weeks), all 11 patients had vertebral osteomyelitis, and nine patients had intervertebral discitis. One patient had motor dysfunction of arms and legs, one patient had lower limb motor dysfunction, one patient had limb numbness, one patient experienced relapse after the conservative treatment, and one patient experienced relapse after the surgical treatment. The follow-up time was 15-24 months. Conclusion: The classic diagnosis of triads (focal spine pain, neurological deficit, and fever) was less specific for SEA. MRI examination, blood culture, tissue culture, and biopsy could be used for the diagnosis for SEA. Suppuritis was a common cause of SEA. Early detection, early diagnosis and early treatment, as well as the selection of the most suitable treatment regimen based on comprehensive evaluation, played crucial roles in a better prognosis of SEA. There was no statistically significant difference in terms of the general condition, diagnosis, treatment and prognosis between the patients with negative and positive culture results (P>0.05). For SEA patient with negative culture, antibiotic treatment should be used empirically.

Fatal Cervical Spinal Epidural Abscess and Spondylodiscitis Complicated With Rhombencephalitis Caused by Klebsiella pneumoniae: A Case Report and Literature Review

“…Among gram-negative SEA and spondylodiscitis, promptly combined therapy of both surgical drainage and antimicrobial therapy remains crucial [11]. Eight of 10 patients with K. pneumoniae SEA from related reports encountered favorable outcomes after combined surgical and medical therapy [7][8][9][10]13,14]. However, only two cases recovered after being conservatively treated with antibiotics [6,11].…”

“…Klebsiella pneumoniae are the family members of Enterobacterales, which are capable of causing various types of community-acquired and healthcare-associated infection (HAI), e.g., pneumonia, internal organ abscess, and bacteremia [5]. Currently, few cases have been reported with isolated and spontaneous K. pneumoniae SEA [6][7][8][9][10][11][12][13][14]. Here, we report the case of fatal isolate and spontaneous K. pneumoniae spondylodiscitis and SEA involving C1-C7 complicated with rhombencephalitis in a patient with diabetes.…”

Cervical Epidural Abscess

“…An additional difficulty in the diagnosis of epidural abscess is the limitation of imaging modalities. Gadolinium-enhanced MRI is the imaging modality of choice, with sensitivity and specificity of greater than 90% and shows a high T2 signal and low T1 signal 5,14 . Unfortunately, CT and plain radiograph images are not as accurate, are of most use when bone involvement is present, and early stages of infection may not show appreciable features 13,14 …”

Case Report: Diagnosis of Primary Klebsiella pneumoniae in Cervical Spine by Metagenomic Next-Generation Sequencing

“…The most common pathogen of spinal infection is Staphylococcus aureus , followed by Streptococcus and Enterococcus ( 3 ). Klebsiella pneumoniae is a common pathogen of nosocomial infections, yet there are few reports of spinal infections caused by K. pneumoniae ( 4 , 5 ). Cervical infection by K. pneumoniae especially preoperative is extremely rare.…”