Management of Spinal Epidural Abscess and Subdural Empyema

Kim, Kee D.; Johnson, J. Patrick; Masciopinto, J. E.

doi:10.1097/00127927-199905040-00006

Cited by 2 publications

(4 citation statements)

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“…The incidence of spinal infection is progressively increasing in western countries, probably due to several different factors: progressive population ageing, diffusion of diabetes, migration from developing countries, and so forth. 17,30,39,60 The majority of spondylodiscitis cases are pyogenic and affect the thoracic level. Gram-positive organisms, including several species of Staphylococcus and Streptococcus, usually sustain the pyogenic infections.…”

Section: Spinal Infectionsmentioning

confidence: 99%

“…67 Osteomyelitis and abscess are the conditions that more frequently require surgery just because they are more likely responsible for bone destruction and instability and/or neural compression. The timing and type of surgery to perform in these cases have been debated often, 17,30,39,60 and some criticisms and doubts have been reported about the safety of instrumentation during the acute infection phase, particularly in cases of tubercular abscess. 39,45 All patients in this series presented with relatively quick neurological deterioration, and thus there was no doubt that they had to undergo surgery during the acute phase.…”

Section: Spinal Infectionsmentioning

confidence: 99%

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Anterior approach to thoracic and lumbar spine lesions: results in 145 consecutive cases

D’Aliberti¹,

Talamonti²,

Villa³

et al. 2008

SPI

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Object The authors report on a series of 145 consecutive patients with different types of spine lesions surgically treated via an anterior approach (AA) at the thoracic and lumbar levels during the past 10 years. Indications, techniques, and surgical results are described. Methods This series included 92 patients with fractures, 30 with neoplasms, 13 with thoracic disc hernias, and 10 with spinal infections. Based on the lesion to be addressed, the AA was used for lesion excision, corpectomy, vertebral body reconstruction with cages, realignment, and/or plating or screwing. The approach was extracavitary in 55 patients and intracavitary in 90. In 126 patients (86.8%), neural decompression and spine stabilization were achieved via a stand-alone AA (SA-AA), whereas 19 patients (13.1%) were treated using a 2-stage anteroposterior approach. This circumferential approach was reserved for select cases of severe traumatic dislocation, particular types of tumors, or specific anatomical locations. The authors developed a simple neuronavigation-based method of identifying the severely injured patients who were eligible for the SA-AA by evaluating the angle of lateral dislocation. Results There were no deaths and no instances of major surgery-related morbidity. Minor morbidity was almost always transitory and was reported in 13 patients (8.9%). Neurological improvement was reported in 20% of injured patients with a preoperative incomplete lesion. Postoperatively, all patients were able to stand or at least sit without load pain. During the follow-up (mean ± standard deviation 3.8 ± 2.4 years), there were no cases of failure, fracture, dislocation, or bending of the anterior instrumentation, and the rate of pseudarthrosis was 0%. Conclusion The anterior route provides direct access to most spine diseases and allows optimal neural decompression and the possibility of adequate realignment and strong reconstruction/fixation. Stability of the vertebral column is achieved, resolution of clinical pain is rapid and almost complete, and the rate of surgical complications is very low. The authors assert that the SA-AA offers so many advantages and has such good results that the 2-stage anteroposterior approach can be reserved for a minority of select cases and that the time for using the posterior approach alone is over.

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Section: Spinal Infectionsmentioning

confidence: 99%

Section: Spinal Infectionsmentioning

confidence: 99%

Anterior approach to thoracic and lumbar spine lesions: results in 145 consecutive cases

D’Aliberti¹,

Talamonti²,

Villa³

et al. 2008

SPI

View full text Add to dashboard Cite

show abstract

“…However, there is still no consensus about the surgical timing [9] and the proper operative approach: posterior, anterior or combined ''back and front'' [19,20]. Although this series included patients who underwent emergency laminectomy, we do not think this treatment should be recommended.…”

Section: Surgical Approachesmentioning

confidence: 90%

“…This is probably related to several factors such as the progressively aging population, diffusion of diabetes and migration from developing countries [9]. The majority of spondylodiscitis are pyogenic and sustained by Gram-positive organisms such as Staphylococcus and Streptococcus and affect more commonly the thoracic spine.…”

Section: Epidemiology and Surgical Indicationsmentioning

confidence: 99%

The anterior stand-alone approach (ASAA) during the acute phase of spondylodiscitis: results in 40 consecutively treated patients

et al. 2012

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Purpose Spondylodiscitis mainly affects the anterior part of the spine. In this paper, we retrospectively analyze our experience with the anterior stand-alone approach (ASAA) in the treatment of spinal infections. Methods Forty consecutive patients with severe spondylodiscitis underwent the ASAA during the acute infective phase. Treatment consisted of disease debridement, vertebral body reconstruction using titanium expandable prostheses and anterior fixation. Results There was neither mortality nor major morbidity. Successful arthrodesis was achieved in 39 out of 40 patients who remained disease free throughout the followup period. Six months after treatment, one patient experienced pseudarthrosis and required supplemented posterior spinal fixation for vertebral instability. However, adequate arthrodesis was eventually obtained even in this patient. Conclusions ASAA with spine reconstruction using synthetic materials during the acute infection phase was safe and effective. The infections were rapidly defeated, the patients were allowed to stand up early after the procedure and the length of hospital stay was significantly reduced.

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Management of Spinal Epidural Abscess and Subdural Empyema

Cited by 2 publications

References 0 publications

Anterior approach to thoracic and lumbar spine lesions: results in 145 consecutive cases

Anterior approach to thoracic and lumbar spine lesions: results in 145 consecutive cases

The anterior stand-alone approach (ASAA) during the acute phase of spondylodiscitis: results in 40 consecutively treated patients

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