Medical vs Surgical Management of Spinal Epidural Abscess

Siddiq, Farhan; Chowfin, Ashish; Tight, Robert R.; Sahmoun, Abe E.; Smego, Raymond A.

doi:10.1001/archinte.164.22.2409

Cited by 155 publications

(118 citation statements)

References 16 publications

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“…Our rough estimate of the incidence of SEA at 1.8/100,000 persons per year accords with other published estimates [1,2], although its appearance after only 1.1% of the spinal operations performed by our neurosurgical service seems less frequent than others have reported [8]. We found that the commonest pathogen causing SEA was Staphylococcus aureus, just as in other reports [4,5,12,13,15,21,22]. SEA is usually associated with one or more comorbidities [7]; the list of our patients' comorbidities resembles the corresponding lists in other reported series [4,5,8,12].…”

Section: Discussionsupporting

confidence: 90%

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Spinal epidural abscess: aetiology, predisponent factors and clinical outcomes in a 4-year prospective study

et al. 2011

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Spinal epidural abscess (SEA) is a rare, but serious, condition with multiple causes. We prospectively studied the aetiology, predisposing factors, and clinical outcomes of SEA in all patients with SEA treated in our hospital's neurosurgical service from 2004 to 2008. For each patient, we recorded the medical history, comorbidities, focus of infection, pathogen(s), and outcome. The 36 patients (19 women and 17 men) ranged in age from 34 to 80 years old (mean 57; median 56). The SEA was primary (i.e., due to haematogenous spread) in 16 patients (44%); it was secondary to elective spinal procedures, either injections or surgery, in 20 patients (56%). The duration of follow-up was 12-60 months (mean 36; median 37.5). The most common pathogen, Staphylococcus aureus, was found in 18 patients (50%). Patients with primary SEA had different underlying diseases and a wider range of pathogens than those with secondary SEA. Only five patients (14%) had no major comorbidity; 16 of the 20 patients with secondary SEA (44% of the overall group) had undergone spinal surgery before developing the SEA; the treatment of the SEA involved multiple surgical operations in all 16 of these patients, and spinal instrumentation in 5 (14%); 22 patients (61% of the overall group) recovered fully.

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Section: Discussionsupporting

confidence: 90%

“…Treatment and outcome SEA has occasionally been treated successfully with minimally invasive techniques [23,24] or with antibiotics alone [13,22,25], although the latter is considered controversial. Some of the patients reportedly cured in these ways had no neurological deficits.…”

Section: Discussionmentioning

confidence: 99%

Spinal epidural abscess: aetiology, predisponent factors and clinical outcomes in a 4-year prospective study

et al. 2011

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“…Recent estimates are around 2-3 cases per 10,000 hospital admissions. 1,11,37,46 Spinal epidural abscesses can be classified into primary versus secondary. Secondary SEAs occur in patients with a history of invasive spinal procedures.…”

Section: Literature Reviewmentioning

confidence: 99%

“…4,28 However, presentation is variable and can be ambiguous, leading to delayed diagnosis. 7,12,14,18,27,37,41 Reportedly, SEA usually occurs in the thoracolumbar spine, dorsally. 19,30,31 In one study, systemic symptoms were more common among those with ventral lesions, and focal deficits were more common among those with dorsal lesions.…”

Section: 10mentioning

confidence: 99%

“…4,15,19 Decompression also serves as a way to identify the causative microbe so that appropriate antibiotic therapy can be expeditiously administered. 4,15,37 In select patients with mild back pain and without neurological deficits, antibiotic treatment and immobilization alone can be sufficient therapy; 4,11,36,37 these patients, however, need close monitoring because immediate operative intervention can become necessary in cases of subsequent neurological deterioration. 4,23,32 Bacterial SEAs have been characterized in several case reports and case series; their epidemiology, predisposing conditions, diagnostic modalities, and approaches to management have all been described.…”

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confidence: 99%

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An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

Shweikeh

Saeed

Bukavina

et al. 2014

FOC

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Object Over the past decade, the incidence of bacterial spinal epidural abscess (SEA) has been increasing. In recent years, studies on this condition have been rampant in the literature. The authors present an 11-year institutional experience with SEA patients. Additionally, through an analysis of the contemporary literature, they provide an update on the challenging and controversial nature of this increasingly encountered condition. Methods An electronic medical record database was used to retrospectively analyze patients admitted with SEA from January 2001 through February 2012. Presenting symptoms, concurrent conditions, microorganisms, diagnostic modalities, treatments, and outcomes were examined. For the literature search, PubMed was used as the search engine. Studies published from January 1, 2000, through December 31, 2013, were critically reviewed. Data from articles on methodology, demographics, treatments, and outcomes were recorded. Results A total of 106 patients with bacterial SEA were identified. The mean ± SD age of patients was 63.3 ± 13.7 years, and 65.1% of patients were male. Common presenting signs and symptoms were back pain (47.1%) and focal neurological deficits (47.1%). Over 75% of SEAs were in the thoracolumbar spine, and over 50% were ventral. Approximately 34% had an infectious origin. Concurrent conditions included diabetes mellitus (35.8%), vascular conditions (31.3%), and renal insufficiency/dialysis (30.2%). The most commonly isolated organism was Staphylococcus aureus (70.7%), followed by Streptococcus spp. (6.6%). Surgery along with antibiotics was the treatment for 63 (59.4%) patients. Surgery involved spinal fusion for 19 (30.2%), discectomy for 14 (22.2%), and corpectomy for 9 (14.3%). Outcomes were reported objectively; at a mean ± SD follow-up time of 8.4 ± 26 weeks (range 0–192 weeks), outcome was good for 60.7% of patients and poor for 39.3%. The literature search yielded 40 articles, and the authors discuss the result of these studies. Conclusions Bacterial SEA is an ominous condition that calls for early recognition. Neurological status at the time of presentation is a key factor in decision making and patient outcome. In recent years, surgical treatment has been advocated for patients with neurological deficits and failed response to medical therapy. Surgery should be performed immediately and before 36–72 hours from onset of neurological sequelae. However, the decision between medical or surgical intervention entails individual patient considerations including age, concurrent conditions, and objective findings. An evidence-based algorithm for diagnosis and treatment is suggested.

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Meningitis and Central Nervous System Infections

Isaacs

Elliott²,

Gilbert³

et al. 2007

Evidence‐based Pediatric Infectious Diseases

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Medical vs Surgical Management of Spinal Epidural Abscess

Abstract: Patients with spinal epidural abscess can be safely and effectively treated with conservative medical treatment without the need for surgery.

Cited by 155 publications

References 16 publications

Spinal epidural abscess: aetiology, predisponent factors and clinical outcomes in a 4-year prospective study

Spinal epidural abscess: aetiology, predisponent factors and clinical outcomes in a 4-year prospective study

An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

Meningitis and Central Nervous System Infections

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