Pan-spinal infection: a case series and review of the literature

Abstract

Background: Panspinal infection usually presents with fever, back pain, neurological deficit, and in advanced cases multi-organ failure and septic shock. The choice of treatment for panspinal infection is challenging because these patients are usually medically unstable with severe neurological compromise.The objective of this study is to review management and long term outcomes for patients with panspinal infection.Methods: A retrospective review of patients with panspinal infection treated in our center over a 5-year period [Jan 2010-Dec 2014 and a review of the current published literatures was undertaken. Results:We identified 4 patients with panspinal infection. One case was managed medically due to high perioperative risk, whilst the other three were managed surgically whilst on antibiotic therapy. All 3 cases managed surgically improved neurologically and infection subsided, whereas the patient managed medically did not change neurologically and infection subsided. Conclusions:Patients with panspinal infection should be treated surgically unless the medical risk of surgery or anaesthesia is prohibitive.

Primary Spinal Epidural Abscesses Not Associated With Pyogenic Infectious Spondylodiscitis: A New Pathogenetic Hypothesis

“…Percutaneous aspiration of the abscess for decompression of the spinal cord and culture is safe and effective in selected patients (23,24). Moreover, panspinal infections are often associated with poor general conditions increasing the risk of open surgery and may be treated medically (42). All our patients, except the patient with the cervical SEA that remained paraplegic, had a significant improvement in their neurological conditions after abscess evacuation.…”

Resolution of group B streptococcal panspinal epidural abscess in a patient with diabetes after treatment with ceftriaxone and linezolid

“…Moreover, the neurosurgical team had significant concerns that the patient would not survive this illness, regardless of whether surgery was pursued or not. Nevertheless, he made a full neurological recovery with no lasting sequelae and remained pain free, demonstrating that medical treatment with antibiotics can lead to resolution of panspinal epidural abscesses in patients who have developed focal neurological signs, and may result in outcomes comparable to those treated surgically 4 12…”

“…SEAs may rarely extend over multiple levels. These are termed panspinal or holospinal epidural abscesses, and have been reported in only a handful of case reports and case series in the literature 4–11. Surgical decompression and drainage, usually via laminectomy, is generally recommended for SEAs extending to one or a few levels, particularly in patients who experience neurological sequelae 1.…”

“…Surgical decompression and drainage, usually via laminectomy, is generally recommended for SEAs extending to one or a few levels, particularly in patients who experience neurological sequelae 1. However, extended laminectomy is not usually recommended for treatment of panspinal epidural abscess spanning many levels due to the increased risks of intervention,2 with mixed outcomes being reported for both surgical and conservative management in this subset of patients 4…”

Panspinal Epidural Abscess: A Devastating Complication of Group B Streptococcal Bacteremia

“…People with weakened immune system or having chronic conditions such as diabetes, renal failure, and alcoholism are at risk of developing SEA [2]. SEAs are usually localized to a speci c spinal region; however, very rarely they can a ect all the spinal levels causing panspinal epidural abscess [3].…”