Pediatric Spinal Subdural Abscesses: A Report of Three Consecutive Patients

Abstract

<b><i>Background:</i></b> Despite technological advances in medical treatment, the prognosis of the rarely reported spinal subdural abscesses (SSAs) has remained a serious entity largely unaffected, especially when they are diagnosed late. In this study, the authors aimed to present the surgical outcomes of 3 consecutive pediatric patients with SSA. <b><i>Materials and Methods:</i></b> We retrospectively reviewed the medical records of pediatric patients with spinal lesions who underwent surgery at 2 neurosurgical centers spanning 7 years, from 2012 to 2019. All pediatric patients who were diagnosed with SSA (<i>n</i> = 3) were selected as the core sample for this study. <b><i>Results:</i></b> Three pediatric patients (2 females and 1 male) with SSA were surgically treated. Holocord SSA was observed in 1 patient. The mean age was 7.1 ± 7.7 years. The most common presenting symptoms were gait disturbance and weakness of lower extremities (100%). The mean preoperative course was 5.7 ± 4.0 weeks. The causative pathogens were <i>Escherichia coli</i> (<i>E. coli)</i> and <i>M. tuberculosis</i>. In the 2nd case, the pathogen was non-tuberculosis mycobacterium in the extramedullary abscess. In the 44th postoperative month, she underwent surgery for intramedullary abscess. The causative pathogen was <i>E. coli</i>. Except for 1 male adolescent who presented with severe clinical status (paraplegic), the improvement was observed in all patients at their last follow-up after 50.3 ± 43.5 months of average. <b><i>Conclusions:</i></b> Drainage followed by appropriate antibiotics is the optimal treatment for SSAs. Early diagnosis and urgent surgical treatment are essential for a good prognosis. All surgically treated SSA patients with neurological deficits were rehabilitated with physical therapy postoperatively.

Surgical Outcome of Spinal Subdural Abscesses: A Report of Four Consecutive Patients and Brief Review of the Literature

“…30,32 Chronic SSA was commonly reported in elderly patients. [27][28][29]31,33 With regard to the histological finding of granulomatous tissue, case 1 was a chronic abscess; however, the preoperative course was 5 weeks, which is short. In case 2, pus without granulation tissue was found, indicating an acute SSA; however, the preoperative course was 10 weeks.…”

“…The gold standard to diagnose SSAs is contrast-enhanced MRI. 26,[30][31][32][33] Low intensity on T1WIs, high intensity on T2WIs, and contrast-enhanced rim on contrast-enhanced T1WIs suggest a SSA. 26,32,33 The differential diagnosis includes subdural hematoma, inflammatory myofibroblastic tumors, spinal meningioma, and schwannoma.…”

“…32 Accordingly, SSAs can be divided into an acute, subacute, and chronic form with different presenting symptoms. 30,32,33 The symptoms of acute SSAs range between mild back pain and paraplegia, 21,29 whereas nonspecific symptoms such as local pain and hypoesthesia can be seen in chronic SSAs. 30,32 Chronic SSA was commonly reported in elderly patients.…”

“…21,26,32 One of the distinguishable features of SSAs on fat suppression MRI is subtracting the high signals of epidural fat and bone marrow. 21,26,32,33 In differentiating SSAs from intradural tumors, some authors recommend diffusion-weighted images (DWI). 26,33 In DWI, most pyogenic abscesses are hyperintense signals, indicating restricted water diffusion related to high viscosity of inflammatory cells in pus.…”

“…26,33 In DWI, most pyogenic abscesses are hyperintense signals, indicating restricted water diffusion related to high viscosity of inflammatory cells in pus. 21,24,26,33 This study has some limitations. First, it is a retrospective study that may be influenced by inherent biases.…”