Recent developments in the treatment of spinal epidural abscesses

Eltorai, Adam E.M.; Naqvi, Syed Muhammad Zulfiqar Hyder; Seetharam, Ashok; Brea, Bielinsky A; Simon, Caroline J.

doi:10.4081/or.2017.7010

Cited by 18 publications

(13 citation statements)

References 57 publications

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“…Emergency providers are conventionally taught the “classic triad” of spinal pain, fever, and neurological deficit assessments, but this constellation of findings only appears in some 10-15% of cases [ 3 , 7 ]. Moreover, back pain and fever, the common early symptoms, are relatively nonspecific, and patients will generally seek medical attention at varying stages of disease progression [ 7 , 14 ]. Additionally, in the event that the abscess is sufficiently large, patients can rapidly develop the neurologic signs of spinal injury, which may necessitate urgent neurosurgical intervention [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Prompt evaluation and treatment is necessary for any clinical concern for this diagnosis [ 2 , 4 , 5 , 14 ]. However, it can be difficult to diagnose SEA without significant clinical suspicion [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Successful SEA diagnosis and management requires neurologists, neurosurgeons, radiologists, and infectious disease physicians to work together [ 5 , 14 ]. At present, medical management and surgical intervention are the two main SEA treatment options [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the vast majority of cases, treatment consists of a combination of both antibiotics and surgical intervention [ 6 ]. While surgery remains the mainstream treatment, SEA can be managed for a certain subset of patients without operative intervention, and select cases offer the possibility of medical management of SEA, similarly to VO, with biopsy and antibiotics [ 11 , 14 ]. The criteria reported for non-operative management include: 1) A known pathogenic organism, neurologic stability, MRI or CT scan availability to enable rapid follow-up, and close serial neurosurgical or nursing monitoring; 2) Patients who have extended-duration pre-existing paralysis (> 36 - 48 h) may not need surgical intervention; and 3) Urgent surgical intervention may be precluded by significant medical comorbidities [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Disseminated Spinal Epidural Abscess in an Immunocompetent Individual: A Case Report and Review of the Literature

et al. 2020

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Spinal epidural abscess (SEA) is an uncommon pyogenic infection, localized between the dura mater and vertebral periosteum, leading to significant morbidity and mortality. SEA development is connected with medical comorbidities and risk factors facilitating bacterial dissemination; multiple factors are believed to play a role, including aging, increased alcohol abuse, use of intravenous drugs, a greater prevalence of medical comorbidities, and increased rates of spinal surgery that furthers iatrogenic spinal infection. Here, we have reported the first known case of disseminated SEA in an immunocompetent individual. A 33-year-old Japanese woman visited our hospital due to 1 week of continuous fever, low back pain, and numbness of the entire left lower limb. She was diagnosed with disseminated SEA by complete spine magnetic resonance imaging scan, of unknown origin. She was treated for 13 days with piperacillin-tazobactam, then for 16 days with levofloxacin tablets; ultimately, she recovered without treatment complications. This case highlights the complicated pathology, diagnosis, and treatment of SEA. In addition, this case suggests the need for a careful and detailed examination when encountering patients presenting with fever, low back pain even in an immunocompetent individual; we should thoroughly investigate, including further image investigations, bacteriological and pathologic examination.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Disseminated Spinal Epidural Abscess in an Immunocompetent Individual: A Case Report and Review of the Literature

et al. 2020

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“…Some opinions then suggest immediate surgery at stages I and II without paralysis, and, in fact, most studies recommend that early surgery is beneficial to improve the outcome. However, the best exact timing for surgical intervention remains controversial (37) , (38) . Even if the symptoms are in stage I at the time of diagnosis, the rate of progression to subsequent stages is difficult to predict.…”

Section: Management and Prognosismentioning

confidence: 99%

Spinal Epidural Abscess: A Review Highlighting Early Diagnosis and Management

Tetsuka

Suzuki

Ogawa

et al. 2019

JMA J

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Spinal epidural abscess (SEA) is still an uncommon but devastating infection of the spine. In recent years, a number of reported cases have risen. The most important prognostic factor for a favorable outcome is early diagnosis and appropriate treatment. However, a diagnosis of SEA is often delayed, particularly in the early stages of the disease before patients present with neurological symptoms. With enough knowledge of risk factors, clinical features, and appropriate diagnostic procedures, it may be possible to reduce diagnostic delay in the early stages of the disease. This review focuses on early diagnosis of SEA based on risk factors, presenting symptoms, and characteristic findings on magnetic resonance imaging (MRI), and also discusses the timing of surgical interventions. Traditionally, the symptoms of SEA are characterized by fever, back pain, and neurological symptoms, which are described as a classical triad of symptoms for this type of infection; but this collection of symptoms is seen in only about 10% of cases. However, most patients complain of severe localized lower back pain. Gadolinium-enhanced MRI is the most sensitive, specific, and beneficial imaging modality for establishing a diagnosis of SEA. Patients diagnosed prior to neurological deficits with a known causative microbial organism can be safely treated with antimicrobial therapy alone. However, about 30%–40% of the patients fail in conservative management without surgery. The best management and timing for surgical decompression in patients with or without mild neurological deficits should be established in the near future. Early diagnosis and management, before the occurrence of serious neurological symptoms, are the most important prognostic factors for good outcomes in patients with SEA. We proposed a simple algorithm for early diagnosis of SEA by selecting patients with severe back pain, leading to emergent MRI.

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