Spinal epidural abscess: an analysis of 24 cases

Pereira, Celestino; Lynch, José Carlos

doi:10.1016/j.surneu.2004.09.021

Cited by 101 publications

(99 citation statements)

References 24 publications

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“…46 Frequently reported concurrent conditions are diabetes mellitus, previous spine surgery, intravenous drug abuse, epidural anesthesia, alcoholism, renal failure, hemodialysis, systemic chronic disorders, and immunosuppression. 3,17,21,33,43 Factors that can be associated with a worse prognosis are older age, diabetes mellitus, neurological and mental deterioration, and dorsal location of the SEA. 1,8,9,19,23,32 Additionally, higher reoperation and mortality rates are associated with renal failure and hemodialysis.…”

Section: Literature Reviewmentioning

confidence: 99%

“…6,19,36,37 However, other more recent studies have indicated that early surgery has better outcomes. 9,26,32,33 Others have demonstrated that medical treatment alone is more likely to fail among elderly patients or those with diabetes mellitus and/or MRSA infection. 23 The operative approach should be guided by the spatial orientation of the abscess.…”

Section: 3341mentioning

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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Section: Literature Reviewmentioning

confidence: 99%

Section: 3341mentioning

confidence: 99%

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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“…Though classical triad of the condition are fever, back pain and progressive neurological deficits [3,13] this condition may present with constellations of clinical signs and symptoms [1] thereby creating delay in early diagnosis. In immune-compromised patients fever may not appear in spite of CEA [1,3,13,14].…”

Section: Discussionmentioning

confidence: 99%

A case of progressive tetraparesis due to cervical epidural abscess

Munakomi¹,

Bhattarai²

2016

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. This can lead to significant delay in the timely diagnosis. Case Report: We report a rare case of sudden onset progressive tetra paresis in a 54-yearold male. Magnetic resonance imaging of cervical spine was suggestive of acute cervical spinal epidural abscess. Emergent surgical evacuation of the abscess resulted in gradual improvement of the neurological status in the patient. Conclusion:Spinal epidural abscess may present with constellation of signs and symptoms. Timely diagnosis and intervention may prevent permanent deficits to the patients.

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“…[10][11][12] Several investigations suggested that decompressive laminectomy and debridement of infected tissues should be performed as soon as possible. 13 Patients may be treated medically when they decline surgical intervention, have high surgery risks, or exhibit pan spinal infection.…”

Section: Discussionmentioning

confidence: 99%

Aggressive Surgical Intervention in End-Stage Renal Disease Patients with Spinal Epidural Abscess

Wu¹,

Fu²,

Chang³

et al. 2011

Renal Failure

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Background: Despite advances in imaging, as well as antibiotic and surgical treatment, spinal epidural abscess (SEA) remains a challenging problem in end-stage renal disease (ESRD) patients. This investigation assesses the influence of ESRD on clinical manifestations, complications, and outcomes in patients with SEA. Methods: This study retrospectively reviewed medical records of 41 patients with SEA treated during [2003][2004][2005][2006]. The patients comprised two groups: group I (patients with ESRD) and group II (patients without ESRD). Patient characteristics, including age, gender, comorbidities, clinical presentations, laboratory data, locations of epidural abscess, and outcome, were recorded and compared. Results: The final sample comprised 41 patients. The mean age of the subjects was 62 + 12 years. The sample included 12 patients with ESRD and 29 without ESRD. The development of symptoms was similar for both groups. Group I patients displayed higher serum erythrocyte sedimentation rate (ESR) (108 + 26 vs. 81 + 31 mm/h, p = 0.014) and lower serum hematocrit (27.1 + 4.3 vs. 33.7 + 5.1%, p < 0.001) than group II patients. Overall survival at 3 months was 88.9% and 93.1% for patients in groups I and II, respectively (p = 0.876). Meanwhile, patients that underwent surgical decompression of epidural abscess received more surgeries than group I patients (1.08 vs. 0.55, p = 0.086), although the difference was not significant. Conclusions: ESRD is a risk factor for repeat surgery in patients with SEA. This investigation suggests that ESRD patients with SEA may require aggressive surgical intervention despite ESRD not affecting their long-term prognosis.

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Spinal epidural abscess: an analysis of 24 cases

Cited by 101 publications

References 24 publications

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

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

A case of progressive tetraparesis due to cervical epidural abscess

Aggressive Surgical Intervention in End-Stage Renal Disease Patients with Spinal Epidural Abscess

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