Spinal Epidural Abscess Complicating Vertebral Osteomyelitis: An Insidious Cause of Deteriorating Spinal Cord Function

Hj, Lee; Bach, Véronique; Re, White

doi:10.1080/01952307.1992.11735858

Cited by 5 publications

(2 citation statements)

References 10 publications

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“…A dissertation from 1962 [333] in the Cologne University Department of Neurosurgery evaluates results obtained with three patients as well as only 100 other cases from the literature, with special attention to reports of SEA following vertebral osteomyelitis. In the present work, the numerous published cases of SEA following purulent or tuberculous vertebral osteomyelitis are not included [7,10,19,29,53,62,75,88,109,130,132,135,139,144,162,165,169,171,190,205,207,219,228,236,272,281,282,285,307,340,344,363,364,371,387]. These cases were excluded from the present analysis because SEA following purulent or tuberculous vertebral osteomyelitis is clearly different from SEA of other etiology with respect to therapy and prognosis, with vertebral rather than epidural infection being the primary clinical problem.…”

Section: Introductionmentioning

confidence: 99%

Spinal epidural abscess: a meta-analysis of 915 patients

Waldbaur²,

2000

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Spinal epidural abscess (SEA) was first described in the medical literature in 1761 and represents a severe, generally pyogenic infection of the epidural space requiring emergent neurosurgical intervention to avoid permanent neurologic deficits. Spinal epidural abscess comprises 0.2 to 2 cases per 10,000 hospital admissions. This review intends to offer detailed evaluation and a comprehensive meta-analysis of the international literature on SEA between 1954 and 1997, especially of patients who developed it following anesthetic procedures in the spinal canal. In this period, 915 cases of SEA were published. This review is the most comprehensive literature analysis on SEA to date. Most cases of SEA occur in patients aged 30 to 60 years, but the youngest patient was only 10 days old and the oldest was 87. The ratio of men to women was 1:0.56. The most common risk factor was diabetes mellitus, followed by trauma, intravenous drug abuse, and alcoholism. Epidural anesthesia or analgesia had been performed in 5.5% of the patients with SEA. Skin abscesses and furuncles were the most common source of infection. Of the patients, 71% had back pain as the initial symptom and 66% had fever. The second stage of radicular irritation is followed by the third stage, with beginning neurological deficit including muscle weakness and sphincter incontinence as well as sensory deficits. Paralysis (the fourth stage) affected only 34% of the patients. The average leukocyte count was 15,700/microl (range 1,500-42,000/microl), and the average erythrocyte sedimentation rate was 77 mm in the first hour (range 2-50 mm). Spinal epidural abscess is primarily a bacterial infection, and the gram-positive Staphylococcus aureus is its most common causative agent. This is true also for patients who develop SEA following spinal anesthetics. Magnetic resonance imaging (MRI) displays the greatest diagnostic accuracy and is the method of first choice in the diagnostic process. Myelography, commonly used previously to diagnose SEA, is no longer recommended. Lumbar puncture to determine cerebrospinal fluid protein concentrations is not needed for diagnosis and entails the risk of spreading bacteria into the subarachnoid space with consequent meningitis; therefore, it should not be performed. The therapeutic method of choice is laminectomy combined with antibiotics. Conservative treatment alone is justifiable only for specific indications. Laminotomy is a therapeutic alternative for children. The mortality of SEA dropped from 34% in the period of 1954-1960 to 15% in 1991-1997. At the beginning of the twentieth century, almost all patients with SEA died. Parallel to improvements in the mortality rate, today more patients experience complete recovery from SEA. The prognosis of patients who develop SEA following epidural anesthesia or analgesia is not better than that of patients with noniatrogenic SEA, and the mortality rate is also comparable. The essential problem of SEA lies in the necessity of early diagnosis, because only timely treatment is able to av...

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Section: Introductionmentioning

confidence: 99%

Spinal epidural abscess: a meta-analysis of 915 patients

Waldbaur²,

2000

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“…The most common spinal location of the infection is the posterior thoracic region (5 0 to 80 percent), followed by lumbar (17 to 38 percent), and then cervical (10 to 25 percent).13 Anterior abscesses are fairl y uncommon and usually occur at cervical levels.l, 9,13,16,[27][28][29] Staphylococcus aureus was the organism isolated in 50 to 95 percent of the cases, aerobic and anerobic streptococci in 10 to 18 percent and gram negative organisms, especially Eschericia coli and Pseudomonas aeruginosa in 13 percent. 1 3 Multiple organisms were isolated in about 10 percent.…”

Section: Discussionmentioning

confidence: 99%

Myelopathy Secondary to Spinal Epidural Abscess: Case Reports and a Review

Yin

Wang²,

Lucero

1998

The Journal of Spinal Cord Medicine

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Spinal epidural abscess (SEA) is a rare disease with an unknown incidence rate. This paper will illustrate that early diagnosis and rehabilitation may result in improved outcomes for patients with neck or back pain presenting with neurological deficits. 1 Three cases of SEA in individuals without the commonly acknowledged risk factors of intravenous drug abuse (IVDA), invasive procedures, or immunosuppression were seen at our institution during a 10-month period between October 1995 and July 1996.2 The patients presented with neck or thoracic back pain and progressive neurological deficits without a febrile illness. Predisposing factors were thought to be urinary tract infection with underlying untreated diabetes mellitus in the first case, a history of recurrent skin infection in the second, and alcoholism without a definite source of infection in the third. Leukocytosis, elevated sedimentation rate, and confirmatory findings reported on magnetic resonance imaging (MRI) led to the diagnosis of SEA in all three cases. Immediate surgical drainage and decompression followed by proper antibiotic treatment and early aggressive rehabilitation led to good functional outcomes.3,4 All the individuals became independent in activities of daily living, wheelchair mobility, and bowel and bladder management. Two eventually became ambulatory.

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Neurologic Complications in Children with Systemic Cancer

Antunes¹

2003

Cancer Neurology in Clinical Practice

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Spinal Epidural Abscess Complicating Vertebral Osteomyelitis: An Insidious Cause of Deteriorating Spinal Cord Function

Cited by 5 publications

References 10 publications

Spinal epidural abscess: a meta-analysis of 915 patients

Spinal epidural abscess: a meta-analysis of 915 patients

Myelopathy Secondary to Spinal Epidural Abscess: Case Reports and a Review

Neurologic Complications in Children with Systemic Cancer

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