Spinal epidural abscesses: risk factors, medical versus surgical management, a retrospective review of 128 cases

Patel, Amit R.; Alton, Timothy B.; Bransford, Richard J.; Lee, Michael J.; Bellabarba, Carlo; Chapman, Jens R.

doi:10.1016/j.spinee.2013.10.046

Cited by 223 publications

(280 citation statements)

References 23 publications

Supporting

Mentioning

265

Contrasting

Unclassified

Order By: Relevance

“…The presence of two risk factors elevates the failure rate to 40.2%; three or more risk factors elevates it to 76.9%. 8 Our patient had three risk factors. He had no neurological deficits, but fever and positive blood culture persisted and paraspinal abscesses in the mediastinum and psoas muscles were found.…”

Section: Discussionmentioning

confidence: 74%

A case of panspinal epidural abscess that presented with meningeal irritation

Okada

Nishiyama

Kurihara

et al. 2017

Acute Medicine & Surgery

View full text Add to dashboard Cite

Case:In rare cases, spinal epidural abscess involves the entire spine and can lead to neurological deficits and sepsis if treatment is delayed or suboptimal. A 65-year-old man was admitted with a diagnosis of bacterial meningitis. After admission, magnetic resonance imaging showed a spinal epidural abscess from the cervical to lumbar spine. Blood culture revealed Staphylococcus aureus. The patient was initially treated medically because he had no neurological deficits. Repeat blood culture remained positive and abscesses were found in the mediastinum and bilateral psoas muscles.Outcome: Surgery was carried out and the patient's postoperative course was satisfactory. Conclusion: Spinal epidural abscess can extensively affect the spine and may present with the symptoms of bacterial meningitis. It is essential to examine the entire spine and paraspinal regions and to treat early in cases of spinal epidural abscess.

show abstract

Section: Discussionmentioning

confidence: 74%

A case of panspinal epidural abscess that presented with meningeal irritation

Okada

Nishiyama

Kurihara

et al. 2017

Acute Medicine & Surgery

View full text Add to dashboard Cite

show abstract

“…A history of diabetes mellitus (21%-38% of cases), intravenous (IV) drug use, end-stage renal disease, human immunodeficiency virus (HIV), or immunosuppressant use and iatrogenic causes, such as epidural spinal procedures, increase the risk of SEA. [5][6][7] Cases of SEA have been documented as presenting to chiropractic offices often masquerading as non-specific neck or back pain. [8][9][10] The classic clinical triad of back pain, fever, and neurological deficits is observed in only~10% of cases.…”

Section: Introductionmentioning

confidence: 99%

“…12 Because of the pervasive nature of neck and back pain, misdiagnosis of SEA on initial presentation is noteworthy, with estimates ranging from 11% to 75%. 7,13 A SEA, on average, crosses 3.85 vertebral levels and is reported in the thoracic (15%-39.1%), lumbosacral (30%-54.7%), and cervical (9%-35.9%) regions. 6,7,14,15 Magnetic resonance imaging (MRI) examination with and without gadolinium of the entire spine is the gold standard, as it differentiates SEA from other space-occupying lesions and malignancy.…”

Section: Introductionmentioning

confidence: 99%

“…7,13 A SEA, on average, crosses 3.85 vertebral levels and is reported in the thoracic (15%-39.1%), lumbosacral (30%-54.7%), and cervical (9%-35.9%) regions. 6,7,14,15 Magnetic resonance imaging (MRI) examination with and without gadolinium of the entire spine is the gold standard, as it differentiates SEA from other space-occupying lesions and malignancy. A computed tomography (CT) myelogram should be obtained when MRI is unavailable or is contraindicated because of an implanted electrical device (eg, pacemaker, spinal stimulator).…”

Section: Introductionmentioning

confidence: 99%

“…5,11,15 The infectious agent causing SEA is most commonly of bacterial origin and overwhelmingly either methicillin-sensitive or methicillin-resistant Staphylococcus aureus. 7,13 Once patients are diagnosed with SEA, best outcomes are achieved with rapid surgical intervention, abscess drainage, and concomitant antibiotic treatment. When monitored closely for clinical deterioration, there are select cases with limited neurological deficit that may be managed with antibiotic therapy only.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Thoracic Spondylodiscitis Epidural Abscess in an Afebrile Navy Veteran: A Case Report

Cupler

Anderson

Stancik

2017

Journal of Chiropractic Medicine

View full text Add to dashboard Cite

Objective: The purpose of this case study was to describe the differential diagnosis of a thoracic epidural abscess in a Navy veteran who presented to a chiropractic clinic for evaluation and management with acupuncture within a Veterans Affairs Medical Center. Clinical Features: An afebrile 59-year-old man with acute thoracic spine pain and chronic low back pain presented to the chiropractic clinic at a Veterans Affairs Medical Center for consideration for acupuncture treatment. Intervention and Outcome: The veteran elected to trial acupuncture once per week for 4 weeks. A routine thoracic magnetic resonance imaging scan without gadolinium detected a space-occupying lesion after the patient failed to attain 50% reduction of pain within 2 weeks with conservative care. The patient was diagnosed with a multilevel thoracic spondylodiscitis epidural abscess and was treated same day with emergency debridement and laminectomy of T7-8 with a T6-9 fusion. The patient had complete recovery without neurological compromise and completed an antibiotic regimen for 6 weeks. Conclusion: A Navy veteran with acute thoracic spine and chronic low back pain appeared to respond initially but failed to achieve clinically meaningful outcomes. Follow-up advanced imaging detected a thoracic spondylodiscitis epidural abscess. Early diagnosis and immediate intervention are important to preserving neurological function and limiting morbidity in cases of spondylodiscitis epidural abscess. (J Chiropr Med 2017;16:246-251)

show abstract