Spinal infection: evaluation with MR imaging and intraoperative US.

Post, M. Judith Donovan; Quencer, R M; Montalvo, Berta M.; Katz, Bernhard; Eismont, Frank J.; Green, B. A.

doi:10.1148/radiology.169.3.3055039

Cited by 121 publications

(48 citation statements)

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“…For 197 patients, the surgical procedure was not specified in the corresponding publications, but it may be assumed that laminectomy was used in most cases. Intraoperative sonography is recommended by many authors to judge the extent of the abscess and to plan the laminectomy [101,222,288,291]. Intraoperative sonography is especially useful in the surveillance of surgical decompression of anteriorly located extensions of the abscess [103,222,228].…”

Section: Treatmentmentioning

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: Treatmentmentioning

confidence: 99%

Spinal epidural abscess: a meta-analysis of 915 patients

Waldbaur²,

2000

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“…Quencer et al was one of the first researcher to evaluate CSF flow dynamics by cine magnitude imaging. 2 Following this phase contrast MRI came into picture which is capable of determining CSF flow velocity (quantitative) in addition to qualitative assessment.…”

Section: Introductionmentioning

confidence: 99%

CSF flowmetry: an innovative technique in diagnosing normal pressure hydrocephalus

Senger¹,

Singh²,

Singh³

et al. 2017

Int J Adv Med

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Background: Normal pressure hydrocephalus is a very gloomy entity. The objective of this study is to analyse aqueductal velocity parameters by phase contrast MRI CSF flowmetry in Idiopathic Normal pressure hydrocephalus patients (NPH).Methods: This study consists of 72 participants which included 36 patients and 36 matched healthy controls. The study stretched over three years in multicentre tertiary research hospitals using 3T MRI scanner. Both normal MRI sequences and phase contrast CSF flowmetry was done for both group of patients and result analysed using SPSS 17 software.Results: Mean age of patients in our study is 61.07 years. The most common clinical symptom was gait unsteadiness in our study. Most common conventional MRI finding was ventriculomegaly with transependymal seepage of CSF. Amongst CSF flowmetry parameters Aqueductal stroke volume, peak systolic velocity, mean systolic velocity, forward flow volume and backward flow volume were statistically significant in differentiating cases from controls.Conclusions: MRI CSF flowmetry using phase contrast method is an advanced imaging parameter which can non-invasively and reliably detect NPH. Also, it can be used to follow the response to treatment following shunting and can act as a prognostic marker.

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“…Abscess is almost always located at the posterior portion of the spinal canal, with very low incidence of anterior location unless associated with osteomyelitis. Epidural abscesses alone tend to be more extensive than those secondary to spondylitis [7,8]. Other pathologies such as meningitis, subdural abscesses, facet infection and retroperitoneal abscesses can be seen in association with SEI [5].…”

Section: Introductionmentioning

confidence: 99%

Spinal infections

Tali

G�ltekin

2004

Eur Radiol

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Spinal infections have an increasing prevalence among the general population. Definitive diagnosis based solely on clinical grounds is usually not possible and radiological imaging is used in almost all patients. The primary aim of the authors is to present an overview of spinal infections located in epidural, intradural and intramedullary compartments and to provide diagnostic clues regarding different imaging modalities, particularly MRI, to the practicing physicians and radiologists.

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Spinal infection: evaluation with MR imaging and intraoperative US.

Cited by 121 publications

References 0 publications

Spinal epidural abscess: a meta-analysis of 915 patients

Spinal epidural abscess: a meta-analysis of 915 patients

CSF flowmetry: an innovative technique in diagnosing normal pressure hydrocephalus

Spinal infections

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