Spinal subdural abscess following epidural steroid injection

Kraeutler, Matthew J.; Bozzay, Joseph; Walker, Matthew P.; John, Kuruvilla

doi:10.3171/2014.9.spine14159

Cited by 34 publications

(20 citation statements)

References 14 publications

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“…Multiple case reports have documented local and distant infections and abscess formation after injection, 6,12,14-17,25,27,35 including extensive cervico-thoraco-lumbo-sacral spinal subdural abscesses. 17,24 The increased risk of surgical site infection after preoperative and intraoperative local steroid injection has been well established in the literature for various orthopedic procedures.…”

Section: Discussionmentioning

confidence: 99%

The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery

Singla

Yang

Werner

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVELumbar epidural steroid injections (LESIs) are performed for both diagnostic and therapeutic purposes for a variety of indications, including low-back pain, the leading cause of disability and expense due to work-related conditions in the US. The steroid agent used in epidural injections is reported to relieve nerve root inflammation, local ischemia, and resultant pain, but the injection may also have an adverse impact on spinal surgery performed thereafter. In particular, the possibility that preoperative epidural injections may increase the risk of surgical site infection after lumbar spinal fusion has been reported but has not been studied in detail. The goal of the present study was to use a large national insurance database to analyze the association of preoperative LESIs with surgical site infection after lumbar spinal fusion.METHODSA nationwide insurance database of patient records was used for this retrospective analysis. Current Procedural Terminology codes were used to query the database for patients who had undergone LESI and 1- or 2-level lumbar posterior spinal fusion procedures. The rate of postoperative infection after 1- or 2-level posterior spinal fusion was analyzed. These study patients were then divided into 3 separate cohorts: 1) lumbar spinal fusion performed within 1 month after LESI, 2) fusion performed between 1 and 3 months after LESI, and 3) fusion performed between 3 and 6 months after LESI. The study patients were compared with a control cohort of patients who underwent lumbar fusion without previous LESI.RESULTSThe overall 3-month infection rate after lumbar spinal fusion procedure was 1.6% (1411 of 88,540 patients). The infection risk increased in patients who received LESI within 1 month (OR 2.6, p < 0.0001) or 1–3 months (OR 1.4, p = 0.0002) prior to surgery compared with controls. The infection risk was not significantly different from controls in patients who underwent lumbar fusion more than 3 months after LESI.CONCLUSIONSLumbar spinal fusion performed within 3 months after LESI may be associated with an increased rate of postoperative infection. This association was not found when lumbar fusion was performed more than 3 months after LESI.

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Section: Discussionmentioning

confidence: 99%

The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery

Singla

Yang

Werner

et al. 2017

Journal of Neurosurgery: Spine

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“…Early diagnosis and treatment is imperative, as delay can lead to irreversible neurological deficits. The treatment of SEA is laminectomy and evacuation of abscess and can lead to good outcome with complete recovery to premorbid state [1,5].…”

Section: Discussionmentioning

confidence: 99%

“…Epidural steroid injection (ESI) is a commonly used treatment modality for patients suffering from chronic low backache due to a multitude of causes [1]. Despite the fact that the procedure lacks evidence for efficacy as a long-term management for chronic back pain (caused by spinal spondylosis and stenosis), the use of ESIs has increased in recent years [2].…”

Section: Introductionmentioning

confidence: 99%

Spinal Epidural Abscess Following Administration of Epidural Steroid Injection for Low Backache – Need for Urgent Diagnosis and Intervention

Mathew¹,

Savardekar²,

Pruthi³

2017

J Spine

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Background: Epidural steroid injection is an innocuous and efficient modality of treatment for chronic low back ache due to a multitude of causes, its use being on the rise in recent times. However, a note needs to be made regarding the potentially serious complications following epidural steroid injection including epidural space infection. This condition requires a high index of suspicion for early diagnosis and treatment.

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“…Finally, a large group of patients (12.1% of cases), including the patients presented here, had pre-existing spinal disease. These included symptomatic spinal stenosis [ 48 ], herniated disc [ 23 , 24 ], degenerative disc disease [ 28 ], and ruptured disc [ 17 ]. All of these patients had surgery or injections performed, which was likely the initial source of infection; however, it is also possible that spinal disease itself is a predisposing factor for infection, secondary to chronic inflammatory changes.…”

Section: Discussion and Review Of Literaturementioning

confidence: 99%

Spinal Subdural Abscess Following Laminectomy for Symptomatic Stenosis: A Report of 2 Cases and Review of the Literature

et al. 2016

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Case seriesPatient: Male, 87 • Male, 62Final Diagnosis: Spinal subdural abscessSymptoms: Fever • pain • weaknessMedication: —Clinical Procedure: Laminectomy • durotomy • drainage • debridementSpecialty: NeurosurgeryObjective:Rare diseaseBackground:Spinal subdural abscesses, also known as empyemas, are rare infectious lesions, the exact incidence of which is unknown. Presentation is typically dramatic, with back pain, fever, motor, and sensory deficits. Rapid identification and surgical intervention with laminectomy, durotomy, and washout provides the best outcomes. While hematogenous spread of an extra-spinal infection is the most common cause of this condition, a significant number of cases result from iatrogenic mechanisms, including lumbar punctures, epidural injections, and surgery.Case Report:Here we present 2 cases: 1) an 87-year-old man with type 2 diabetes, schizophrenia, mild cognitive impairment, and symptomatic lumbar spinal stenosis and 2) a 62-year-old man with a prior L3–4 spinal fusion with symptomatic lumbar spinal stenosis. In both cases, patients underwent laminectomy for spinal stenosis and developed epidural abscess. Following successful drainage of the epidural abscess, they continued to be symptomatic, and repeat imaging revealed the presence of a subdural abscess that was subsequently evacuated. Case 1 had significant improvement with residual lower-extremity weakness, while Case 2 made a complete neurological recovery.Conclusions:These cases illustrate patients at increased risk for developing this rare spinal infection, and demonstrate that rapid recognition and surgical treatment is key to cure and recovery. Review of the literature highlights pertinent risk factors and demonstrates nearly one-third of reported cases have an iatrogenic etiology. The cases presented here demonstrate that a subdural process should be suspected in any patient with intractable pain following treatment of an epidural abscess.

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Spinal subdural abscess following epidural steroid injection

Cited by 34 publications

References 14 publications

The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery

The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery

Spinal Epidural Abscess Following Administration of Epidural Steroid Injection for Low Backache – Need for Urgent Diagnosis and Intervention

Spinal Subdural Abscess Following Laminectomy for Symptomatic Stenosis: A Report of 2 Cases and Review of the Literature

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