Treatment Strategies and Outcome in Patients with Non-Tuberculous Spinal Epidural Abscess - A Review of 46 Cases

Boström, Azize; Oertel, Markus Florian; Ryang, Yu‐Mi; Rohde, Veit; Bürgel, Uli; Krings, T; Korinth, Marcus C.

doi:10.1055/s-2007-1004547

Cited by 39 publications

(37 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regarding diagnosis, the literature describes the most common presenting complaints as neck and back pain, but other reported signs and symptoms are neurological deficits, fever, altered mental status, and incontinence. 4,10,19 Our study confirms all signs and symptoms described in the literature; back pain and neurological deficits (or both) were most common among patients in our study (experienced by almost half of patients).…”

Section: Discussionsupporting

confidence: 90%

“…4,15,19 Decompression also serves as a way to identify the causative microbe so that appropriate antibiotic therapy can be expeditiously administered. 4,15,37 In select patients with mild back pain and without neurological deficits, antibiotic treatment and immobilization alone can be sufficient therapy; 4,11,36,37 these patients, however, need close monitoring because immediate operative intervention can become necessary in cases of subsequent neurological deterioration. 4,23,32 Bacterial SEAs have been characterized in several case reports and case series; their epidemiology, predisposing conditions, diagnostic modalities, and approaches to management have all been described.…”

mentioning

confidence: 99%

“…The most common signs and symptoms are neck and back pain, fever, and neurological deficits. 4,28 Others, such as altered mental status and incontinence, can also be present. 4,28 However, presentation is variable and can be ambiguous, leading to delayed diagnosis.…”

mentioning

confidence: 99%

“…4,28 Others, such as altered mental status and incontinence, can also be present. 4,28 However, presentation is variable and can be ambiguous, leading to delayed diagnosis. 7,12,14,18,27,37,41 Reportedly, SEA usually occurs in the thoracolumbar spine, dorsally.…”

mentioning

confidence: 99%

“…For 25% of patients, antibiotic therapy for less than 4 weeks is associated with treatment failure. 4,38 Therapy should be culture specific, and peripheral blood cultures can be possibly used as indicators of the pathogen. 10,17,32 Computed to- mography-guided percutaneous aspiration can be both diagnostic and therapeutic.…”

mentioning

confidence: 99%

See 4 more Smart Citations

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

Shweikeh

Saeed

Bukavina

et al. 2014

FOC

View full text Add to dashboard Cite

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.