Acute spinal epidural abscess

Bouchez, B; Arnott, G; Delfosse, J. M.

doi:10.1007/bf00313714

Cited by 51 publications

(12 citation statements)

References 5 publications

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“…[4][5][6] Some authors have proposed that with earlier diagnosis due to improved imaging modalities, the results of nonoperative management may be similar to the results demonstrated with operative decompression. [1][2][3]7,14,[22][23][24] However, neurological deterioration has been consistently demonstrated in a substantial number of patients even while receiving appropriate antibiotic agents. 3,4,6,12,26 We endeavored to examine the cumulative experience regarding operative and nonoperative management of SEA at our institution.…”

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confidence: 99%

Comparison of operative and nonoperative management of spinal epidural abscess: a retrospective review of clinical and laboratory predictors of neurological outcome

Connor

Chittiboina²,

Caldito

et al. 2013

SPI

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Object Spinal epidural abscess (SEA), once considered a rare occurrence, has showed a rapid increase in incidence over the past 20–30 years. Recent reports have advocated for conservative, nonoperative management of this devastating disorder with appropriate risk stratification. Crucial to a successful management strategy are decisive diagnosis, prompt intervention, and consistent follow-up care. The authors present a review of their institutional experience with operative and nonoperative management of SEA to assess morbidity and mortality and the accuracy of microbiological diagnosis. Methods A retrospective analysis of patient charts, microbiology reports, operative records, and radiology reports was performed on all cases involving patients admitted with the diagnosis of SEA between July 1998 and May 2009. Results Seventy-seven cases were reviewed (median patient age 51.4 years, range 17–78 years). Axial pain was the most common presenting symptom (67.5% of cases). Presenting signs included focal weakness (55.8%), radiculopathy (28.6%), and myelopathy (5.2%). Abscesses were localized to the lumbar, thoracic, and cervical spine, respectively, in 39 (50.6%), 20 (26.0%), and 18 (23.4%) of the patients. Peripheral blood cultures were negative in 32 (45.1%) of 71 patients. Surgical site or interventional biopsy cultures were diagnostic in 52 cases (78.8%), with concordant blood culture results in 36 (60.0%). Methicillin-resistant Staphylococcus aureus (MRSA) was the most frequent isolate in 24 cases (31.2%). The mean time from admission to surgery was 5.5 days (range 0–42 days; within 72 hours in 66.7% of cases). Outcome data were available in 72 cases. At discharge, patient condition had improved or resolved in 57 cases (79.2%), improved minimally in 6 (8.3%), and showed no improvement or worsening in 9 (12.5%). Patient age and premorbid weakness were the only factors found to be significantly associated with outcome (p = 0.04 and 0.012, respectively). Conclusions These results strongly support immediate surgical decompression combined with appropriately tailored antibiotic therapy for the treatment of symptomatic SEA presenting with focal neurological deficit. The nonsuperiority discovered in other patient subsets may be due to allocation biases between surgically treated and nonsurgically treated cohorts. The present data demonstrate the accuracy of peripheral blood culture for the prediction of causative organisms and confirm patient age as a predictor of outcomes.

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confidence: 99%

Comparison of operative and nonoperative management of spinal epidural abscess: a retrospective review of clinical and laboratory predictors of neurological outcome

Connor

Chittiboina²,

Caldito

et al. 2013

SPI

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“…1,2,7,11,22,37,40,48,54,62,68,70 Figure 1 summarizes our evidence-based treatment algorithm to safely triage patients to initial operative or nonoperative management. Initial nonoperative management is indicated in patients who are not medically stable for surgery.…”

Section: 2950mentioning

confidence: 99%

The indications and timing for operative management of spinal epidural abscess: literature review and treatment algorithm

Tuchman

Pham²,

Hsieh³

2014

FOC

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Object Delayed or inappropriate treatment of spinal epidural abscess (SEA) can lead to serious morbidity or death. It is a rare event with significant variation in its causes, anatomical locations, and rate of progression. Traditionally the treatment of choice has involved emergency surgical evacuation and a prolonged course of antibiotics tailored to the offending pathogen. Recent publications have advocated antibiotic treatment without surgical decompression in select patient populations. Clearly defining those patients who can be safely treated in this manner remains in evolution. The authors review the current literature concerning the treatment and outcome of SEA to make recommendations concerning what population can be safely triaged to nonoperative management and the optimal timing of surgery. Methods A PubMed database search was performed using a combination of search terms and Medical Subject Headings, to identify clinical studies reporting on the treatment and outcome of SEA. Results The literature review revealed 28 original case series containing at least 30 patients and reporting on treatment and outcome. All cohorts were deemed Class III evidence, and in all but two the data were obtained retrospectively. Based on the conclusions of these studies along with selected smaller studies and review articles, the authors present an evidence-based algorithm for selecting patients who may be safe candidates for nonoperative management. Conclusions Patients who are unable to undergo an operation, have a complete spinal cord injury more than 48 hours with low clinical or radiographic concern for an ascending lesion, or who are neurologically stable and lack risk factors for failure of medical management may be initially treated with antibiotics alone and close clinical monitoring. If initial medical management is to be undertaken the patient should be made aware that delayed neurological deterioration may not fully resolve even after prompt surgical treatment. Patients deemed good surgical candidates should receive their operation as soon as possible because the rate of clinical deterioration with SEA is notoriously unpredictable. Although patients tend to recover from neurological deficits after treatment of SEA, the time point when a neurological injury becomes irreversible is unknown, supporting emergency surgery in those patients with acute findings.

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“…In the past, decompressive laminectomy was the only therapeutic approach to SEA until the recent demonstra tion that many patients can be fully managed medically [1][2][3][4]. However, it is generally agreed that the absence of severe neurological deficits and a definite identification of a pathogenic organism are prerequisites for a nonsurgical approach [4], In this case report, two conditions were present, tuber culosis and gram-negative sepsis, which are potentially causative agents of SEA [5].…”

Section: Discussionmentioning

confidence: 99%

Successful Nonoperative Treatment of Tuberculous Spinal Epidural Abscess with Cord Compression: The Role of Magnetic Resonance Imaging

Latronico

Tansini

et al. 1993

Eur Neurol

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Acute spinal epidural abscess

Abstract: An anterolateral cervical epidural abscess occurred in the course of a septicaemia caused by Staphylococcus aureus. Early diagnosis, before permanent neurological signs developed, was provided by CT scan without myelography. Total recovery occurred with antibiotic therapy alone.

Cited by 51 publications

References 5 publications

Comparison of operative and nonoperative management of spinal epidural abscess: a retrospective review of clinical and laboratory predictors of neurological outcome

Comparison of operative and nonoperative management of spinal epidural abscess: a retrospective review of clinical and laboratory predictors of neurological outcome

The indications and timing for operative management of spinal epidural abscess: literature review and treatment algorithm

Successful Nonoperative Treatment of Tuberculous Spinal Epidural Abscess with Cord Compression: The Role of Magnetic Resonance Imaging

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