Cervical spine epidural abscess: experience with microsurgical treatment in eight cases

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The authors report a series of eight consecutive cases in which epidural abscesses in the cervical spine were treated by microsurgery without arthrodesis, including two cases of concomitant pyogenic and tubercular infection.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors used a minimally invasive surgical approach consisting of single-level anterior microsurgical discectomy and drainage of the epidural abscess via a silicone catheter, and then initiated antibiotic therapy. At follow-up examination (mean duration 39 months), six patients exhibited complete recovery and two suffered from minor residual deficits. In all cases, spontaneous vertebral fusion occurred. Sagittal alignment was maintained in seven patients, and in one there was slight asymptomatic kyphosis. In two patients, tubercular and pyogenic infections were found. Prior intervention for dental infection was recorded in four cases.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>In the absence of preoperative spinal instability, microsurgical drainage of the abscess followed by specific antibiotic therapy resulted in spinal cord decompression and neurological recovery, thereby facilitating spontaneous fusion and vertebral stability. The presence of combined tubercular and pyogenic infections of the cervical spine should be considered, especially in patients whose immune systems are depressed.</jats:p></jats:sec>

Cervical spondylodiscitis: change in clinical picture and operative management during the last two decades. A series of 50 patients and review of literature

“…This has been suggested by Reihsaus et al to be a possible interpretation for male predominance in cervical spine infection, together with trauma and intravenous drug abuse [16]. Indeed, more than half of our patients were male in the two groups and this coincides with the findings of almost all authors dealing with cervical spondylodiscitis (Table 2) [13,14,17,21,23].…”

“…First, the most common causative organism was and remained Staphylococcus aureus in both groups (mean 58 % in the 50 patients). This agrees with most of the authors dealing with this subject [6,8,9,13,14,16,17,19,23]. Conversely, most of the patients in the study of Stone et al had Pseudomonas infection (44.4 %) [21].…”

“…b, c MRI and X-ray of the same patient done 15 months postoperatively after corpectomy C5 and C6 and stand-alone cage Fig. 3 The number of patients treated yearly in the different studies arranged chronologically [4, 8, 11-14, 17-19, 21, 22] Eur Spine J 2004 including the first group in this work revealed a mean age younger than 60 years, while those conducted after 2004 including the second group of the current work showed a mean age older than 60 years (Table 3) [5,13,14,17,19,21,23]. This denotes that the group of people affected by cervical spondylodiscitis is becoming older.…”

Multiple nocardial abscesses of the brainstem and spinal cord diagnosed after an open biopsy through a cervical partial central corpectomy: case report

“…Deciding upon the anterior approach, it was felt that an adequate exposure of the dura mater and the spinal cord was necessary to be able to access and decompress the lesion, perform hemostasis, and close the dura in a controlled manner. Although single-level discectomies and midline trough corpectomies have both been documented for the evacuation of extensive epidural abscesses without the need for additional instrumented fusion, 3,14 in this case, the need to open the dura, as well as the need for instrumented fusion, warranted a wider corridor. Performing an instrumented fusion in an infected environment has been reported in previous articles.…”

Retropharyngeal cellulitis complicated by cervical spondylodiscitis: A case report

“…Laboratory findings in spondylodiscitis are raised ESR, leucocytosis, increased C-reactive protein (CRP), and left shift in the leucocytes, positive blood cultures may be seen. 6,7 There was an increase in CRP level in our patient but blood cultures were negative.…”