Extradural infections of the spine

Abstract

Objectives:We have observed a recent increase in the incidence of spinal extradural infections. To determine postoperative outcome and prognosis we have undertaken a retrospective study on patients with spinal extradural abscesses between 1978 and 1996 treated in the Department of Neurosurgery at the Nordstadt Hospital in Hannover, Germany. Methods: Case records, outpatient ®les, operation notes, neuroradiological examinations and pathological reports were analysed. Neurological function was documented using a score system for each symptom. Results: Twenty-two patients underwent 24 operations during the study period. Staphylococcus aureus was the organism most commonly isolated. Patients presented after a mean history of 1.8+2.6 months with acute development of severe para-or tetraparesis and were followed up for an average period of 6+7 months. Two groups were distinguished. One group was characterized by epidural collections of pus (14 patients). Two patients in this group were not operated due to their moribund state and died from uncontrollable septicemia. Two of the remaining 12 operated patients died within 30 days after surgery due to generalized septicemia or other medical problems unrelated to the spinal involvement. Of the ten surviving patients, ®ve sustained major neurological de®cits, whereas the remaining ®ve patients made an incomplete recovery. The second group consisted of eight patients in a signi®cantly better pre-operative health condition in whom granulomatous material was obtained during the operation and the outcome was considerably better. No patient in this group died. Six patients recovered with no or mild neurological de®cits. Conclusion: Spinal extradural infections require immediate surgical intervention. Neurological outcome depends on the pre-operative neurological status. Survival is determined by the general health condition of the patient.

Nonoperative Management of a Multi-Regional Epidural Abscess with Neurological Dysfunction

“…Although uncommon overall, gram negative bacilli are often seen in intravenous drug users. 9,19 Gadolinium-enhanced magnetic resonance imaging of the whole spine is the investigation of choice for diagnosis and determining the extent and location of the abscess. 8,20,21 Even with a rising incidence of SEA, there is currently no clear consensus regarding treatment; the use of nonoperative versus surgical management remains widely debated.…”

Spinal Epidural Abscess

“…The most common causative organism, Staphylococcus aureus, is present in up to 70% of cases (6,7). This is followed in frequency by Streptococcus species, which account for approximately 7% of the cases (6).…”

A posterior epidural mass causing paraparesis in a 20-year-old healthy individual

“…It most frequently occurs following lumbar interventions, epidural anesthesia and spinal surgery. However, spontaneous spinal epidural abscess is a very rare entity that is typically seen in immunocompromised patients (diabetes, cirrhosis, AIDS, long-term steroid use, malignancies and chronic renal failure dialysis cases) secondary to dissemination of systemic or local infections [3]. SEA is a life-threatening condition, and its early diagnosis and therapy are critical to prevent mortality and serious morbidity.…”