Hematogenous Pyogenic Spinal Infections and Their Surgical Management

Abstract

Pyogenic spinal infection can be thought of as a spectrum of disease comprising spondylitis, discitis, spondylodiscitis, pyogenic facet arthropathy, and epidural abscess. Spondylodiscitis is more prone to develop epidural abscesses in the cervical spine (90%) than the thoracic (33.3%) or lumbar (23.6%) areas. Thecal sac neurocompression has a greater chance of causing neurologic deficit in the thoracic spine (81.8%). Treatment of neurologic deficit caused by epidural abscess is prompt surgical decompression, with or without fusion. Patients with frank abscess had less favorable outcomes than those with granulation tissue, and paraplegia responded to treatment more poorly than paraparesis. Surgery was preferable to nonsurgical treatment for improving back pain.

Spinal epidural abscess: aetiology, predisponent factors and clinical outcomes in a 4-year prospective study

“…Our rough estimate of the incidence of SEA at 1.8/100,000 persons per year accords with other published estimates [1,2], although its appearance after only 1.1% of the spinal operations performed by our neurosurgical service seems less frequent than others have reported [8]. We found that the commonest pathogen causing SEA was Staphylococcus aureus, just as in other reports [4,5,12,13,15,21,22]. SEA is usually associated with one or more comorbidities [7]; the list of our patients' comorbidities resembles the corresponding lists in other reported series [4,5,8,12].…”

“…SEA is usually associated with one or more comorbidities [7]; the list of our patients' comorbidities resembles the corresponding lists in other reported series [4,5,8,12]. The close association of chronic inflammatory diseases, endocarditis, and other septic conditions with SEA has already been pointed out [15], as has the risk of SEA in persons under immunosuppressive treatment [4,8,14]. SEA is known to become more common with advancing age because of the rising frequency of spinal disorders and of comorbidities [13], and the age distribution of our patients was similar to those previously reported [12,13].…”

“…Primary SEA has been reported to arise by haematogenous spread from skin lesions and from oral [3,6,11,16,17] and enteric foci, including bowel perforation in inflammatory bowel disease [18,19], as well as from injections and infusion therapy at distant sites [15]. We found primary SEA of all these types among our patients.…”

“…Some of the patients reportedly cured in these ways had no neurological deficits. In contrast, nearly all patients with SEA on our neurosurgery service present with neurological deficits and are operated on as soon as SEA is diagnosed; previous reports imply that this yields a better outcome than giving antibiotics alone [10,12,15]. Nonetheless, our two patients whose poor condition precluded surgery did well on antibiotics alone.…”

“…We treat SEA by an interdisciplinary approach involving immediate surgical intervention, as previously described and recommended [10,12,14,15]. We know of no previously published comparisons of primary and secondary SEA regarding their origins, treatment, or outcome.…”