Holocord Spinal Epidural Abscess

Ghosh, Partha S.; Loddenkemper, Tobias; Blanco, Manuel Buitrago; Marks, Michelle; Sabella, Camille; Ghosh, Debabrata

doi:10.1177/0883073808329524

Cited by 24 publications

(2 citation statements)

References 15 publications

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“…Consideration of delayed complications is particularly important in the pediatric population given skeletal immaturity and greater remaining life expectancy. SEA in children is even rarer than in the adult population, and holocord involvement makes up a small minority of these cases [7, 9]. Laminectomy/laminoplasty involving greater than four levels is known to be associated with increased risk of spinal deformity that necessitates surgical fusion in a pediatric population [4].…”

Section: Discussionmentioning

confidence: 99%

Pediatric Holocord Epidural Abscess Treated with Apical Laminotomies with Catheter-directed Irrigation and Drainage

Kurudza

Stadler

2019

Cureus

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Spinal epidural abscesses (SEA), while fortunately rare, carry significant risk to affected patients. Optimal treatment of these infections is poorly defined due to the heterogeneity of clinical and radiographic presentations. Urgent surgical evacuation of the infection is critical in cases with spinal cord compression or neurological compromise, though challenges may arise from competing surgical objectives, including the need for successful debridement of the infection, desire to minimize operative intervention, and risk of delayed iatrogenic instability. This is particularly concerning in young children with large multiregional collections. We present the first report case of pediatric holocord abscess treated with apical laminotomies and epidural catheterization for irrigation and drainage. This technique allowed successful treatment while avoiding extensive laminectomies and associated morbidities.

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Section: Discussionmentioning

confidence: 99%

Pediatric Holocord Epidural Abscess Treated with Apical Laminotomies with Catheter-directed Irrigation and Drainage

Kurudza

Stadler

2019

Cureus

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“…Although epidural abscess usually extends over three to four vertebrae, it can involve the whole spine and is known as panspinal infection. 2,26,27 MRI findings of pyogenic spondylodiscitis include high signal on T 2 weighted images and low signal on T 1 weighted images with contrast enhancement. T 2 weighted images demonstrate spinal cord compression and abnormal cord signal.…”

Section: Patterns Of Extension Of Pyogenic Abscess and Pus Collectionmentioning

confidence: 99%

Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections

Moritani

Kim²,

Capizzano³

et al. 2014

BJR

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The incidence of spinal infections has increased in the past two decades, owing to the increasing number of elderly patients, immunocompromised conditions, spinal surgery and instrumentation, vascular access and intravenous drug use. Conventional MRI is the gold standard for diagnostic imaging; however, there are still a significant number of misdiagnosed cases. Diffusion-weighted imaging (DWI) with a b-value of 1000 and apparent diffusion coefficient (ADC) maps provide early and accurate detection of abscess and pus collection. Pyogenic infections are classified into four types of extension based on MRI and DWI findings: (1) epidural/paraspinal abscess with spondylodiscitis, (2) epidural/ paraspinal abscess with facet joint infection, (3) epidural/paraspinal abscess without concomitant spondylodiscitis or facet joint infection and (4) intradural abscess (subdural abscess, purulent meningitis and spinal cord abscess). DWI easily detects abscesses and demonstrates the extension, multiplicity and remote disseminated infection. DWI is often a key image in the differential diagnosis. Important differential diagnoses include epidural, subdural or subarachnoid haemorrhage, cerebrospinal fluid leak, disc herniation, synovial cyst, granulation tissue, intra-or extradural tumour and post-surgical fluid collections. DWI and the ADC values are affected by susceptibility artefacts, incomplete fat suppression and volume-averaging artefacts. Recognition of artefacts is essential when interpreting DWI of spinal and paraspinal infections. DWI is not only useful for the diagnosis but also for the treatment planning of pyogenic and nonpyogenic spinal infections.Spinal and paraspinal infections include vertebral osteomyelitis, spondylodiscitis, infectious facet arthropathy, epidural infections, meningitis, myelitis and infections of paraspinal soft tissue and musculature. Evidence of spinal infections has been discovered in the remains of prehistoric humans from 7000 BC. 1 The incidence has increased in the past two decades, owing to the rising number of elderly patients, immunocompromised conditions, spinal surgery and instrumentation, vascular access and intravenous drug use.1-4 Despite advances in medical knowledge, imaging modalities and surgical interventions, the diagnosis of this entity is still challenging since the clinical features can be subtle and misleading. MRI including post-contrast studies is the gold standard for diagnostic imaging. However, although MRI has relatively high diagnostic sensitivity, specificity and accuracy, there are still a significant number of challenging cases. In such cases, diagnostic delays and suboptimal management can result in irreversible paralysis, critical sepsis and even death.Diffusion-weighted imaging (DWI) has proven to be a useful tool for the diagnosis of a variety of intracranial infections especially in the detection of brain abscesses and pus collections, which encompass subdural and epidural empyema, purulent meningitis and ventriculitis. [5][6][7][8] Therefore, DWI ...

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