How Best to Manage the Spinal Epidural Abscess? A Current Systematic Review

Suppiah, Suganth; Meng, Ying; Fehlings, Michael G.; Massicotte, Eric M.; Yee, Albert; Shamji, Mohammed F.

doi:10.1016/j.wneu.2016.05.074

Cited by 55 publications

(55 citation statements)

References 35 publications

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“…Therapy usually include vancomycin, last generation cephalosporin, and sometimes aminoglycoside, and/or metronidazole [3,4,6,7]. There are no guidelines for the duration of therapy, but patients typically require 4-8 weeks of therapy [3][4][5][6][7]9] Postoperative recovery depends on age, health status, comorbidities, and history duration [13][14][15] but above all on the patient's neurologic status immediately before surgery [2,4,5,7]. Despite recent improvements, outcomes of SEA remain poor, with mortality ranging from 5% to 23% and neurological morbidity ranging from 4% to 55% [4][5][6][7]9,16].…”

Section: Seamentioning

confidence: 99%

Spinal Epidural Abscess in COVID-19 patients

Talamonti

Colistra

Crisà

et al. 2020

Preprint

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Abstract Objective: To report the peculiarities of spinal epidural abscess in COVID-19 patients, because we observed an unusually high number of these patients following the outbreak of SARS-Corona Virus-2.Methods: We reviewed the clinical documentation of six consecutive COVID-19 patients with primary spinal epidural abscess that we had to surgically manage during a two-month period. These cases were analyzed for what concerns both the viral infection and the spinal abscess.Results: Abscess was primary in all cases meaning that no evident infective source was found. Primary abscess represents the rarest form of spinal epidural abscess, which is usually secondary to invasive procedures or spreading from adjacent infective sites, such as spondylodiscitis and generally occurs in patients with diabetes, obesity, cancer, or other chronic disease. In all cases, there was mild lymphopenia but the spinal abscess occurred regardless the severity of the viral disease, the immunologic state, and the presence of bacteremia. Obesity was the only risk factor and was reported just in two patients. All patients but one were hypertensive. The preferred localizations were cervical and thoracic, whereas the classic abscess generally occurs at lumbar level. No patient had history of pyogenic infection, even though previous asymptomatic bacterial contaminations were reported in three cases.Conclusion: We wonder about the concentration of this uncommon disease in a so short period. To our knowledge, cases of epidural spinal abscess in COVID-19 patients have been not yet reported. Accordingly, we ignore if the SARS-Corona Virus-2 may really predispose to spinal epidural abscesses. However, we hypothesize that, in our patients, the spinal infection could have depended on the coexistence of an initially asymptomatic bacterial contamination. The well-known COVID-19-related endotheliitis might have created the conditions for retrograde bacterial invasion of the correspondent spinal epidural space. Anyway, the spinal epidural abscess carries significantly high morbidity and mortality. It is difficult to diagnose, especially in compromised COVID-19 patients but it should be kept in mind because early diagnosis and treatment are crucial.

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Section: Seamentioning

confidence: 99%

Spinal Epidural Abscess in COVID-19 patients

Talamonti

Colistra

Crisà

et al. 2020

Preprint

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“…13 Epidural collections usually require surgical drainage. 14 Unless blood cultures have already revealed a causative organism, deep microbiological samples should be obtained. This can be with intraoperative samples if surgery is indicated, or by radiological biopsy in other cases.…”

Section: Spinal Infections (Vertebral Osteomyelitis Discitis Epidurmentioning

confidence: 99%

Bone and joint infection

Colston

Atkins

2018

Clinical Medicine

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Bone and joint infections include septic arthritis, prosthetic joint infections, osteomyelitis, spinal infections (discitis, vertebral osteomyelitis and epidural abscess) and diabetic foot osteomyelitis. All of these may present through the acute medical take. This article discusses the pathogenesis of infection and highlights the importance of taking a careful history and fully examining the patient. It also emphasises the importance of early surgical intervention in many cases. Consideration of alternative diagnoses, appropriate imaging and high-quality microbiological sampling is important to allow appropriate and targeted antimicrobial therapy. This article makes some suggestions as to empiric antibiotic choice; however, therapy should be guided by local antimicrobial policies and infection specialists. Involvement of a multidisciplinary team is essential for optimal outcomes.

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“…[ 8 ] Although the period of antibiotic therapy for epidural abscess is still being debated, it is preferable to continue treatment for at least 4 weeks, because studies have shown a 25% rate of relapse in patients who were treated for less than 4 weeks. [ 11 , 14 , 15 ] In the present case, the patient received antibiotic therapy for more than 1 month and showed no evidence of relapse during the 3-month follow-up period.…”

Section: Discussionmentioning

confidence: 49%

Cervical epidural analgesia complicated by epidural abscess

2017

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Rationale:Spinal epidural abscess is an uncommon complication in clinical practice. If the abscess is large enough, the patient will rapidly develop neurologic signs of spinal injury, and urgent neurosurgical intervention may be required.Patient concerns:Rapid and correct diagnosis and treatment is important for spinal epidural abscess complication.Diagnoses:This report describes a cervical epidural abscess (CEA) caused by epidural analgesia, wherein the patient was punctured twice. A CEA was suspected based on the patient's significant neck pain and elevated white blood cell and neutrophil counts. A CEA from C6 to T8 was confirmed by magnetic resonance imaging scan.Interventions:The patient was treated with a combination of intravenous vancomycin and imipenem/cilastatin for more than 4 weeks.Outcomes:After more than 2 weeks of intensive antibiotic treatment, the epidural abscess gradually diminished in size, the white blood cell count, neutrophil count, hyperallergic C-reactive protein (CRP), and general CRP decreased, and the patient's neck and back pain resolved. After more than 4 weeks of anti-inflammation therapy, the epidural abscess was completely absorbed, and there was no relapse during the 3-month follow-up period.Lessons:Although an effective combination of intravenous antibiotics can cure an epidural abscess, caution is warranted when performing epidural steroid injections in immunocompromised patients.

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How Best to Manage the Spinal Epidural Abscess? A Current Systematic Review

Cited by 55 publications

References 35 publications

Spinal Epidural Abscess in COVID-19 patients

Spinal Epidural Abscess in COVID-19 patients

Bone and joint infection

Cervical epidural analgesia complicated by epidural abscess

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