Management of a Spontaneous Spinal Epidural Abscess

Karikari, Isaac O.; Powers, Ciarán J.; Reynolds, Renée; Mehta, Ankit I.; Isaacs, Robert E.

doi:10.1227/01.neu.0000356972.97356.c5

Cited by 104 publications

(80 citation statements)

References 8 publications

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“…7,12,14,18,27,37,41 Reportedly, SEA usually occurs in the thoracolumbar spine, dorsally. 19,30,31 In one study, systemic symptoms were more common among those with ventral lesions, and focal deficits were more common among those with dorsal lesions. 19 In the absence of contraindications, the standard imaging modality is MRI; CT myelography is an equivalent option.…”

Section: 10mentioning

confidence: 98%

“…3,17,21,33,43 Factors that can be associated with a worse prognosis are older age, diabetes mellitus, neurological and mental deterioration, and dorsal location of the SEA. 1,8,9,19,23,32 Additionally, higher reoperation and mortality rates are associated with renal failure and hemodialysis. 44,45 In terms of pathogenic microorganisms, overwhelmingly the most common is S. aureus, followed by Streptococcus spp.…”

Section: Literature Reviewmentioning

confidence: 99%

“…9 In previous years, surgical intervention was the mainstay of management of this infection process, particularly when symptoms had not been present for longer than 36-72 hours. 1,9,19,23,31,39 Later studies have shown successful outcomes with medical management alone. 6,19,36,37 However, other more recent studies have indicated that early surgery has better outcomes.…”

Section: 3341mentioning

confidence: 99%

“…4,15,19 Decompression also serves as a way to identify the causative microbe so that appropriate antibiotic therapy can be expeditiously administered. 4,15,37 In select patients with mild back pain and without neurological deficits, antibiotic treatment and immobilization alone can be sufficient therapy; 4,11,36,37 these patients, however, need close monitoring because immediate operative intervention can become necessary in cases of subsequent neurological deterioration.…”

mentioning

confidence: 99%

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An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

Shweikeh

Saeed

Bukavina

et al. 2014

FOC

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Object Over the past decade, the incidence of bacterial spinal epidural abscess (SEA) has been increasing. In recent years, studies on this condition have been rampant in the literature. The authors present an 11-year institutional experience with SEA patients. Additionally, through an analysis of the contemporary literature, they provide an update on the challenging and controversial nature of this increasingly encountered condition. Methods An electronic medical record database was used to retrospectively analyze patients admitted with SEA from January 2001 through February 2012. Presenting symptoms, concurrent conditions, microorganisms, diagnostic modalities, treatments, and outcomes were examined. For the literature search, PubMed was used as the search engine. Studies published from January 1, 2000, through December 31, 2013, were critically reviewed. Data from articles on methodology, demographics, treatments, and outcomes were recorded. Results A total of 106 patients with bacterial SEA were identified. The mean ± SD age of patients was 63.3 ± 13.7 years, and 65.1% of patients were male. Common presenting signs and symptoms were back pain (47.1%) and focal neurological deficits (47.1%). Over 75% of SEAs were in the thoracolumbar spine, and over 50% were ventral. Approximately 34% had an infectious origin. Concurrent conditions included diabetes mellitus (35.8%), vascular conditions (31.3%), and renal insufficiency/dialysis (30.2%). The most commonly isolated organism was Staphylococcus aureus (70.7%), followed by Streptococcus spp. (6.6%). Surgery along with antibiotics was the treatment for 63 (59.4%) patients. Surgery involved spinal fusion for 19 (30.2%), discectomy for 14 (22.2%), and corpectomy for 9 (14.3%). Outcomes were reported objectively; at a mean ± SD follow-up time of 8.4 ± 26 weeks (range 0–192 weeks), outcome was good for 60.7% of patients and poor for 39.3%. The literature search yielded 40 articles, and the authors discuss the result of these studies. Conclusions Bacterial SEA is an ominous condition that calls for early recognition. Neurological status at the time of presentation is a key factor in decision making and patient outcome. In recent years, surgical treatment has been advocated for patients with neurological deficits and failed response to medical therapy. Surgery should be performed immediately and before 36–72 hours from onset of neurological sequelae. However, the decision between medical or surgical intervention entails individual patient considerations including age, concurrent conditions, and objective findings. An evidence-based algorithm for diagnosis and treatment is suggested.

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Section: 10mentioning

confidence: 98%

Section: Literature Reviewmentioning

confidence: 99%

Section: 3341mentioning

confidence: 99%

mentioning

confidence: 99%

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An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

Shweikeh

Saeed

Bukavina

et al. 2014

FOC

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“…14, 15 Savage et al 16 reported that medical treatment with antibiotics is a viable alternative to surgery for patients without systemic sepsis or neurological symptoms. However, the limited literature does not clarify the role and outcome of medical treatment or surgical intervention, 17 particularly in patients with ESRD, and thus close clinical follow-up is required. All patients with neurologic deficit should undergo urgent spinal decompression and abscess drainage.…”

Section: Discussionmentioning

confidence: 99%

Aggressive Surgical Intervention in End-Stage Renal Disease Patients with Spinal Epidural Abscess

Wu¹,

Fu²,

Chang³

et al. 2011

Renal Failure

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Background: Despite advances in imaging, as well as antibiotic and surgical treatment, spinal epidural abscess (SEA) remains a challenging problem in end-stage renal disease (ESRD) patients. This investigation assesses the influence of ESRD on clinical manifestations, complications, and outcomes in patients with SEA. Methods: This study retrospectively reviewed medical records of 41 patients with SEA treated during [2003][2004][2005][2006]. The patients comprised two groups: group I (patients with ESRD) and group II (patients without ESRD). Patient characteristics, including age, gender, comorbidities, clinical presentations, laboratory data, locations of epidural abscess, and outcome, were recorded and compared. Results: The final sample comprised 41 patients. The mean age of the subjects was 62 + 12 years. The sample included 12 patients with ESRD and 29 without ESRD. The development of symptoms was similar for both groups. Group I patients displayed higher serum erythrocyte sedimentation rate (ESR) (108 + 26 vs. 81 + 31 mm/h, p = 0.014) and lower serum hematocrit (27.1 + 4.3 vs. 33.7 + 5.1%, p < 0.001) than group II patients. Overall survival at 3 months was 88.9% and 93.1% for patients in groups I and II, respectively (p = 0.876). Meanwhile, patients that underwent surgical decompression of epidural abscess received more surgeries than group I patients (1.08 vs. 0.55, p = 0.086), although the difference was not significant. Conclusions: ESRD is a risk factor for repeat surgery in patients with SEA. This investigation suggests that ESRD patients with SEA may require aggressive surgical intervention despite ESRD not affecting their long-term prognosis.

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Spinal cord compression

Patel

Payne

Patel

2015

Evidence‐Based Neurology: Management of Neurological Disorders

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Management of a Spontaneous Spinal Epidural Abscess

Abstract: Our data do not support the hypothesis that patients treated without early surgery are more likely to have a poor outcome. Furthermore, we propose that the anatomy of the SEA (ventral or dorsal) should play an important role in determining the treatment plan.

Cited by 104 publications

References 8 publications

An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

Aggressive Surgical Intervention in End-Stage Renal Disease Patients with Spinal Epidural Abscess

Spinal cord compression

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