Nonoperative treatment of spinal epidural infections

Mampalam, Thomas J.; Rosegay, Harold; Andrews, Brian T.; Rosenblum, Mark L.; Pitts, Lawrence H.

doi:10.3171/jns.1989.71.2.0208

Cited by 106 publications

(36 citation statements)

References 10 publications

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“…Epidural abscesses have been treated successfully with intravenous antibiotics alone. However, these were in older adults with minor neurologic deficit [5,6]. In infants surgery is the preferred option; in one review, six of seven children who did not have an operation (because of missed diagnoses or they were considered too ill for general anaesthesia) died [8].…”

Section: Discussionmentioning

confidence: 99%

Epidural abscess in an infant

Grevitt

Mehdian

1998

European Spine Journal

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A previously well 2-year-old female infant was admitted as an emergency with status epilepticus. She was apyrexial and general examination was unremarkable. Initial investigation revealed profound hypoglycaemia (glucose < 0.6 mmol/l). The seizures settled following administration of anticonvulsant medication and intravenous glucose. She remained comatose for 24 h. Mid-Chain Acyl-CoA Dehydrogenase Deficiency (MCAD) was suspected, and later confirmed on blood tests. Following the intravenous administration of L-carnitine she became more alert and responsive. At that stage she had an extensor response to painful stimuli with generalised spasticity. Electroencephalogram tests revealed a diffuse encephalopathy.Ten days after admission she developed a pyrexia of 38.4°C; blood cultures were negative. Further pyrexial episodes continued over the next 2 weeks, at the end of which she developed a varicella infection. The skin vesicles became secondarily infected with Staphylococcus aureus, which progressed to a septicaemia and pneumonitis. Her condition deteriorated; although her white cell count was elevated at 16.1 × 10 9 /l, she was profoundly neutropoenic (1.0 × 10 9 /l). Scalp and praecordial abscesses erupted and required formal surgical drainage.Immediately after the above operation there was no voluntary movement of the lower limbs. She had a pyrexia of 39°C and neurological examination showed absent deep tendon reflexes and bilaterally positive Babinski reflexes. Her general condition was poor with inspiratory stridor and low blood saturation even with supplemental oxygen. Plain radiographs were initially interpreted as normal; in retrospect the lateral radiograph of the thoracic spine showed a kyphosis between T5 and T7 (Fig. 1). MRI revealed complete vertebral collapse of T6 and localised kyphosis at this level. There was an extensive epidural abscess and extrusion of granulation tissue posteriorly causing predominant anterior compression of the spinal cord. There was marked marrow oedema of the adjacent vertebrae (Fig. 2).Despite her condition (ASA grade 4), surgery was deemed necessary but was delayed for 12 h for further resuscitation and chest physiotherapy.A left thoracotomy was performed and the MRI findings were confirmed. There was marked paravertebral thickening of the somatic pleura. Frank pus was obtained from within the canal. Decompression of the cord was achieved by means of a T6 vertebrectomy. A rib strut graft was used to maintain correction of the kyphosis. Confirmatory cultures of Staphylococcus aureus were obtained from the intraoperative specimens.Post-operatively she was transferred to the paediatric intensive care unit. High-dose intravenous flucloxacillin, fucidin and gentamicin antibiotic therapy was commenced. The pyrexia rapidly settled and she was successfully weaned from assisted ventilation at 48 h. Spontaneous movements of the legs returned 5 days after the spinal surgery. Oral antibiotic treatment was maintained for 6 weeks. A moulded polypropylene thoracolumbar support orthosis w...

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Section: Discussionmentioning

confidence: 99%

Epidural abscess in an infant

Grevitt

Mehdian

1998

European Spine Journal

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“…Although 62% of blood cultures gives a positive result, 90% of abscesses material and 19% of the liquor can result in a specific germ (Angtuaco et al, 1987;Reihsaus et al, 2000;Sendi et al, 2008). The most common site of infection is the thoracolumbar region, due to the greater presence of fatty tissue, vascularization and lower adherence of the dura mater to the cord, as observed in this case (L4 to S1) (Grewal et al, 2006;Mampalam et al, 1989;Simpson et al, 1999).…”

Section: Discussionmentioning

confidence: 60%

“…If the paralysis persists for more than 36 to 48 h, nonsurgical approach is recommended (Mampalam et al, 1989). In cases without acute neurological involvement, diagnostic aspiration followed by antibiotic therapy for 4 to 8 weeks may be a reasonable choice (Angtuaco et al, 1987;Bremer and Darouiche, 2004).…”

Section: Discussionmentioning

confidence: 99%

Epidural abscess in a diabetic patient with complicated pyelonephritis: Case report and literature review

Silva¹,

Safadi²,

Silva³

et al. 2016

Med. Case Stud.

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Epidural abscess is a rare condition, with increasing incidence, but still underdiagnosed. Clinical set is often confused with common diseases, which delays the diagnosis and may progress to irreversible neurological sequelae or death, if no early intervention is taken. We have reported a case of a patient immunosuppressed by diabetes who developed an epidural abscess due to a complicated pyelonephritis.

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“…Several authors have shown satisfactory results in patients treated non-operatively [10,11,17,18]. Leys et al [10] proposed four indications for the non-surgical m a n a g e m e n t of SEA.…”

Section: Discussionmentioning

confidence: 99%

Surgical decompression: a life-saving procedure for an extensive spinal epidural abscess

1997

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A b s t r a c t Extensive spinal epidural abscesses (SEAs) carry a high mortality rate. Traditionally they are treated non-operatively with longterm antibiotics and/or surgical decompression, but there is a continuing debate as to whether they should be managed by emergency surgical decompression. However, such decisions are made in the light of the clinical setting. We report the successful m a n a g e m e n t of a female patient who presented with features of upper cervical cord compression and later developed septic shock and multisystem failure. Surgical decompression of the cervical spine and irrigation of the epidural space with a paediatric catheter was performed followed by tricortical strut grafting and plating. At review, 36 weeks after surgery, the patient remained asymptomatic, having made full neurological recovery. The purpose of this report is to highlight the importance of emergency surgical intervention for extensive S E A in the presence of progressive neurological loss associated with multisystem failure.

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Nonoperative treatment of spinal epidural infections

Cited by 106 publications

References 10 publications

Epidural abscess in an infant

Epidural abscess in an infant

Epidural abscess in a diabetic patient with complicated pyelonephritis: Case report and literature review

Surgical decompression: a life-saving procedure for an extensive spinal epidural abscess

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