Pan-regional (cervico-thoraco-lumbo-sacral) spinal epidural abscess with multi-level discitis, vertebral body osteomyelitis and facet joint septic arthritis: complete resolution with non-operative management

Manickam, Appukutty; Marshman, Laurence A.G.; Korah, Ipeson

doi:10.1016/j.inat.2014.05.002

Cited by 2 publications

(3 citation statements)

References 10 publications

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“…22 Primary nonoperative treatment with antibiotics has been described in the literature. 3,22 Several factors to favour medical management have been identified, including patients over 50 years old or with significant co-morbidities; the absence of neurology, or conversely, neurological dysfunction that has been persistent for more than 36 hours. As in our case, extensive multi-regional SEA has also been described as an indication for conservative management.…”

Section: Discussionmentioning

confidence: 99%

“…Abscesses can affect any spinal level however, and one third of cases extend over more than six vertebral segments. 3 Despite this, extensive multi-regional, or holospinal abscesses remain rare and pose a particular challenge when deciding on treatment options; both nonoperative and operative management of these patients has been described in the literature. We describe such a case of a 77-yearold patient who presented with a multi-regional epidural abscess and associated neurological deficit.…”

Section: Introductionmentioning

confidence: 99%

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Nonoperative Management of a Multi-Regional Epidural Abscess with Neurological Dysfunction

et al. 2015

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Spinal epidural abscesses are uncommon, but their incidence is increasing. They represent a collection of purulent material in the epidural space and most commonly occur in the lumbar spine, where they remain localised.Abscesses that affect all three spinal levels (holospinal or multiregional abscesses) are extremely rare, with only a few cases published in the literature.Epidural abscesses are particularly high risk infections as progressive neurological dysfunction can occur rapidly; early diagnosis and treatment is therefore essential to avoid long term neurological complications and reduce potential mortality.Given the uncommon nature of this condition, the treatment remains controversial with no definitive guidance on conservative versus surgical management. The literature mostly recommends surgical decompression along with intravenous antibiotics in patients with neurological abnormalities.We describe a case of a 77-year-old patient presenting with a delayed diagnosis of a multi-regional epidural abscess with associated upper motor neurone signs. The patient was successfully treated nonoperatively with a course of antibiotics resulting in complete radiological resolution of the abscess and full neurological recovery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nonoperative Management of a Multi-Regional Epidural Abscess with Neurological Dysfunction

et al. 2015

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“…Involvement of the cervical, thoracic, lumbar and sacral (CTLS) regions is referred to as a pan-or holo-spinal epidural abscess and have been reported a limited number of times in the literature. Among reported cases of this phenomena, none have reported Escherichia coli as being the causative organism [2,[13][14][15] . These abscesses are traditionally thought of as a surgical emergency.…”

Section: Discussionmentioning

confidence: 99%

Holospinal epidural abscess: An unexpected find

Calderón¹,

Haralsingh²,

Ramnarine³

2020

Int. J. Orthop. Sci.

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Introduction: Spinal epidural abscesses present infrequently in surgical practice resulting in neurological morbidity, and mortality. A rare find is the presence of an abscess involving the entire cervical, thoracic and lumbosacral regions of the spine, with limited reported cases in literature. When this is encountered urgent neurosurgical intervention is required to improve patient prognosis. Case Description: A 58-year-old, poorly controlled type II diabetic male, presented with a 3-week history of lower back pain and progressive limitation in ambulation. Further deterioration was observed in-hospital, with a sudden decline in power of the lower limbs from a Medical Research Council (MRC) grade 5 to 2. This prompted urgent magnetic resonance imaging of the whole spine, which depicted an epidural abscess extending from the cervical vertebrae -C3, to the sacrum -S1, with resulting compression of the spinal cord. An emergency multi-level laminectomy was performed with drainage of the epidural space. There was resolution of his sensory deficits and objective improvement in power of the lower limbs post-operation. Culture reports showed the culprit organism to be Escherichia coli. Conclusion:Severe back pain in the diabetic patient requires careful assessment and monitoring. Emergency surgical decompression within 72 hours of neurological symptoms improves prognostic outcomes in patients with spinal epidural abscesses. We contend that performing a multi-level laminectomy procedure is the best option for an extensive posterior spinal epidural abscesses without bony involvement. Other methods such as image-guided percutaneous drainage, catheter procedures and intermediate level fenestration procedures, while less invasive, may be more likely to fail.

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Pan-regional (cervico-thoraco-lumbo-sacral) spinal epidural abscess with multi-level discitis, vertebral body osteomyelitis and facet joint septic arthritis: complete resolution with non-operative management

Cited by 2 publications

References 10 publications

Nonoperative Management of a Multi-Regional Epidural Abscess with Neurological Dysfunction

Nonoperative Management of a Multi-Regional Epidural Abscess with Neurological Dysfunction

Holospinal epidural abscess: An unexpected find

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