Paraspinal Edema Is the Most Sensitive Feature of Lumbar Spinal Epidural Abscess on Unenhanced MRI

Shifrin, Anna; Lü, Qing; Lev, Michael H.; Meehan, Timothy; Hu, Ranliang

doi:10.2214/ajr.16.17108

Cited by 10 publications

(10 citation statements)

References 15 publications

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“…In our series, we confirmed by CT, MRI, and PET scan that primary SEA may sometimes develop before infection of the adjacent vertebrae and disks. At least at the thoracolumbar level, the presence of posterior paraspinal muscle edema is more sensitive and specific for SEA associated with PS compared to bone marrow edema, psoas edema, and intervertebral disk signal abnormality in isolation (30). Paraspinal muscle edema was not present in patients in our series even in those affected by thoracolumbar SEA.…”

Section: Discussionmentioning

confidence: 45%

Primary Spinal Epidural Abscesses Not Associated With Pyogenic Infectious Spondylodiscitis: A New Pathogenetic Hypothesis

et al. 2020

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Spinal epidural abscess (SEA) incidence is rising. However, most series do not differentiate between SEAs associated with pyogenic infectious spondylodiscitis (PS) and SEAs limited to the epidural space. Methods: We retrospectively reviewed the records and radiological images of all patients admitted to our institutions with a diagnosis of SEA not associated with PS between January 2013 and December 2018. Results: We found three males and four females; five of the seven were intravenous drug users. All patients presented with pain: in six, it was associated with acute motor and sensory deficits, while one had only pain and paresthesias. Staphylococcus aureus was cultured from abscesses and/or from multiple blood cultures in four patients. Abscesses were localized to the cervical spine in one patient, thoracic in three, lumbar in one, and in two, the SEAs involved multiple segments. All patients but one underwent urgent open surgery. This patient had a multisegmental abscess and was successfully treated by percutaneous aspiration when pain became intractable. After abscess evacuation, the neurological deficits improved in all patients except one. The patients that were treated without spine instrumentation did not develop delayed kyphosis or instability at follow-up. Conclusion: Patients with SEAs not associated with PS are likely to present with pain and motor deficits, appear to benefit from urgent abscess evacuation, and seem to be less dependent on spine instrumentation to avoid delayed spinal deformities compared to SEA associated with PS. Finally, the lack of initial involvement of bone and intervertebral disks may suggest that at least some of the SEAs without PS originate from infection of epidural lymphatic vessels that are not present inside those structures.

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Section: Discussionmentioning

confidence: 45%

Primary Spinal Epidural Abscesses Not Associated With Pyogenic Infectious Spondylodiscitis: A New Pathogenetic Hypothesis

et al. 2020

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“…The expanded clinical features reported in these 5 articles are presented in tabular form in Table 2. 1, 5 -8…”

Section: Resultsmentioning

confidence: 99%

“…The expanded clinical features reported in these 5 articles are presented in tabular form in Table 2. 1,[5][6][7][8] In 2000, Reihsaus et al conducted an extensive metaanalysis on SEA, covering 915 patients described in the literature between 1954 and 1997. 1 Two hundred and eighty-seven of these patients had SEA in the lumbar spine (38.9%; N ¼ 738 with localization data).…”

Section: Clinical Presentation Risk Factors or Special Populationsmentioning

confidence: 99%

Lumbar Epidural Abscesses: A Systematic Review

Leeuw

Fann

Tanenbaum

et al. 2018

Global Spine Journal

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Study Design:Systematic review.Objectives:Spinal epidural abscesses (SEAs) are rare, but when missed or when diagnosis is delayed, SEA can lead to permanent neurological impairment or death. Limited information exists on the optimal treatment modalities for SEA, especially in the lumbar spine. We synthesize the current literature to identify the clinical features, diagnosis, management, and outcomes of lumbar SEA.Methods:Queries in 4 databases—EMBASE, MEDLINE, Scopus, and Web of Science—were performed using comprehensive search terms to locate published literature on lumbar SEA.Results:Ten articles reporting results for 600 cases of lumbar SEA were included, published between 2000 and 2017. Negative prognostic factors included diabetes, older age, methicillin-resistant Staphylococcus aureus, immune compromise, and more severe disease at presentation. Early first-line surgically treated patients responded better, specifically in terms of motor recovery, than those undergoing medical management or failing medical treatment, despite generally worse initial presentation. Elevated C-reactive protein, leukocytosis, and positive blood cultures predicted medical management failure.Conclusions:This systematic review provides guidance to neurological and orthopedic spine surgeons seeking the best treatment for lumbar-localized SEA. This study is limited by a dearth of high-quality publications to support evidenced-based management recommendations. Surgical treatment appears to provide better outcomes than medical treatment alone, especially in those who present with a motor deficit. Further investigation is needed to confirm this finding. What is clear is that early recognition and treatment remains crucial to minimizing morbidity and mortality of SEA.

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“…The presence of edema in the paraspinal musculature on unenhanced MRI is associated with epidural abscess, and severe paraspinal edema demonstrates low sensitivity (54%) but high specificity (99%) for epidural abscess (32).…”

Section: Selection Of Diagnostic Imaging Techniquementioning

confidence: 99%

Best Practices: CT-Guided Percutaneous Sampling of Vertebral Discitis-Osteomyelitis and Technical Factors Maximizing Biopsy Yield

Husseini

Habibollahi

Nelson

et al. 2021

American Journal of Roentgenology

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Paraspinal Edema Is the Most Sensitive Feature of Lumbar Spinal Epidural Abscess on Unenhanced MRI

Abstract: Paraspinal edema is highly sensitive for SEA. Familiarity with the findings for SEA at unenhanced MRI could help expedite further definitive evaluation when contrast agent is not administered.

Cited by 10 publications

References 15 publications

Primary Spinal Epidural Abscesses Not Associated With Pyogenic Infectious Spondylodiscitis: A New Pathogenetic Hypothesis

Primary Spinal Epidural Abscesses Not Associated With Pyogenic Infectious Spondylodiscitis: A New Pathogenetic Hypothesis

Lumbar Epidural Abscesses: A Systematic Review

Best Practices: CT-Guided Percutaneous Sampling of Vertebral Discitis-Osteomyelitis and Technical Factors Maximizing Biopsy Yield

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