Predicting patients with concurrent noncontiguous spinal epidural abscess lesions

Ju, Kevin L.; Kim, Sang Do; Melikian, Rojeh; Bono, Christopher M.; Harris, Mitchel B.

doi:10.1016/j.spinee.2014.06.008

Cited by 32 publications

(25 citation statements)

References 20 publications

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“…This should not detract from the work of Ju et al [5], which sheds important light on a heretofore unexplored aspect of epidural abscess management. As the authors point out, their effort is the largest series to date on cases of noncontiguous epidural abscess, and their descriptive statistics alone make a valuable and immediate contribution to patient care.…”

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confidence: 77%

“…Viewed in this context, the contribution of Ju et al [5] advances our understanding of the epidemiology of this condition. Yet, due to limitations the authors readily acknowledge, their predictive rules are not ready for full clinical application.…”

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confidence: 99%

“…Yet, due to limitations the authors readily acknowledge, their predictive rules are not ready for full clinical application. Using a dataset spanning two decades and consisting of cases from two tertiary academic centers, Ju and colleagues [5] identified 233 patients for inclusion, 22 of whom had noncontiguous epidural abscesses. Within this sample, the authors determined that concurrent extraspinal infection, erythrocyte sedimentation rate O95 mm/h and more than 7-day delay in presentation were independent risk factors for noncontiguous abscesses [5].…”

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confidence: 99%

“…With this in mind, it is important to recognize the limitations of the risk prediction tool developed by Ju and colleagues [5]. Despite the major undertaking of collecting all cases in two facilities over almost 20 years, the very low incidence of epidural abscesses resulted in only 22 identified cases of noncontiguous abscess.…”

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confidence: 99%

“…As the authors recognize: ''.it was difficult to establish the precise reason why certain patients with [epidural abscesses] received full spinal imaging, whereas others did not.provider preference was the predominant reason'' [5]. As a result, numerous patients may have had unrecognized/undiagnosed noncontiguous abscesses over the course of the study period.…”

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confidence: 99%

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Predictive modeling for epidural abscess: what we can, can't, and should do about it

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confidence: 77%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Predictive modeling for epidural abscess: what we can, can't, and should do about it

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Preclinical models of vertebral osteomyelitis and associated infections: Current models and recommendations for study design

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Spine-related infections, such as vertebral osteomyelitis, discitis, or spondylitis, are rare diseases that mostly affect adults, and are usually of hematogenous origin. The incidence of this condition has gradually risen in recent years because of increases in spine-related surgery and hospital-acquired infections, an aging population, and intravenous (IV) drug use. Spine infections are most commonly caused by Staphylococcus aureus, while other systemic infections such as tuberculosis and brucellosis can also cause spondylitis. Various animal models of vertebral osteomyelitis and associated infections have been investigated in mouse, rat, chicken, rabbit, dog, and sheep models by hematogenous and direct inoculation in surgery, each with their strengths and limitations. This review is the first of its kind to concisely analyze the various existing animal models used to reproduce clinically relevant models of infection. Spine-related infection models must address the unique anatomy of the spine, the avascular nature of its structures and tissues and the consequences of tissue destruction such as spinal cord compression. Further investigation is necessary to elucidate the specific mechanisms of host-microbe response to inform antimicrobial therapy and administration techniques in a technically demanding body cavity. Small-animal models are not suitable for large instrumentation, and difficult IV access thwarts antibiotic administration. In contrast, large-animal models can be implanted with clinically relevant instrumentation and are resilient to repeat procedures to study postoperative infection. A canine model of infection offers a unique opportunity to design and investigate antimicrobial treatments through recruitment a rich population of canine patients, presenting with a natural disease that is suitable for randomized trials.

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Predicting patients with concurrent noncontiguous spinal epidural abscess lesions

Cited by 32 publications

References 20 publications

Predictive modeling for epidural abscess: what we can, can't, and should do about it

Predictive modeling for epidural abscess: what we can, can't, and should do about it

Spinal Infections

Preclinical models of vertebral osteomyelitis and associated infections: Current models and recommendations for study design

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