Review and case report demonstrate that spontaneous spinal epidural abscesses are rare but dangerous in childhood

Fotaki, Anastasia; Anatoliotaki, Maria; Tritou, Ioanna; Tzagaraki, Aggeliki; Kampitaki, Maria; Vlachaki, Georgia

doi:10.1111/apa.14579

Cited by 12 publications

(21 citation statements)

References 24 publications

(106 reference statements)

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“…In adults, it usually occurs in those with predisposing conditions such as diabetes mellitus, chronic renal failure, cancer, immunodeficiency, alcoholism, and intravenous drug abuse, with diabetes mellitus being the most common risk factor. Pediatric risk factors include sickle cell anemia, leukemia, long-term use of steroids, and other causes of immunodeficiency [ 4 , 8 ]. The usual location for SEA is the mid-thoracic to the lumbar spine due to the narrowing of the spinal cord at these levels leading to a larger epidural space; the epidural venous plexus is the presumed route of infection.…”

Section: Discussionmentioning

confidence: 99%

“…The etiology of SEA is bacterial spread to the epidural space through contiguous spread (primary SEA) or hematogenous dissemination (secondary SEA). The most frequent cause in children is hematogenous spread [ 2 , 8 , 9 ]. Extensive or holocord SEA is more commonly seen in children due to more fat and septation in the epidural space compared to adults.…”

Section: Discussionmentioning

confidence: 99%

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Successful Treatment of Pediatric Holo-Spinal Epidural Abscess With Percutaneous Drainage

Ammar¹,

Hamad²,

Obeidallah³

et al. 2022

Cureus

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Spinal epidural abscess (SEA) is a rare and potentially devastating neurologic disease that is commonly treated with neurosurgical decompression and evacuation. We describe the case of an 11-month-old immunocompetent infant who presented with a large multiloculated methicillin-resistant Staphylococcus aureus abscess in the left lung apex with likely mediastinal involvement, extending into the epidural space from C7 down to L2 causing cord compression which was successfully treated with percutaneous placement of an epidural drainage catheter and antibiotic therapy. Although there are rare reports of percutaneous drainage of SEAs, to our knowledge, there are no reports of successful use of percutaneous indwelling catheters resulting in the complete resolution of an SEA. Holo-spinal epidural abscess in an infant is an extremely rare disease with limited literature available regarding the best practice for its treatment. Multiple considerations must be taken into account when weighing the different treatment options ranging from surgical decompression to conservative management with antibiotic therapy. We present a unique case of successful treatment with percutaneous epidural drain placement. This provides a reasonable alternative for management in children for whom surgical decompression carries multiple risks for complications both acutely and delayed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Pediatric Holo-Spinal Epidural Abscess With Percutaneous Drainage

Ammar¹,

Hamad²,

Obeidallah³

et al. 2022

Cureus

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“…Pediatric spinal epidural abscesses have been historically been associated with high rates of morbidity and mortality due to delayed diagnosis or misdiagnosis and non-specific symptoms at disease onset [15] . Streptococci represent 8-17% of the reported infecting organisms in pediatric SEA, with staphylococcus aureus accounting for 50-90% of cases, and gram negative bacteria 10-17% [ 2 , 21 ]. Bacteria gain access to the epidural space occurs via contiguous spread from adjacent foci of osteomyelitis or muscular abscess in 10-30% of cases, or by hematogenous dissemination from a remote source (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 22 case reports of spontaneous pediatric SEA have been documented in the literature [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] . Expedient diagnosis, surgical decompression where indicated, and long-term targeted antibiotic therapy have been shown to be most effective [ 2 , 15 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Pediatric Group A streptococcal spinal epidural abscess presenting with recurrent symptoms of viral illness: An operative case report

Vig

Amarante

Hutchinson

et al. 2021

North American Spine Society Journal (NASSJ)

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Background: Spinal epidural abscess (SEA) in children is a rare condition with dangerous sequelae, and with only 22 other cases reported in the literature, treatment algorithms are poorly understood. Quick identification of the classic tried of sepsis, back pain and neurological deficit is critical. Source identification difficult and often cannot be identified. Reported pathogens include varicella-zoster virus, S. aureus, and S pyogenes. Case description:We report a case of spontaneous pediatric SEA in a 22-month old female without obvious neurologic deficit, who underwent a T10-11 decompressive laminotomy and evacuation of abscess and subsequent 3-week course of intravenous ceftriaxone for culture positive S. pyogenes Outcome: The patient showed marked improvement in symptoms after decompression. 5 weeks postoperatively after transitioning from intravenous ceftriaxone to oral ceftin, the patient redeveloped a deep space infection and was taken back for a repeat debridement. The cultures from this procedure were negative and the patient was discharged on oral clindamycin.Conclusions: Pediatric spontaneous SEA is a rare condition and early diagnosis and surgical intervention if indicated can prevent dangerous sequelae. Further studies into the surgical indications for decompression will aid in algorithmic decision making.

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“…[ 2 ] However, IV drug use and epidural catheter placement are becoming increasingly important risk factors for the development of this disease. [ 5 , 6 ]…”

Section: Introductionmentioning

confidence: 99%

Mixed pyogenic and tuberculous spinal epidural abscesses perforating the dura and extending into the subdural space: A case report and review of the literature

Almotairi,

Alsaleh,

Basalamah

et al. 2023

Surgical Neurology International

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Background: Spinal infections are associated with a wide variety of clinical conditions, including osteomyelitis, spondylitis, diskitis, septic facet joints, and abscesses. Based on its anatomical relationship with the dura mater, the abscess can be epidural (extradural) or subdural (intrathecal). Subdural intramedullary abscesses of the lumbar spinal canal are more common than subdural extramedullary abscesses. Here, we present a rare case of a patient with a mixed pyogenic and tuberculous epidural abscess in the lumbar spine, which perforated the dura and extended to the subdural space. Case Description: A 29-year-old male presented with progressively worsening back pain and lower-limb weakness over a period of 3 months, with an associated inability to walk, intermittent radicular pain primarily on the left side, intermittent incontinence, and a history of low-grade fever and night sweats. The patient had a history of intravenous (IV) drug abuse and reported practicing unprotected sexual intercourse. Furthermore, the patient had recently came into contact with a person diagnosed with tuberculosis (TB). The patient was administered empirical broad-spectrum antibiotics and underwent emergent L4–L5 laminectomy and spinal abscess decompression. IV antibiotics were selected based on culture results, and anti-TB medications were started. Postoperatively, the patient demonstrated a remarkable lower-limb power improvement and radicular pain alleviation. Conclusion: Spinal epidural abscess perforation of the dura and extension into the subdural space is extremely rare. Distinguishing between epidural and subdural abscesses radiologically is challenging. Multiple risk factors, such as unprotected sexual contact and IV drug misuse, may be associated with the development of polymicrobial abscesses in the lumbar spine. Careful anticipation, identification, and isolation of the causative micro-organisms can ensure effective antibacterial treatment. Early diagnosis, expeditious surgical decompression, and antibiotic treatment are associated with promising outcomes.

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Review and case report demonstrate that spontaneous spinal epidural abscesses are rare but dangerous in childhood

Abstract: SEAs were underestimated in children due to the rarity and spectrum of differential diagnoses. Timely diagnosis, immediate antibiotics, spinal magnetic resonance imaging and prompt neurosurgical consultations were essential for favourable outcomes.

Cited by 12 publications

References 24 publications

Successful Treatment of Pediatric Holo-Spinal Epidural Abscess With Percutaneous Drainage

Successful Treatment of Pediatric Holo-Spinal Epidural Abscess With Percutaneous Drainage

Pediatric Group A streptococcal spinal epidural abscess presenting with recurrent symptoms of viral illness: An operative case report

Mixed pyogenic and tuberculous spinal epidural abscesses perforating the dura and extending into the subdural space: A case report and review of the literature

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