Spinal epidural abscess ? review of 10 cases

Tacconi, Leonello; Johnston, Francis G.; Symon, Lindsay

doi:10.1007/bf01411171

Cited by 33 publications

(19 citation statements)

References 14 publications

(15 reference statements)

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“…This localization corresponds to the results of most large case series in the literature [16,138,177,235,253]. The preferential thoracic or lumbar localization of SEA is likely related to the greater extension of the epidural space in the thoracolumbar segment of the vertebral column and to the welldeveloped extradural venous plexus in this region [366].…”

Section: Pathogenesis and Risk Factorssupporting

confidence: 83%

“…Almost all reviews and case series on spinal epidural abscess emphasize this point [8,16,31,67,80,82,98,154,158,164,179,189,195,201,213,214,230,232,235,262,264,283,297,300,306,309,314,316,330,350,366,378,401]. Immediate therapy is necessary to prevent compression of the spinal cord and cauda equina, with the corresponding neurological lesions (Fig.…”

Section: Introductionmentioning

confidence: 99%

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Spinal epidural abscess: a meta-analysis of 915 patients

Waldbaur²,

2000

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Spinal epidural abscess (SEA) was first described in the medical literature in 1761 and represents a severe, generally pyogenic infection of the epidural space requiring emergent neurosurgical intervention to avoid permanent neurologic deficits. Spinal epidural abscess comprises 0.2 to 2 cases per 10,000 hospital admissions. This review intends to offer detailed evaluation and a comprehensive meta-analysis of the international literature on SEA between 1954 and 1997, especially of patients who developed it following anesthetic procedures in the spinal canal. In this period, 915 cases of SEA were published. This review is the most comprehensive literature analysis on SEA to date. Most cases of SEA occur in patients aged 30 to 60 years, but the youngest patient was only 10 days old and the oldest was 87. The ratio of men to women was 1:0.56. The most common risk factor was diabetes mellitus, followed by trauma, intravenous drug abuse, and alcoholism. Epidural anesthesia or analgesia had been performed in 5.5% of the patients with SEA. Skin abscesses and furuncles were the most common source of infection. Of the patients, 71% had back pain as the initial symptom and 66% had fever. The second stage of radicular irritation is followed by the third stage, with beginning neurological deficit including muscle weakness and sphincter incontinence as well as sensory deficits. Paralysis (the fourth stage) affected only 34% of the patients. The average leukocyte count was 15,700/microl (range 1,500-42,000/microl), and the average erythrocyte sedimentation rate was 77 mm in the first hour (range 2-50 mm). Spinal epidural abscess is primarily a bacterial infection, and the gram-positive Staphylococcus aureus is its most common causative agent. This is true also for patients who develop SEA following spinal anesthetics. Magnetic resonance imaging (MRI) displays the greatest diagnostic accuracy and is the method of first choice in the diagnostic process. Myelography, commonly used previously to diagnose SEA, is no longer recommended. Lumbar puncture to determine cerebrospinal fluid protein concentrations is not needed for diagnosis and entails the risk of spreading bacteria into the subarachnoid space with consequent meningitis; therefore, it should not be performed. The therapeutic method of choice is laminectomy combined with antibiotics. Conservative treatment alone is justifiable only for specific indications. Laminotomy is a therapeutic alternative for children. The mortality of SEA dropped from 34% in the period of 1954-1960 to 15% in 1991-1997. At the beginning of the twentieth century, almost all patients with SEA died. Parallel to improvements in the mortality rate, today more patients experience complete recovery from SEA. The prognosis of patients who develop SEA following epidural anesthesia or analgesia is not better than that of patients with noniatrogenic SEA, and the mortality rate is also comparable. The essential problem of SEA lies in the necessity of early diagnosis, because only timely treatment is able to av...

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Section: Pathogenesis and Risk Factorssupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Spinal epidural abscess: a meta-analysis of 915 patients

Waldbaur²,

2000

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“…The incidence of spinal epidural abscesses is very low with estimates ranging from 1–2 cases in 10,000 hospital admissions [1, 2, 3]. The most frequent aetiology is Staphylococcus aureus [4]but other bacteria or fungi may also occasionally be involved such as Candida glabrata, Fusobacterium nucleatum, Actinobacillus sp., Mycobacterium tuberculosis, Haemophilus paraphrofillus, Escherichia coli, Salmonella enteritidis, Pseudomonas sp., Nocardia sp., Pneumococcus sp., and Brucella .…”

Section: Introductionmentioning

confidence: 99%

Brucellar Spinal Epidural Abscess of Cervical Location: Report of Four Cases

Pina

Modrego²,

Uroz³

et al. 2001

Eur Neurol

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Spinal epidural abscesses account for 1 or 2 of every 10,000 hospital admissions, Staphylococcus aureus being the bacterium most frequently involved. Brucellosis is a disorder of worldwide distribution, relatively frequent in South America and in Mediterranean countries in Europe and Africa. Whilst in the USA only 200 cases are reported every year, in Spain it is the most frequent zoonosis. This systemic disease seldom produces spondylodiscitis which in a minority of cases may be complicated by spinal epidural abscesses, in general of lumbar location. The purpose of this article is to analyse 4 cases of brucellar spinal epidural abscess of cervical location and diagnosed in the Province of Teruel, Spain, an endemic area for the disease, through 10 consecutive years (1990–1999). We consider noteworthy the following facts: the first case was a technical employee who acquired the infection in our laboratory of microbiology, the second presented with an extensive purulent collection invading prevertebral and retropharyngeal regions, the third case was cured only with antibiotics without residual deficits. In the fourth case we were not able to demonstrate spondylodiscitis accompanying the epidural abscess at the C₂–C₆ levels. We discuss especially the epidemiological aspects of brucellosis, the existence of epidural abscess without spondylodiscitis, the clinical manifestations, the diagnosis by means of magnetic resonance imaging, specific serological tests for Brucella, antibiotic treatment and the prognosis of our cases.

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“…With early diagnosis and treatment, however, prognosis is quite good. 2,[4][5][6][9][10][11]17 First described in 1761, little has changed in terms of symptomatology and clinical description. Reihsaus, et al,13 have published the largest study in which they performed a metaanalysis of data obtained in 915 patients.…”

mentioning

confidence: 99%

Is spinal instrumentation a risk factor for late-onset infection in cases of distant infection or surgery?

Naderi

Acar²,

Mertol³

2003

FOC

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As a cause of revision spinal surgery, spinal epidural abscess after instrumentation-assisted fusion is rare in neurosurgical practice. Postoperative infections are frequently seen in the time period soon after surgery. The authors report on the case of a 45-year-old woman who had undergone posterior instrumentation-augmented fusion for L4–5 degenerative spondylolisthesis. Ten months after the operation she presented to the neurosurgery clinic with complaints of severe low-back pain and radicular right lower-extremity pain. She had undergone laparoscopic surgery for acute cholecystitis 1 month prior to readmission. Radiological study revealed a spinal epidural abscess in communication with a right psoas abscess at L4–5. The abscess was drained percutaneously with the aid of C-arm fluoroscopic guidance, and a 6-week course of parenteral antibiotic therapy was administered. Retrograde lymphatic bacterial translocation, hematopoietic spread, and the suitable charectaristics in the host may facilitate the development of infection around the implant. Thus, distant surgery and infection may be a risk factor in cases in which spinal instrumentation is placed. In such cases a prolonged antibiotic therapy for distant infection after surgery is recommended.

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Spinal epidural abscess ? review of 10 cases

Cited by 33 publications

References 14 publications

Spinal epidural abscess: a meta-analysis of 915 patients

Spinal epidural abscess: a meta-analysis of 915 patients

Brucellar Spinal Epidural Abscess of Cervical Location: Report of Four Cases

Is spinal instrumentation a risk factor for late-onset infection in cases of distant infection or surgery?

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