Spinal Epidural Infection

Russell, Neville; Vaughan, Richard J.; Morley, Thomas

doi:10.1017/s0317167100023957

Cited by 65 publications

(31 citation statements)

References 11 publications

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“…Infection-induced vascular factor-associated myelomalacia may be present, 15) in addition to mechanical compression by abscess, and the spinal arterial circulation was maintained in the presence of chronic compression, but thrombus formation, vasculitis, and compression were present in the venous system inside and outside of the spinal dura mater, and caused spinal edema and venous infarction, suggesting involvement of these factors. 13) A case of epidural granuloma in which symptoms developed after a blow due to falling was caused by dynamic factors loaded on the vertebrae. 14) In the present case, compression fracture of the vertebral body had apparently occurred based on the findings of postoperative MR imaging 1 year following surgery.…”

Section: Discussionmentioning

confidence: 99%

Paraplegia Caused by Intratumoral Hemorrhage Within Thoracic Epidural Granuloma -Case Report-

Fukao

Hanakita

Kitahama

et al. 2009

Neurol. Med. Chir.(Tokyo)

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An 84-year-old man presented with a rare case of spinal epidural granuloma with intratumoral hematoma resulting in acute paraplegia. He was admitted to our hospital because of lumbago and hematemesis following a fall 10 days before. Progressive paraparesis occurred 2 days after admission. Neurological examination showed paraplegia and hypesthesia below the T10 level. Thoracic radiography revealed some spondylotic changes of the thoracic vertebrae without osteolytic changes. Sagittal T 1 -and T 2 -weighted magnetic resonance imaging of the thoracic spine demonstrated a hyperintense epidural mass lesion compressing the dorsal portion of the thoracic spinal cord at T10-11 space. Emergency laminectomy was performed, and the epidural encapsulated hematoma and elastic yellowish mass adhered to the dura mater were totally removed. Histological examination of the excised specimens showed a granuloma. Motor weakness improved after surgery, and he could walk with a cane about 3 months after surgery. The minor spinal injury probably caused intratumoral hemorrhage within a previous epidural granuloma, suddenly resulting in the paraplegic symptoms.

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Section: Discussionmentioning

confidence: 99%

Paraplegia Caused by Intratumoral Hemorrhage Within Thoracic Epidural Granuloma -Case Report-

Fukao

Hanakita

Kitahama

et al. 2009

Neurol. Med. Chir.(Tokyo)

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“…The neurologic deficit is less likely to be reversible the more severe and the longer it has been present. Thus, many authors have recognized that prompt and early diagnosis is critical to the management of this potentially curable disease [1][2][3][4][5][6][7][8][9][10][11][12][13]. We recently encountered four patients with spinal epidural infections (three pyogenic, one tuberculous) in whom MR imaging of the spine led to expeditious treatment and better clinical outcome.…”

Section: The Findings In Our Four Cases Support Previous Reports Thatmentioning

confidence: 99%

MR imaging of spinal epidural sepsis

Angtuaco

McConnell

et al. 1987

American Journal of Roentgenology

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are found. Left untreated, the natural course of the disease leads to paraplegia and death [1 -9]. Paraplegia results from compression of the spinal cord or cauda equina by the epidural mass or from thrombophlebitis of the spinal epidural veins resulting in venous infarction of the spinal cord. Death is a result of septicemia. The prognosis for survival and prevention of serious neurologic deficit relates to the rapidity with which appropriate decompression and antibiotic therapy are instituted. The neurologic deficit is less likely to be reversible the more severe and the longer it has been present. Thus, many authors have recognized that prompt and early diagnosis is critical to the management of this potentially curable disease [1-13]. We recently encountered four patients with spinal epidural infections (three pyogenic, one tuberculous) in whom MR imaging of the spine led to expeditious treatment and better clinical outcome. Materials and Methods Four patients with spinal epidural infections (three Staphylococcus aureus, one Mycobacterium tuberculosis)were examined with MR imaging. MR was performed on a GE Signa system with a 1.5-T superconducting CT scans of the spine were obtained on a Siemens DR3 Somatom or Picker 1200 SX unit. Radiographs of the spine were available in all cases.

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“…33,35,51,54 The pathogenesis by which infection in the epidural space leads to neurological deficit remains a controversial topic, with evidence for both direct compression and vascular occlusion caused by septic thrombophlebitis as the offending mechanism. 8,23,24,30,55,66 The direct-inoculation rabbit model studied by Feldenzer et al along with the clinical improvement seen after surgically addressing mass effect caused by SEA, support the direct compression model. 13,23,24 However, instances of rapid clinical deterioration in the absence of radiographic compression and postmortem examinations showing venous and arterial thrombosis lend credence to a vascular etiology.…”

mentioning

confidence: 74%

“…17,27 In cases of complete spinal cord injury for at least 48 hours prior to presentation we also advocate initial nonoperative management, because the surgical risks probably outweigh the chance of functional neurological recovery at that point. 17,25,27,54,55,71 Obviously surgery may still be indicated if there is concern for an ascending deficit, such as in cases where the clinical level is lower than the anatomical location of the infection.…”

Section: 2950mentioning

confidence: 99%

“…13,23,24 However, instances of rapid clinical deterioration in the absence of radiographic compression and postmortem examinations showing venous and arterial thrombosis lend credence to a vascular etiology. 8,30,55,66 Probably both factors potentiate the development of neurological injury and help explain why the clinical course is often unpredictable. 58 The treatment of SEA is two-pronged, with antibiotics for treating the systemic manifestations and surgery for local disease control.…”

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confidence: 99%

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The indications and timing for operative management of spinal epidural abscess: literature review and treatment algorithm

Tuchman

Pham²,

Hsieh³

2014

FOC

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Object Delayed or inappropriate treatment of spinal epidural abscess (SEA) can lead to serious morbidity or death. It is a rare event with significant variation in its causes, anatomical locations, and rate of progression. Traditionally the treatment of choice has involved emergency surgical evacuation and a prolonged course of antibiotics tailored to the offending pathogen. Recent publications have advocated antibiotic treatment without surgical decompression in select patient populations. Clearly defining those patients who can be safely treated in this manner remains in evolution. The authors review the current literature concerning the treatment and outcome of SEA to make recommendations concerning what population can be safely triaged to nonoperative management and the optimal timing of surgery. Methods A PubMed database search was performed using a combination of search terms and Medical Subject Headings, to identify clinical studies reporting on the treatment and outcome of SEA. Results The literature review revealed 28 original case series containing at least 30 patients and reporting on treatment and outcome. All cohorts were deemed Class III evidence, and in all but two the data were obtained retrospectively. Based on the conclusions of these studies along with selected smaller studies and review articles, the authors present an evidence-based algorithm for selecting patients who may be safe candidates for nonoperative management. Conclusions Patients who are unable to undergo an operation, have a complete spinal cord injury more than 48 hours with low clinical or radiographic concern for an ascending lesion, or who are neurologically stable and lack risk factors for failure of medical management may be initially treated with antibiotics alone and close clinical monitoring. If initial medical management is to be undertaken the patient should be made aware that delayed neurological deterioration may not fully resolve even after prompt surgical treatment. Patients deemed good surgical candidates should receive their operation as soon as possible because the rate of clinical deterioration with SEA is notoriously unpredictable. Although patients tend to recover from neurological deficits after treatment of SEA, the time point when a neurological injury becomes irreversible is unknown, supporting emergency surgery in those patients with acute findings.

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Spinal Epidural Infection

Cited by 65 publications

References 11 publications

Paraplegia Caused by Intratumoral Hemorrhage Within Thoracic Epidural Granuloma -Case Report-

Paraplegia Caused by Intratumoral Hemorrhage Within Thoracic Epidural Granuloma -Case Report-

MR imaging of spinal epidural sepsis

The indications and timing for operative management of spinal epidural abscess: literature review and treatment algorithm

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