Spinal epidural suppuration, with special reference to osteomyelitis of the vertebræ

Stammers, F. A. R.

doi:10.1002/bjs.18002610216

Cited by 35 publications

(7 citation statements)

References 3 publications

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“…25,26 The terminology used for location description is inconsistent and photographic documentation is lacking with these respective reports. The sinuses described in the reports by Ripley and Thompson 25 and by Stammers 26 may actually be located above the natal cleft of the buttocks representative of well-characterized cutaneous signatures of OSD.…”

Section: Resultsmentioning

confidence: 99%

Coccygeal Pits

Weprin

Oakes

2000

Pediatrics

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ABSTRACT. Background. Congenital dermal sinuses represent cutaneous depressions or tracts that are lined by stratified squamous epithelium. They communicate between the surface of the skin and deeper structures and may occur anywhere along the craniospinal axis. These sinuses are thought to result from abnormal separation of the cutaneous and neural ectoderm between the third and fifth week of intrauterine life. They may be often accompanied by other cutaneous stigmata, various dysraphic abnormalities, or intraspinal tumors.In the sacrococcygeal area, cutaneous congenital abnormalities are relatively common. It is estimated that 2% to 4% of children harbor intergluteal dorsal dermal sinuses. These intergluteal sinuses in the perianal region are frequently referred to as pits or dimples. Their cause is considered similar to other congenital dermal sinuses and appears unrelated to acquired pilonidal conditions observed in adults. They may become susceptible to local recurrent infection from trauma or hirsutism.Controversy regarding the evaluation and management of cutaneous defects in the coccygeal region exists.Methods. Both a literature review and a career review of clinical material were performed. Databases for articles published in English were surveyed for key words relating to coccygeal sinuses using standard computerized search techniques. The medical records of children presenting to our neurosurgical clinic for evaluation of dorsal dermal sinuses were reviewed to identify those with intergluteal sinuses.Results. In the evaluation of reported cases and of our own, we were unable to identify any children with coccygeal sinuses without other cutaneous markers other than hair with findings suggestive of intraspinal communication.Conclusions. Intergluteal dorsal dermal sinuses are relatively common lesions that frequently come to neurosurgical attention.

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Section: Resultsmentioning

confidence: 99%

Coccygeal Pits

Weprin

Oakes

2000

Pediatrics

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“…Since then, laminectomy has been standard treatment (see "Treatment"). Following the above mentioned articles, there were numerous communications on the operative treatment aspects of SEA in the medical literature from the 1930s to the 1950s [8,15,26,34,47,48,51,64,68,69,83,90,120,131,136,151,197,218,246,248,284,289,295,296,301,310,349,356,396].…”

Section: The History Of Spinal Epidural Abscessmentioning

confidence: 99%

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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“…The pain becomes very severe later and it is the intensity of this pain which is outstanding and diagnostic. Stammers (1938) noted that this pain is increased by flexion of the spine as opposed to extension. If the diagnosis is not made and the pus is not released, sooner or later abnormal neurological signs develop.…”

Section: Typical Symptoms and Signsmentioning

confidence: 99%

“…Spinal epidural abscess is a condition which has been well documented, mainly in American literature but notably in this country by Stammers (1938) and Hulme and Dott (1954). Despite all that is known about this condition, the diagnosis is still being made too late with the disastrous consequence to the patient of permanent paraplegia.…”

Section: Introductionmentioning

confidence: 99%