Successful Nonoperative Treatment of Tuberculous Spinal Epidural Abscess with Cord Compression: The Role of Magnetic Resonance Imaging

Latronico, Nicola; Tansini, A; Gf, Gualandi; Bonetti, M.; Scalzini, Alfredo; Candiani, A; Chiesa, A.

doi:10.1159/000116929

Cited by 8 publications

(5 citation statements)

References 5 publications

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“…Our experience, along with that of other surgeons, [2][3][4]8,9,18,23,38,40,44,46 suggests that surgical evacuation of the abscess is advisable in most cases, especially when the abscesses are located in the cervical region. 21,[25][26][27]37,43,48 One goal of surgery is to preserve spinal stability. 16 In cases involving normal neurological function or a slight deficit, however, some authors prefer to undertake conservative treatment, particularly if the microbe can be identified.…”

Section: Discussionmentioning

confidence: 99%

Cervical spine epidural abscess: experience with microsurgical treatment in eight cases

Muzii

Mariottini

Zalaffi

et al. 2006

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Object The authors report a series of eight consecutive cases in which epidural abscesses in the cervical spine were treated by microsurgery without arthrodesis, including two cases of concomitant pyogenic and tubercular infection. Methods The authors used a minimally invasive surgical approach consisting of single-level anterior microsurgical discectomy and drainage of the epidural abscess via a silicone catheter, and then initiated antibiotic therapy. At follow-up examination (mean duration 39 months), six patients exhibited complete recovery and two suffered from minor residual deficits. In all cases, spontaneous vertebral fusion occurred. Sagittal alignment was maintained in seven patients, and in one there was slight asymptomatic kyphosis. In two patients, tubercular and pyogenic infections were found. Prior intervention for dental infection was recorded in four cases. Conclusions In the absence of preoperative spinal instability, microsurgical drainage of the abscess followed by specific antibiotic therapy resulted in spinal cord decompression and neurological recovery, thereby facilitating spontaneous fusion and vertebral stability. The presence of combined tubercular and pyogenic infections of the cervical spine should be considered, especially in patients whose immune systems are depressed.

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Section: Discussionmentioning

confidence: 99%

Cervical spine epidural abscess: experience with microsurgical treatment in eight cases

Muzii

Mariottini

Zalaffi

et al. 2006

SPI

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“…In patients with little or stable neurology in whom an anaesthetic may be risky or surgery perhaps unnecessary then conservative treatment appears to be a reasonable option and recently some attention has been focused on this method of treatment [7,9]. Obviously a correct microbiological diagnosis is essential and is usually available from blood cultures or from closed biopsy of a para-vertebral abscess.…”

Section: Discussionmentioning

confidence: 99%

Spinal epidural abscess ? review of 10 cases

1996

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“…A dissertation from 1962 [333] in the Cologne University Department of Neurosurgery evaluates results obtained with three patients as well as only 100 other cases from the literature, with special attention to reports of SEA following vertebral osteomyelitis. In the present work, the numerous published cases of SEA following purulent or tuberculous vertebral osteomyelitis are not included [7,10,19,29,53,62,75,88,109,130,132,135,139,144,162,165,169,171,190,205,207,219,228,236,272,281,282,285,307,340,344,363,364,371,387]. These cases were excluded from the present analysis because SEA following purulent or tuberculous vertebral osteomyelitis is clearly different from SEA of other etiology with respect to therapy and prognosis, with vertebral rather than epidural infection being the primary clinical problem.…”

Section: Introductionmentioning

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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Successful Nonoperative Treatment of Tuberculous Spinal Epidural Abscess with Cord Compression: The Role of Magnetic Resonance Imaging

Abstract: A patient is described with a tuberculous spinal epidural abscess and signs of cord compression, who was successful treated without surgery. Magnetic resonance imaging, in addition to its role as a diagnostic tool, was helpful in monitoring the resolution of inflammation

Cited by 8 publications

References 5 publications

Cervical spine epidural abscess: experience with microsurgical treatment in eight cases

Cervical spine epidural abscess: experience with microsurgical treatment in eight cases

Spinal epidural abscess ? review of 10 cases

Spinal epidural abscess: a meta-analysis of 915 patients

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