Upper Cervical Epidural Abscess in Clinical Practice: Diagnosis and Management

Abstract

Study Design Narrative review. Objective Upper cervical epidural abscess (UCEA) is a rare surgical emergency. Despite increasing incidence, uncertainty remains as to how it should initially be managed. Risk factors for UCEA include immunocompromised hosts, diabetes mellitus, and intravenous drug use. Our objective is to provide a comprehensive overview of the literature including the history, clinical manifestations, diagnosis, and management of UCEA. Methods Using PubMed, studies published prior to 2015 were analyzed. We used the keywords “Upper cervical epidural abscess,” “C1 osteomyelitis,” “C2 osteomyelitis,” “C1 epidural abscess,” “C2 epidural abscess.” We excluded cases with tuberculosis. Results The review addresses epidemiology, etiology, imaging, microbiology, and diagnosis of this condition. We also address the nonoperative and operative management options and the relative indications for each as reviewed in the literature. Conclusion A high index of suspicion is required to diagnose this rare condition with magnetic resonance imaging being the imaging modality of choice. There has been a shift toward surgical management of this condition in recent times, with favorable outcomes.

Spinal Cord Injury in the Geriatric Population: Risk Factors, Treatment Options, and Long-Term Management

“…6,7 Preexisting hyperostotic conditions such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH) can render the spine highly unstable following a minor fall. 8 Treating SCIs can be complicated by the presence of comorbid conditions.…”

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

“…Cervical epidural abscesses are distinctly rarer . Our review only found five cases with cervical spinal abscesses during period 2000–2017.…”

“…Cervical epidural abscesses are distinctly unusual in childhood, but they are arguably more dangerous than other SEAs. Degradation of the odontoid ligaments, with subsequent atlantoaxial subluxation or dislocation, is a risk .…”

Preliminary clinical study: percutaneous lumbar discectomy combined with external drainage for treatment of intervertebral disc infections with epidural abscess.

“…Non-enhanced sagittal T2-weighted-MRI reveals that a fusiformis hyperintensity is shrinked and spinal dura sac compressed was dramatically relieved vertebral disc infection with epidural abscess is an indication for surgery. Once the patient shows any neurologic deficit, surgical decompression should be considered [8]. Although the period of antibiotic therapy for epidural abscess is still being debated, it is preferable to continue treatment for at least 4 weeks, because studies have shown a 25% rate of relapse in patients who were treated for less than 4 weeks [9][10][11].…”