What are we waiting for? An argument for early surgery for spinal epidural abscesses

Epstein, Nancy E.

doi:10.4103/2152-7806.166894

Cited by 5 publications

(8 citation statements)

References 17 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among patients who died or developed plegia, the average time from presentation to surgical intervention was 58.1 h; for patents without plegia or death, the average time was nearly twice that, at 96.7 h. Recent research has advocated for advancing patients to surgery more quickly when suspicious for a SEA [9]. Better achieving this may mean expediting evaluation and treatment for patients with SEA; times to imaging and intervention should be explored as potential quality measures.…”

Section: Discussionmentioning

confidence: 99%

Time-to-completed-imaging, survival and function in patients with spinal epidural abscess: Description of a series of 34 patients, 2015–2018

King

Fisher

Brown

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

Introduction: Spinal epidural abscess (SEA) is a rare and life-threatening infection with increasing incidence over the past two decades. Delays in diagnosis can cause significant morbidity and mortality among patients. Objective: The objective of this study was to describe trends in time-to-imaging and intervention, risk factors, and outcomes among patients presenting to the emergency department with SEA at a single academic medical center in Portland, Oregon. Methods: This retrospective cohort study analyzed data from patients with new SEA diagnosis at a single hospital from October 1, 2015 to April 1, 2018. We describe averages to time-to-imaging and interventions, and frequencies of risk factors and outcomes among patients presenting to the emergency department with SEA. Results: Of the 34 patients included, 7 (20%) died or were discharged with plegia during the study period. Those who died or were discharged with plegia (n = 7) had shorter mean time-to-imaging order (20.8 h versus 29.2 h). Patients with a history of intravenous drug use had a longer mean time-to-imaging order (30.2 h versus 23.7 h) as compared to those without intravenous drug use. Patients who died or acquired plegia had longer times from imaging completed to final imaging read (20.9 h versus 7.1 h), but shorter times from final imaging read to surgical intervention among patients who received surgery (4.9 h versus 46.2 h). Further, only three (42.9%) of the seven patients who died or acquired plegia presented with the three-symptom classic triad of fever, neurologic symptoms, and neck or back pain. Conclusions: SEA is a potentially deadly infection that requires prompt identification and treatment. This research provides baseline data for potential quality improvement work at the study site. Future research should evaluate multi-center approaches for identifying and intervening to treat SEA, particularly among patients with intravenous drug use.

show abstract

Section: Discussionmentioning

confidence: 99%

Time-to-completed-imaging, survival and function in patients with spinal epidural abscess: Description of a series of 34 patients, 2015–2018

King

Fisher

Brown

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…MR's typically require at least 2-4 weeks to document infection, while CT's usually take 6-10 weeks to become "positive"). [1,2] Fourth, these patients may undergo delayed surgery for SEA which carries mortality rates as high as 25-20%. [1,2]…”

Section: Discussionmentioning

confidence: 99%

“…Older patients with spinal epidural abscesses (SEA) may present in an atypical fashion, failing to exhibit the classical triad of pain (92-100%), fever (50%), and neurological deficits (47%). [1,2] Rather, they may be unaware of "new" pain, fail to mount a fever, and attribute their deficits to "old age. " Additionally, their immunological compromise may fail to produce abnormal laboratory findings.…”

Section: Introductionmentioning

confidence: 99%

“…minimum of 2-4 weeks), and/or CT studies (i.e., minimum of 6-10 weeks). [1,2] In this "precis", an elderly immunocompromised patient presented with several months of falls, and a severe progressive monoparesis. is deficit was finally explained by the large, high cervical retropharyngeal/diskitis/osteomyelitis/epidural abscess shown on the fourth MR scan, at which point the patient underwent an emergent anterior cervical diskectomy/fusion.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Case report (precis): Atypical delayed presentation of cervical spinal epidural abscess

Epstein

2020

Surgical Neurology International

View full text Add to dashboard Cite

Background: Older patients with spinal epidural abscesses (SEA) may present in an atypical fashion, failing to exhibit the classical triad of pain, fever, and a neurological deficit. Rather, they may be less aware of pain, fail to develop a fever, and attribute their neurological deficit to “old age.” Further, their laboratory studies may not be abnormal, and critical findings on MR (i.e., more so than CT studies) may be overlooked. Here, we present an elderly patient with severe upper extremity monoparesis whose cervical SEA was overlooked for months. Case Description: Over 10 months, and 6 months ago respectively, the patient had two successive MR scans ordered due to falls; both were interpreted as normal. Within the past few months, a third cervical MR, and an initial CT scan were performed; they both showed “questionable” changes (e.g. cortical irregularity/epidural air) that were largely ignored. When the patient presented to a spine surgeon with severe upper extremity monoparesis, the fourth MR clearly demonstrated a high cervical SEA. Of interest, laboratory findings were normal (e.g. white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP)). The patient successfully underwent an anterior cervical discectomy/and fusion (ACDF); cultures grew Staphylococcus aureus, and he was appropriately managed with intravenous antibiotic therapy. Conclusion: This case report (precis) highlights three “teaching” points. First, elderly immunologically compromised patients may not develop the classical SEA triad of pain, fever, and a neurological deficit. Second, laboratory studies may remain normal. Third, it may take longer for abnormal findings to develop on MR/CT studies consistent with SEA in immunocompromised older patients, thus resulting in very delayed surgery.

show abstract

“…13 Moreover, early surgery helps to avoid the development of sepsis, a leading cause of death. 10 Apart from open microsurgery and antibiotics, percutaneous endoscopic debridement as well as percutaneous lavage and drainage have recently been tested as new therapies for cases of spondylitis. 20,21 These methods certainly allow one to obtain adequate samples for microbiological diagnostics and can support the remission of neurological symptoms.…”

Section: Discussionmentioning

confidence: 99%

A spinal epidural abscess due to Streptobacillus moniliformis infection following a rat bite: case report

Hammer

Wolff

Geißdörfer

et al. 2017

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

The authors describe the case of a 40-year-old man suffering from an epidural abscess in the thoracic spine due to a rarely isolated pathogen, Streptobacillus moniliformis, the causative agent of rat bite fever. Besides diffuse abdominal pain, ataxia, paresthesia, hypesthesia, and enhanced reflexes of the lower extremities, the patient suffered from a decreased sensation of bladder filling. His history was also positive for a rat bite 6 weeks earlier. Magnetic resonance imaging showed an epidural, space-occupying lesion compressing the spinal cord at the vertebral levels of T6–8. Neurosurgery revealed an epidural abscess, which was drained via laminectomy (T-7) and excision of the ligamentum flavum (T6–8). The etiological agent S. moniliformis was identified by 16S rRNA-based polymerase chain reaction and sequencing as well as by culture and mass spectrometry. Treatment with penicillin G led to complete resolution of the abscess and clinical recovery of the patient, who regained his bladder-filling sensation and free walking ability.This case demonstrates that careful attention to the patient's history is essential in suspecting unusual bacterial pathogens as the cause of an epidural abscess and initiating the optimal diagnostic procedure and antimicrobial therapy.

show abstract

What are we waiting for? An argument for early surgery for spinal epidural abscesses

Cited by 5 publications

References 17 publications

Time-to-completed-imaging, survival and function in patients with spinal epidural abscess: Description of a series of 34 patients, 2015–2018

Time-to-completed-imaging, survival and function in patients with spinal epidural abscess: Description of a series of 34 patients, 2015–2018

Case report (precis): Atypical delayed presentation of cervical spinal epidural abscess

A spinal epidural abscess due to Streptobacillus moniliformis infection following a rat bite: case report

Contact Info

Product

Resources

About