A Classification System for Spinal Cord Compression and its Association With Neurological Deficit in Spinal Epidural Abscess

✓ An experimental model of spinal epidural abscess was developed in rabbits by injecting Staphylococcus aureus into the posterior thoracolumbar epidural space. This model has been shown to reproduce the neurological, bacteriological, and radiological aspects of the human disease. In this study, the effect of the infectious epidural mass on the vasculature of the spinal cord in paraplegic rabbits was studied using microangiographic techniques. The normal vascular anatomy of the rabbit spinal cord was defined in control experiments. Vascular proliferation was demonstrated in the epidural space surrounding the abscesses. Anterior and paired posterior spinal arteries remained patent in paraplegic rabbits with mild or moderate spinal cord compression and in some cases of severe compression. In animals with severe compression, the anterior epidural venous plexus remained patent, but the dorsal spinal vein was occluded. Occlusion of perforating arteries occurred only with extreme spinal cord compression. These data indicate that the initial neurological deficit associated with experimental spinal epidural abscess is not due to vascular thrombosis.

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Our institutional experience with Spinal Epidural Abscess

Nepal Journal of Neuroscience ◽

10.3126/njn.v16i2.25940 ◽

2019 ◽

Vol 16 (2) ◽

pp. 16-19

Author(s):

Y. Joulali ◽

F. Lakhdar ◽

M. Benzagmout ◽

K. Chakour ◽

M. F. Chaoui

Keyword(s):

Neurological Deficit ◽

Epidural Abscess ◽

Cord Compression ◽

University Hospital ◽

Initial Assessment ◽

Spinal Epidural Abscess ◽

Point Of Entry ◽

Institutional Experience ◽

Spinal Epidural ◽

Peripheral Enhancement

CorrigendumThe article published in Nepal Journal of Neurosciences 2019;16:16-19 by Joulali Youssef etal was mistakenlypublished with a wrong co-author.The corresponding author has submitted following authors as responsible for the article, Y. Joulali, F. Lakhdar,M. Benzagmout, K. Chakour and M.F. Chaoui. Bipin Chaurasia was added in error.Please cite this article as Joulali Y, Lakhdar F, Benzagmout M, Chakour K, Chaoui MF. Our institutionalexperience with Spinal Epidural Abscess. Nepal Journal of Neurosciences 2019 ; 16:16-19 in future citations. Abstract: Spinal epidural abscess is a rare pathology which is manifested by a classic triad of pain, fever and neurological deficit. In most cases, the clinical picture is incomplete which makes its diagnosis difficult. In this retrospective study, we report five cases of spinal epidural abscess treated in the neurosurgery department of Hassan II University Hospital of Fez. Four of our patients were admitted due to spinal cord compression, while one patient was admitted for isolated spinal syndrome without neurological deficit. Fever was present in all our patients, nevertheless no point of entry was identified in the initial assessment. MRI was performed on emergency basis in all of our patients which demonstrated an extra-dural hypo intensity on T1WI, hyper intensity on T2WI. It also showed lesions with peripheral enhancement after contrast with gadolinium. Four of our patients underwent surgical treatment which involved performing alaminectomy/laminotomy with drainage of the abscess, while one patient received medical treatment alone. The evolution was favorable in 4 of our patients while one patient died post operatively due to severe sepsis.

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Pressure Ulcer Associated with Testicular Prosthesis as a Rare Cause of Spinal Epidural Abscess

Case Reports in Infectious Diseases ◽

10.1155/2019/9090462 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Amulya Prakash ◽

Rishi Raj ◽

Aasems Jacob ◽

Douglas Ross

Keyword(s):

Spinal Cord ◽

Pressure Ulcer ◽

Epidural Abscess ◽

Cord Compression ◽

Sensory Function ◽

Cervical Region ◽

Spinal Epidural Abscess ◽

Delay In Diagnosis ◽

Spinal Cord Decompression ◽

Spinal Epidural

Spinal epidural abscess is a neurologic emergency with a potential complication to the spinal cord such as paralysis. Frequently, it has a nonspecific initial presentation such as neck or back pain, and hence there is a delay in diagnosis. We present the case of a 60-year-old Caucasian male who presented to emergency room with one week of numbness and weakness of all four extremities. Neurological examination showed variable quadriparesis. Urgent MRI of spine with contrast revealed epidural abscess in the cervical region C4–C6 with resultant cord compression, the underlying etiology for hematogenous spread of infection being pressure ulcer associated with testicular prosthesis. Urgent neurosurgical intervention was done to achieve spinal cord decompression. Both blood and pus cultures were positive for Streptococcus intermedius, requiring prolonged administration of intravenous antibiotics. Clinical outcome was encouraging with progressive gain in motor and sensory function. Spinal epidural abscess is a rare diagnosis; hence, clinicians should have a high index of suspicion for timely diagnosis.

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Spontaneous Spinal Epidural Haematomas and the Prognostic Implications of Interval to Surgical Decompression: A Report of Two Cases

Journal of Orthopaedic Surgery ◽

10.1177/230949900901700220 ◽

2009 ◽

Vol 17 (2) ◽

pp. 216-219 ◽

Cited By ~ 7

Author(s):

Colin Yi-Loong Woon ◽

Benedict Chan-Wearn Peng ◽

John Li-Tat Chen

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Lower Limb ◽

Cord Compression ◽

Surgical Decompression ◽

Neurological Recovery ◽

Uncontrolled Hypertension ◽

Motor Deficit ◽

Mri Features ◽

Spinal Epidural

Spontaneous spinal epidural haematomas (SSEHs) are rare causes of spinal cord compression. We present 2 cases of thoracic SSEHs with similar magnetic resonance imaging (MRI) features. Patient 1 was on long-term oral anticoagulants and patient 2 had uncontrolled hypertension. Patient 1 presented with a dense motor deficit, whereas patient 2 developed progressive lower limb weakness. Decompression laminectomy and haematoma evacuation was performed 51 hours later for patient 1 and 14 hours later for patient 2. Both had recovered their lower limb power, but neurological recovery was greater for patient 2. In patients with bleeding diatheses or uncontrolled hypertension, acute SSEHs must be suspected when they present with atraumatic back pain and signs of spinal cord compression. The interval to surgical decompression greatly influences the prognosis for neurological recovery.

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Primary vertebral and spinal epidural non-Hodgkin's lymphoma with spinal cord compression

Neuroradiology ◽

10.1007/s002340050256 ◽

1996 ◽

Vol 38 (4) ◽

pp. 333-337 ◽

Cited By ~ 1

Author(s):

M. Boukobza ◽

C. Mazel ◽

E. Touboul

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Hodgkin’S Lymphoma ◽

Cord Compression ◽

Hodgkin's Lymphoma ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma ◽

Spinal Epidural

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Primary Spinal Epidural Non-Hodgkin's Lymphoma the Contribution of Nuclear Magnetic Resonance Imaging, Therapeutic Approach and Review of the Literature

Tumori Journal ◽

10.1177/030089169207800612 ◽

1992 ◽

Vol 78 (6) ◽

pp. 397-402 ◽

Cited By ~ 5

Author(s):

llan G. Ron ◽

Irith Reider ◽

Nelly Wigler ◽

Samario Chaitchik

Keyword(s):

Spinal Cord ◽

Back Pain ◽

Spinal Cord Compression ◽

Hodgkin’S Lymphoma ◽

Cord Compression ◽

Hodgkin's Lymphoma ◽

Characteristic Appearance ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma ◽

Spinal Epidural

Primary spinal epidural lymphoma (Stage I) is diagnosed predominantly late after a long prodromal phase of local back pain resulting in spinal cord compression. The use of CT and NMR images in the early stage of investigation and their analysis may help to diagnose these cases prior to the appearance of neurologic deficit. We report on 2 patients who presented with prolonged localized back pain with sudden symptoms of spinal cord compression. CAT scan and NMR imaging demonstrated the characteristic appearance of lymphoma. Decompressive laminectomy supported the diagnosis. Radiotherapy treatment to the region of the non-Hodgkin's lymphoma resulted in complete resolution. Thereafter, systemic chemotherapy with CHOP achieved a good response.

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Spinal epidural angiolipoma: A rare cause of spinal cord compression

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.102617 ◽

2012 ◽

Vol 03 (03) ◽

pp. 341-343 ◽

Cited By ~ 11

Author(s):

Rajesh K Ghanta ◽

Kalyan Koti ◽

Srinivas Dandamudi

Keyword(s):

Spinal Cord ◽

Blood Vessels ◽

Spinal Cord Compression ◽

Surgical Excision ◽

Cord Compression ◽

Benign Tumors ◽

Thoracic Region ◽

Spinal Angiolipomas ◽

Spinal Epidural

ABSTRACTSpinal epidural angiolipomas are rare, benign tumors composed of mature lipocytes admixed with abnormal blood vessels. Only 128 cases of spinal epidural angiolipomas have been reported in literature till now. Spinal angiolipomas are predominantly located in the mid-thoracic region. We report a case of dorsal epidural angiolipoma in a 56-year-old male who presented with paraparesis and was diagnosed to have D4-5 epidural angiolipoma. Total surgical excision of the epidural angiolipoma was done and his paraparesis gradually improved.

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Recurrence of spinal epidural abscess after inadequate antibiotic dosage regimen

Grande Medical Journal ◽

10.3126/gmj.v1i1.22419 ◽

2019 ◽

Vol 1 (1) ◽

pp. 66-69

Author(s):

Ram Krishna Dahal ◽

Javad Ahmad Khan ◽

Binod Bijukachhe

Keyword(s):

Back Pain ◽

Neurological Deficit ◽

Epidural Abscess ◽

Blood Parameters ◽

Surgical Decompression ◽

Clinical Suspicion ◽

Spinal Epidural Abscess ◽

Threatening Condition ◽

Clinical Triad ◽

Spinal Epidural

Introduction: Spinal epidural abscess (SEA) is a potentially life threatening condition which can present with a clinical triad of fever, back pain and neurological deficit. It is more common in elderly population with risk factors like immunocompromised status, diabetes mellitus and alcoholism. High index of clinical suspicion of SEA warrants prompt investigated and treatment. Immediate surgical decompression along with antibiotic is recommended for better outcome. Case Presentation : A 16 years old boy presented with complaints of fever, upper back pain which had developed gradually over a period of 10 days. He had history of furuncle in perineal region 3 weeks prior to his symptoms, which was drained. With high clinical suspicion of SEA, Contrast enhanced Magnetic Resonance Imaging (CEMRI) was done along with blood parameters and was diagnosed as SEA D3-D6 level. He underwent immediate surgical decompression and was given 3 weeks of antibiotics. Post-operative period was uneventful with clinical improvement of the symptoms. He again presented to us with relapse of the infection on 28th post-operative day with similar fever and back pain. He was reinvestigated with MRI and blood investigations which revealed relapse of the infection. He was then managed with intravenous (IV) Vancomycin for 2 weeks and oral Erythromycin for another 6 weeks. He did not require any surgical intervention in his later presentation. Conclusion: Spinal epidural abscess is a surgical emergency and prompt diagnosis with surgical drainage is recommended for better outcome even when there is no neurological deficit. Abscess drainage should be adjunct with longer duration of antibiotics for at least 6 weeks for optimum results.

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