scholarly journals Pus in Spinal Needle: Diagnosis and Management of a Long-Segment Spinal Epidural Abscess

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
B. M. Munasinghe ◽  
N. Pathirage ◽  
M. S. Hameed ◽  
C. T. Hapuarachchi

Spinal-epidural abscess (SEA) is believed to be primarily of haematogenous origin and very rarely as a consequence of central neuraxial blockade. Early diagnosis and pertinent management invariably improve neurological outcomes. We report a case of long-segment SEA, which was suspected during subarachnoid anaesthesia, subsequently diagnosed and managed appropriately, averting irreversible neurological deficits.


2021 ◽  
Vol 2021 ◽  
pp. 1-1
Author(s):  
B. M. Munasinghe ◽  
N. Pathirage ◽  
M. S. Hameed ◽  
C. T. Hapuarachchi



2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Abdurrahman Aycan ◽  
Ozgür Yusuf Aktas ◽  
Feyza Karagoz Guzey ◽  
Azmi Tufan ◽  
Cihan Isler ◽  
...  

Spinal epidural abscess (SEA) is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI) remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.





Author(s):  
Meryem Badem ◽  
Serpil Ugur Baysal ◽  
İlknur Karyağdı ◽  
Nusret Oren ◽  
Hamit Selim Karabekir ◽  
...  

Spinal infections in immunocompetent children are very rare. But it is a serious infection in the epidural space along the spinal cord. It should be considered in patients with backache, fever, neurological deficits and/or spinal tenderness. There are cases which an etiology could not determined. In the English medical literature, there are only 31 reported pediatric cases in the last two decades. In children with neurologic deficits, surgery combined with systemic antibiotics constitutes the optimal therapy. We report a case of thoracal spinal epidural abscess in a 12-year-old adolescent boy who was immunocompetent and presented with spinal tenderness, back pain and four days of fever. A spinal magnetic resonance imaging demonstrated an epidural abscess between T2 and T10 level. An emergent surgical intervention was applied. Cultures remained negative. He was given systemic antibiotics for six weeks. He recovered without any sequelae.



2011 ◽  
Vol 7 (2) ◽  
pp. 205-208 ◽  
Author(s):  
Zulma Tovar-Spinoza ◽  
Michelle Bode

Spinal epidural abscess constitutes a neurosurgical emergency in which early diagnosis and prompt decompression are necessary to avoid permanent cord damage. This entity is rare in premature infants and neonates in whom diagnosis can be challenging. The authors present a case of a premature twin neonate who developed an epidural abscess with complete paraparesis after coagulase-negative Staphylococcus epidermidis bacteremia that was treated with a single-level flavotomy and catheter irrigation.



Author(s):  
David Mabey

An epidural abscess is a collection of pus that has accumulated between the dura and the calvarium or spine. It is rare but can lead to severe neurologic dysfunction or death. There are two main subsets of epidural abscess: spinal epidural abscess (SEA) and intracranial epidural abscess (ICEA). Early diagnosis is key to minimizing complications. Back pain is the most common presentation of SEA, along with spinal tenderness. Treatment requires prolonged hospitalization, surgical drainage in most cases, and long-term antibiotics. Except in rare cases, patients with SEA and ICEA will require hospital admission. In the stable patient, antibiotics should be withheld until culture data can be obtained. If surgical treatment is not readily available, biopsy is often performed to obtain samples for culture before starting antibiotics.



2014 ◽  
Vol 37 (2) ◽  
pp. E9 ◽  
Author(s):  
Faris Shweikeh ◽  
Kashif Saeed ◽  
Laura Bukavina ◽  
Stephanie Zyck ◽  
Doniel Drazin ◽  
...  

Object Over the past decade, the incidence of bacterial spinal epidural abscess (SEA) has been increasing. In recent years, studies on this condition have been rampant in the literature. The authors present an 11-year institutional experience with SEA patients. Additionally, through an analysis of the contemporary literature, they provide an update on the challenging and controversial nature of this increasingly encountered condition. Methods An electronic medical record database was used to retrospectively analyze patients admitted with SEA from January 2001 through February 2012. Presenting symptoms, concurrent conditions, microorganisms, diagnostic modalities, treatments, and outcomes were examined. For the literature search, PubMed was used as the search engine. Studies published from January 1, 2000, through December 31, 2013, were critically reviewed. Data from articles on methodology, demographics, treatments, and outcomes were recorded. Results A total of 106 patients with bacterial SEA were identified. The mean ± SD age of patients was 63.3 ± 13.7 years, and 65.1% of patients were male. Common presenting signs and symptoms were back pain (47.1%) and focal neurological deficits (47.1%). Over 75% of SEAs were in the thoracolumbar spine, and over 50% were ventral. Approximately 34% had an infectious origin. Concurrent conditions included diabetes mellitus (35.8%), vascular conditions (31.3%), and renal insufficiency/dialysis (30.2%). The most commonly isolated organism was Staphylococcus aureus (70.7%), followed by Streptococcus spp. (6.6%). Surgery along with antibiotics was the treatment for 63 (59.4%) patients. Surgery involved spinal fusion for 19 (30.2%), discectomy for 14 (22.2%), and corpectomy for 9 (14.3%). Outcomes were reported objectively; at a mean ± SD follow-up time of 8.4 ± 26 weeks (range 0–192 weeks), outcome was good for 60.7% of patients and poor for 39.3%. The literature search yielded 40 articles, and the authors discuss the result of these studies. Conclusions Bacterial SEA is an ominous condition that calls for early recognition. Neurological status at the time of presentation is a key factor in decision making and patient outcome. In recent years, surgical treatment has been advocated for patients with neurological deficits and failed response to medical therapy. Surgery should be performed immediately and before 36–72 hours from onset of neurological sequelae. However, the decision between medical or surgical intervention entails individual patient considerations including age, concurrent conditions, and objective findings. An evidence-based algorithm for diagnosis and treatment is suggested.



2019 ◽  
Vol 27 (2) ◽  
pp. 230949901986007
Author(s):  
Tomoki Matsuo ◽  
Atsushi Tanji ◽  
Koichi Tateyama ◽  
Yuhei Yoda ◽  
Yusaku Kamata ◽  
...  

We present a 70-year-old woman with severe diabetes mellitus, who experienced low back pain and left lower leg paralysis. Computed tomography showed air in the spinal canal from C4 to S5, and magnetic resonance imaging revealed an epidural abscess from Th11 to L1. Laboratory findings showed increases in inflammatory indicators and blood culture indicated the presence of Escherichia coli. The patient was treated conservatively with antibiotics. Neurological deficits and inflammatory data improved during the course. Follow-up imaging studies showed the disappearance of gas and epidural abscess. The existence of air in the spinal canal is a rare condition known as pneumorachis. To the best of our knowledge, such a long pneumorachis ranging from the cervical to the sacral spinal canal with epidural abscess caused by gas gangrene has not yet been described. We should therefore realize the possibility of epidural abscess produced by gas gangrene and treat it appropriately.



2020 ◽  
Vol 11 (Vol.11, no.3) ◽  
pp. 288-293
Author(s):  
Vitalie VĂCĂRAȘ ◽  
Cristian ABRUDAN ◽  
Silvina ILUȚ ◽  
Imelda RAHOVAN ◽  
Ronela POPA ◽  
...  

Introduction: Spinal epidural abscess is a rare clinical entity with considerable morbidity. Even with prompt diagnosis and treatment, many patients are left with persistent residual neurological deficits. Case report: The purpose of this article is to report a rare case of primary pyogenic spinal epidural abscess. The patient admitted to our clinic because of lumbar pain of increasing severity and fever. Case management consisted of surgical and medical treatment with antibiotics. Postoperatively, with proper rehabilitation program, he markedly improved. Conclusions: Despite a correct management, spinal epidural abscess is associated with a high degree of morbidity and mortality. Proper treatment, rehabilitation programs and long-term follow-up is critical for a better outcome.



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