Etiology and Surgical Management of Cervical Spinal Epidural Abscess (SEA):: A Systematic Review

Study Design: Systematic analysis and review. Objective: Evaluation of the presentation, etiology, management strategies (including both surgical and nonsurgical options), and neurological functional outcomes in patients with cervical spinal epidural abscess (SEA). Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria were used to create a framework based on which articles pertaining to cervical SEA were chosen for review following a search of the Ovid and PubMed databases using the search terms “epidural abscess” and “cervical.” Included studies needed to have at least 4 patients aged 18 years or older, and to have been published within the past 20 years. Results: Database searches yielded 521 potential articles in PubMed and 974 potential articles in Ovid. After review, 11 studies were ultimately identified for inclusion in this systematic review. Surgery appears to be a well-tolerated management strategy with limited complications for patients with cervical SEA. However, the quantity of data comparing medical and surgical treatment of cervical SEA is limited and the bulk of the data is derived from low quality studies. Conclusion: Data reporting was heterogeneous among studies making it difficult to draw discrete conclusions. Early surgical intervention may be appropriate in selected patients with cervical epidural abscess, but it is not clear what distinguishes these patients from those who are successfully managed nonoperatively.

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Eco-innovation in hospitality research (1998-2018): a systematic review

International Journal of Contemporary Hospitality Management ◽

10.1108/ijchm-01-2019-0002 ◽

2020 ◽

Vol 32 (2) ◽

pp. 913-933 ◽

Cited By ~ 4

Author(s):

Tanmay Sharma ◽

Joseph Chen ◽

Wan Yu Liu

Keyword(s):

Systematic Review ◽

Flow Diagram ◽

Measurement Scales ◽

Systematic Analysis ◽

Research Attention ◽

Content Type ◽

The Past ◽

Theoretical Support ◽

Sustainability Research ◽

Meta Analyses

Purpose Theoretical and empirical developments in academic literature have not been able to keep pace with the growing industry focus on eco-innovation and green hospitality practices. This paper aims to address this gap and provide an up-to-date review of research on eco-innovative practices in 13 leading hospitality journals over the past two decades, 1998-2018. Design/methodology/approach A systematic review that incorporates the preferred reporting items for systematic reviews and meta-analyses flow diagram is used to guide the data selection for this paper. The paper analyzes 403 studies published in 13 established hospitality journals to identify homogeneous research themes. Findings A unified conceptual framework is proposed by identifying seven research domains under eco-innovative practices. Even though research attention on green practices has increased in recent years, the development of conceptual frameworks, appropriate measurement scales and theoretical support for eco-innovative practices is warranted. Research limitations/implications Although the paper attempts to include as many environmentally related studies as possible, by being restricted to papers published only in 13 leading hospitality journals, it may not have drawn on all relevant eco-innovation studies in hospitality research. Originality/value To the knowledge of the authors, this is the first systematic analysis of hospitality research on eco-innovative practices that reviews such a large number (403) of studies spanning the past two decades (1998-2018). The most recent review by Kim et al. (2017) covered 146 green research studies published between 2000 and 2014; whereas, out of 403 studies reviewed in this study, 231 (57per cent) have been published between 2014 and 2018. This trend is indicative of the fast-evolving nature of sustainability research and the need for an up-to-date systematic review of recent literature in the field.

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How Best to Manage the Spinal Epidural Abscess? A Current Systematic Review

World Neurosurgery ◽

10.1016/j.wneu.2016.05.074 ◽

2016 ◽

Vol 93 ◽

pp. 20-28 ◽

Cited By ~ 27

Author(s):

Suganth Suppiah ◽

Ying Meng ◽

Michael G. Fehlings ◽

Eric M. Massicotte ◽

Albert Yee ◽

...

Keyword(s):

Systematic Review ◽

Epidural Abscess ◽

Spinal Epidural Abscess ◽

Current Systematic Review ◽

Spinal Epidural ◽

A Current

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Recent developments in the treatment of spinal epidural abscesses

Orthopedic Reviews ◽

10.4081/or.2017.7010 ◽

2017 ◽

Vol 9 (2) ◽

Author(s):

Adam E.M. Eltorai ◽

Syed S. Naqvi ◽

Ashok Seetharam ◽

Bielinsky A. Brea ◽

Chad Simon

Keyword(s):

Epidural Abscess ◽

Recent Literature ◽

Surgical Care ◽

Spinal Epidural Abscess ◽

Delayed Presentation ◽

Multidisciplinary Management ◽

The Past ◽

Neurologic Sequelae ◽

Recent Developments ◽

Spinal Epidural

Spinal epidural abscess (SEA) is a serious condition that can be challenging to diagnose due to nonspecific symptomology and delayed presentation. Despite this, it requires prompt recognition and management in order to prevent permanent neurologic sequelae. Several recent studies have improved our understanding of SEA. Herein, we summarize the recent literature from the past 10 years relevant to SEA diagnosis, management and outcome. While surgical care remains the mainstay of treatment, a select subset of SEA patients may be managed without operative intervention. Multidisciplinary management involves internal medicine, infectious disease, critical care, and spine surgeons in order to optimize care.

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Spontaneous spinal epidural abscess in patients 50 years of age and older: a 15-year institutional perspective and review of the literature

Journal of Neurosurgery Spine ◽

10.3171/2013.11.spine13527 ◽

2014 ◽

Vol 20 (3) ◽

pp. 344-349 ◽

Cited By ~ 48

Author(s):

Owoicho Adogwa ◽

Isaac O. Karikari ◽

Kevin R. Carr ◽

Max Krucoff ◽

Divya Ajay ◽

...

Keyword(s):

Antimicrobial Therapy ◽

Epidural Abscess ◽

Clinical Status ◽

Spinal Instrumentation ◽

Multivariate Logistic Regression Model ◽

Spinal Epidural Abscess ◽

Ct Guided ◽

Presenting Symptoms ◽

The Past ◽

Spinal Epidural

Object A spinal epidural abscess (SEA) is a rare but severe infection requiring prompt recognition and management. The incidence of SEA has doubled in the past decade, owing to an aging population and to increased use of spinal instrumentation and vascular access. The optimal management of SEAs in patients 50 years of age and older remains a matter of considerable debate. In an older patient population with multiple comorbidities, whether intravenous antibiotics alone or in combination with surgery lead to superior outcomes remains unknown. The present study retrospectively analyzes cases of SEAs, in patients 50 years of age and older, treated at Duke University Medical Center over the past 15 years. Methods Eighty-two patients underwent treatment for a spinal epidural abscess between 1999 and 2013. There were 46 men and 36 women, whose overall mean age (± SD) was 65 ± 8.58 years (range 50–82 years). The mean duration of clinical follow-up was 41.38 ± 86.48 weeks. Thirty patients (37%) underwent surgery for removal of the abscess, whereas 52 (63%) were treated more conservatively, undergoing CT-guided aspiration or receiving antibiotics alone based on the results of blood cultures. The correlation between pretreatment variables and outcomes was evaluated in a multivariate regression analysis. Results Back pain and severe motor deficits were the most common presenting symptoms. Compared with baseline neurological status, the majority of patients (68%) reported being neurologically “better” or “unchanged.” Twelve patients (15%) had a good outcome (7 [23%] treated operatively vs 5 [10%] treated nonoperatively, p = 0.03), while clinical status in 41 patients (50%) remained unchanged (10 [33%] treated operatively vs 31 [60%] treated nonoperatively, p = 0.01). Overall, 20 patients (25%) died (9 [30%] treated operatively vs 11 [21%] treated nonoperatively, p = 0.43). In a multivariate logistic regression model, an increasing baseline level of pain, the presence of paraplegia or quadriplegia on initial presentation, and a dorsally located SEA were independently associated with poor outcomes. Conclusions The results of the study suggest that in patients 50 years of age and older, early surgical decompression combined with intravenous antimicrobial therapy was not associated with superior clinical outcomes when compared with intravenous antimicrobial therapy alone.

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Spinal epidural abscess due to tropical pyomyositis in immunocompetent adolescents

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.3.peds1017 ◽

2010 ◽

Vol 6 (1) ◽

pp. 33-37 ◽

Cited By ~ 8

Author(s):

Donnell K. Bowen ◽

Lex A. Mitchell ◽

Mark W. Burnett ◽

Veronica J. Rooks ◽

Jonathan E. Martin

Keyword(s):

Skeletal Muscle ◽

Differential Diagnosis ◽

Epidural Abscess ◽

Spinal Epidural Abscess ◽

The Past ◽

Common Causes ◽

Atypical Manifestations ◽

Spinal Epidural ◽

Suppurative Infection ◽

Tropical Pyomyositis

Pyomyositis, a suppurative infection of skeletal muscle, is a disease not frequently encountered by neurosurgical providers. While previously considered an infection localized to tropical and semitropical locations, clinical reports of pyomyositis in temperate climates have increased over the past decade. Paraspinal involvement is uncommon in pyomyositis; however, the potential exists for spread into the epidural space resulting in a spinal epidural abscess (SEA). Early diagnosis of an SEA is frequently hampered by the absence of specific signs, unfamiliarity with the disease, atypical manifestations, and a broad differential diagnosis that includes more common causes of back pain. To date, 1 such case of paraspinal pyomyositis associated with an SEA has been reported in the neurosurgical literature. The authors present 2 cases of pyomyositis with an SEA and review the epidemiology, pathophysiology, diagnostic workup, and management of this disorder.

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Long segment spinal epidural abscess: An unusual presentation of spinal tuberculosis

The Journal of Medical Research ◽

10.31254/jmr.2019.5201 ◽

2019 ◽

Vol 5 (2) ◽

pp. 46-49

Author(s):

Sanjay Kumar ◽

Keyword(s):

Disease Burden ◽

Epidural Abscess ◽

Surgical Intervention ◽

Spinal Tuberculosis ◽

Unusual Presentation ◽

Spinal Epidural Abscess ◽

Spinal Epidural ◽

Significant Disease ◽

Rare Diagnosis ◽

Early Surgical Intervention

Spinal tuberculosis has a significant disease burden in India and presents with a myriad of features on neuroimaging. Spinal epidural abscess (SEA) is relatively rare diagnosis. Long segment SEA is a possibility in patients with spinal tuberculosis and these patients will respond to conservative’s management with ATT unlike pyogenic SEA which frequently may require early surgical intervention

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Catheter induced spinal epidural abscess in dialysis patients: A Systematic review of descriptive studies

10.22541/au.162220747.74402501/v1 ◽

2021 ◽

Author(s):

Mohammed Zuber ◽

BH Vidhyashree ◽

Shifa Taj ◽

Rajesh Venkatraman ◽

BP Sathish Kumar ◽

...

Keyword(s):

Systematic Review ◽

Epidural Abscess ◽

Grey Literature ◽

Renal Dialysis ◽

Spinal Epidural Abscess ◽

High Grade Fever ◽

Literature Report ◽

Mesh Terms ◽

Pubmed Database ◽

Spinal Epidural

ABSTRACT Purpose: Recently, there is an increased number of reports being published on catheter-induced spinal epidural abscess (SEA). This review aims to identify and critically evaluate all the descriptive studies that report the SEA due to catheterization and its presentation, diagnosis, management, and outcomes. Methodology: A literature search was performed in the PubMed database using MeSH terms “epidural abscess” AND “renal dialysis” from inception to January 2021 without any language restriction. Google Scholar, grey literature databases (GreyNet. OpenGrey, Grey literature Report, BIOSIS Previews), and the bibliographic search of included studies were carried out to find the additional studies. Descriptive studies describing the SEA induced by catheter usage were included in the review. Study selection, data extraction, and quality assessment were conducted by two independent reviewers any disagreement was resolved by discussing with the third reviewer. Results: Data of 6 studies were retrieved for this review which includes 11 patients (5 females and 6 males) aged from 26 to 79 years old. The most common patient’s presentation was back pain, high-grade fever, quadriparesis, neck pain, drowsy, and altered mental status. The most common isolated microorganism from the blood and catheter tip was Methicillin-resistant Staphylococcus aureus. The most common findings in all the patients were elevated erythrocyte sedimentation rate and leucocyte count. Conclusion: Clinicians must be aware of the possibilities of SEA initiated by catheter usage to prevent further consequences. Aggressive antibiotic therapy along with surgical intervention are the cornerstones in the management of SEA. Early diagnosis and initiation of treatment are important factors that decide the mortality and morbidity in patients with SEA. Keywords: Catheter; Dialysis; Spinal epidural abscess; Systematic review; Case report Protocol registration: International Prospective Register for Systematic Reviews (PROSPERO) ID: CRD42021233375

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Incidence and risk factors for failed medical management of spinal epidural abscess: a systematic review and meta-analysis

Journal of Neurosurgery Spine ◽

10.3171/2016.6.spine151249 ◽

2017 ◽

Vol 26 (1) ◽

pp. 81-89 ◽

Cited By ~ 16

Author(s):

Alexandra Stratton ◽

Karla Gustafson ◽

Kenneth Thomas ◽

Matthew T. James

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Medical Management ◽

Epidural Abscess ◽

Meta Analysis ◽

Original Data ◽

Primary Objective ◽

Spinal Epidural Abscess ◽

Consensus Definition ◽

Spinal Epidural

OBJECTIVE Spinal epidural abscess (SEA) is a life-threatening infection. It is uncertain whether medical versus surgical treatment is the ideal initial approach for neurologically intact patients with SEA. Recent evidence demonstrates that initial medical management is increasingly common; however, patients who ultimately require surgery after failed medical management may have a worse prognosis than those whose treatment was initially surgical. The primary objective of this study was to establish the current incidence of failed medical management for SEA. The secondary aim was to identify risk factors associated with the failure of medical management. METHODS The authors conducted a systematic review and meta-analysis by searching electronic databases (MEDLINE, Embase, CINAHL, and PubMed), recent conference proceedings, and reference lists of relevant articles. Studies that reported original data on consecutive adult patients with SEA treated medically were eligible for inclusion. RESULTS Twelve studies met the inclusion criteria, which included a total of 489 medically treated patients with SEA. Agreement on articles for study inclusion was very high between the reviewers (kappa 0.86). In a meta-analysis, the overall pooled risk of failed medical management was 29.3% (95% CI 21.4%–37.2%) and when medical to surgical crossover was used to define failure the rate was 26.3% (95% CI 13.0%–39.7%). Only 6 studies provided data for analysis by intended treatment, with a pooled estimate of 35.1% (95% CI 15.7%–54.4%) of failed medical management. Two studies reported predictors of the failure of medical management. CONCLUSIONS Although the incidence of failed medical management of SEA was relatively common in published reports, estimates were highly heterogeneous between studies, thus introducing uncertainty about the frequency of this risk. A consensus definition of failure is required to facilitate comparison of failure rates across studies.

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More than 50 long-term effects of COVID-19: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-95565-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sandra Lopez-Leon ◽

Talia Wegman-Ostrosky ◽

Carol Perelman ◽

Rosalinda Sepulveda ◽

Paulina A. Rebolledo ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Management Strategies ◽

Original Data ◽

Long Term Effects ◽

Pooled Prevalence ◽

Attention Disorder ◽

Initial Recovery ◽

Meta Analyses

AbstractCOVID-19 can involve persistence, sequelae, and other medical complications that last weeks to months after initial recovery. This systematic review and meta-analysis aims to identify studies assessing the long-term effects of COVID-19. LitCOVID and Embase were searched to identify articles with original data published before the 1st of January 2021, with a minimum of 100 patients. For effects reported in two or more studies, meta-analyses using a random-effects model were performed using the MetaXL software to estimate the pooled prevalence with 95% CI. PRISMA guidelines were followed. A total of 18,251 publications were identified, of which 15 met the inclusion criteria. The prevalence of 55 long-term effects was estimated, 21 meta-analyses were performed, and 47,910 patients were included (age 17–87 years). The included studies defined long-COVID as ranging from 14 to 110 days post-viral infection. It was estimated that 80% of the infected patients with SARS-CoV-2 developed one or more long-term symptoms. The five most common symptoms were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). Multi-disciplinary teams are crucial to developing preventive measures, rehabilitation techniques, and clinical management strategies with whole-patient perspectives designed to address long COVID-19 care.

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Aggregatibacter aphrophilus spinal epidural abscess

BMJ Case Reports ◽

10.1136/bcr-2020-235320 ◽

2020 ◽

Vol 13 (7) ◽

pp. e235320

Author(s):

Antoine Altdorfer ◽

Pierre Gavage ◽

Filip Moerman

Keyword(s):

Risk Factors ◽

Lower Limb ◽

Rare Case ◽

Epidural Abscess ◽

Spinal Epidural Abscess ◽

Surgical Drainage ◽

Eikenella Corrodens ◽

Aggregatibacter Aphrophilus ◽

Progressive Neurological Deficit ◽

Spinal Epidural

A 76-year-old woman with a rare case of spinal epidural abscess (SEA) that had no risk factors for such type of infection, presented symptoms of back pain, progressive neurological deficit of the lower limb and loss of sphincter control. A gadolinium-enhanced MRI confirmed the diagnosis of an SEA. The patient underwent laminectomy with surgical drainage, where cultures showed the presence of Aggregatibacter aphrophilus, a bacterium of the HACEK group (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species), rarely involved in SEA. Following surgery, the patient was treated with intravenous ceftriaxone for 6 weeks, and this gave excellent results.

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