Changing Concepts in Spinal Epidural Abscess: A Report of 29 Cases

Neurosurgery ◽  
1990 ◽  
Vol 27 (2) ◽  
pp. 185-192 ◽  
Author(s):  
O. Del Curling ◽  
David J. Gower ◽  
Joe M. McWhorter
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Epidural Abscess ◽  
Infectious Agent ◽  
Spinal Epidural Abscess ◽  
Recent Experience ◽  
Resonance Imaging ◽  
Gram Negative ◽  
Operative Findings ◽  
Spinal Epidural

Abstract A review of our recent experience with spinal epidural abscess (SEA) reveals several important changing concepts in diagnosis, etiology, management, and outcome. All cases of SEA seen by our service from August 1975 to July 1989 were reviewed retrospectively, and 29 patients were identified (19 men and 10 women, aged 13-78 years). Abscesses were located in the lumbar (n = 21), thoracic (n = 7), and cervical (n = 1) epidural spaces. Gram-positive organisms were the infectious agent in 72% of the cases, and Staphyloccus aureus was the sole agent in 45% other agents were Gram-negative aerobes (n = 5), a Gram-negative anaerobe (n = 1), Mycobacterium tuberculosis(n = 1), and Sporotrichum schenckii(n = 1), the last occurring in a young woman with acquired immune deficiency syndrome. Seventeen patients had concomitant extraspinal infections. Diagnosis was confirmed by myelography, computed tomography, or magnetic resonance imaging. All patients underwent operative decompression and debridement; 2 required a second procedure for persistent infection. The most common operative findings were pus and granulation tissue in the epidural space (52%); the preoperative course correlated poorly with operative findings. The wound was closed primarily in 84% of cases. Postoperative intravenous antibiotic courses for the bacterial abscesses ranged from 1.5 to 6 weeks (median, 2 weeks), followed by antibiotics given orally for 0 to 6 weeks. Two patients died perioperatively. Neurological outcome was good in 21 patients and fair in 6 (mean follow-up, 1.4 years). Over the last 50 years the spectrum of organisms causing SEA has broadened, and the distinction between acute and chronic SEAs has minimal clinical significance. In addition, magnetic resonance imaging has come to have an adjunctive diagnostic role. Treatment by operative debridement, primary wound closure, and short courses of antibiotics given intravenously and orally has a consistently good result, and prognosis has markedly improved.

Magnetic Resonance Imaging in the Diagnosis of Spinal Epidural Abscess

1988 ◽  
Vol 20 (3) ◽  
pp. 323-327 ◽  
Author(s):  
Mats Erntell ◽  
Stig Holtås ◽  
Karin Norlin ◽  
Erik Dahlquist ◽  
Ingrid Nilsson-Ehle
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Resonance Imaging ◽  
Spinal Epidural

Spinal epidural abscess complicating chronic epidural analgesia in 11 cancer patients: clinical findings and magnetic resonance imaging

1999 ◽  
Vol 246 (9) ◽  
pp. 815-820 ◽  
Author(s):  
Peter Sillevis Smitt ◽  
Anna Tsafka ◽  
Martin van den Bent ◽  
Hein de Bruin ◽  
Willem Hendriks ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Epidural Analgesia ◽  
Cancer Patients ◽  
Epidural Abscess ◽  
Clinical Findings ◽  
Spinal Epidural Abscess ◽  
Resonance Imaging ◽  
Spinal Epidural

Spinal Epidural Abscess: A Ten-Year Perspective

Neurosurgery ◽  
1990 ◽  
Vol 27 (2) ◽  
pp. 177-184 ◽  
Author(s):  
Mary Louise Hlavin ◽  
Henry J. Kaminski ◽  
Jeffery S. Ross ◽  
Edward Ganz
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Epidural Abscess ◽  
Surgical Intervention ◽  
Imaging Modality ◽  
Spinal Epidural Abscess ◽  
Resonance Imaging ◽  
Laboratory Findings ◽  
Prognostic Features ◽  
Spinal Epidural

Abstract A retrospective study of spinal epidural abscess spanning 10 years and encompassing 40 patients was done. Epidemiology, clinical features, laboratory findings, radiographic imaging, therapy, and outcome were examined and compared with previous series. An increasing incidence of the disease (up to 1.96 patients per 10,000 admissions per year) and an older, more debilitated population (67% having factors predisposing them to infection) were discovered. Over half of the population was studied with magnetic resonance imaging, which was found to be equally as sensitive (91%) as myelography with computed tomography (92%). Magnetic resonance imaging offers the advantages of being noninvasive and able to delineate other entities, which makes it the imaging modality of choice. Preoperative paralysis and neurological deterioration from normal were identified as poor prognostic features. Of 7 patients with preoperative paralysis, 5 died, and the rest failed to recover neurological function. Eleven patients with initially normal neurological exams deteriorated in the hospital before surgical intervention. Eight of these patients were being treated with appropriate antibiotics; 2 became paralyzed despite more than 3 weeks of antibiotic therapy. Only 3 of these 11 patients recovered fully. Immediate surgical decompression combined with antibiotics remains the treatment of choice.

scholarly journals Spinal epidural abscess: appearance on magnetic resonance imaging as a guide to surgical management

2004 ◽  
Vol 17 (6) ◽  
pp. 1-6 ◽  
Author(s):  
Jonathon F. Parkinson ◽  
Lali H. S. Sekhon
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Epidural Abscess ◽  
Surgical Approaches ◽  
Spinal Instability ◽  
Spinal Epidural Abscess ◽  
Resonance Imaging ◽  
Decompressive Laminectomy ◽  
Spinal Epidural ◽  
Invasive Techniques

Spinal epidural abscess is associated with considerable rates of morbidity and mortality despite its infrequent occurrence. Advances in magnetic resonance (MR) imaging technology have allowed easier diagnosis of this potentially devastating condition. It is also possible to predict the intraoperative appearance of each case of spinal epidural abscess prior to the procedure, based on the MR findings. Surgical treatment of this condition usually involves extensive decompressive laminectomy, which predisposes patients to spinal instability and deformity. Recent advances in surgical approaches to spinal epidural abscess have included the institution of less invasive techniques to manage this condition, including saline washes of the epidural space through catheters introduced via limited laminotomy. The cases reported here illustrate the ability to predict the intraoperative findings in patients with spinal epidural abscess, and to adjust the surgical approach accordingly to minimize the extent of potentially destabilizing procedures without impinging on the effectiveness of treatment.

scholarly journals Rapidly Progressive Spontaneous Spinal Epidural Abscess

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Abdurrahman Aycan ◽  
Ozgür Yusuf Aktas ◽  
Feyza Karagoz Guzey ◽  
Azmi Tufan ◽  
Cihan Isler ◽  
...  
Keyword(s):  
Epidural Abscess ◽  
Delayed Diagnosis ◽  
Clinical Findings ◽  
Neurological Deficits ◽  
Spinal Epidural Abscess ◽  
Low Back ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Paraspinal Abscess ◽  
Spinal Epidural

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.

scholarly journals Magnetic resonance imaging-monitored conservative management of traumatic spinal epidural hematomas

1999 ◽  
Vol 6 (1) ◽  
pp. E8 ◽  
Author(s):  
Giovanni La Rosa ◽  
Domenico d'Avella ◽  
Alfredo Conti ◽  
Salvatore Cardali ◽  
Domenico La Torre ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Nonsurgical Treatment ◽  
Spine Injury ◽  
Real Spectrum ◽  
Mri Imaging ◽  
Resonance Imaging ◽  
Traumatic Injuries ◽  
Lumbar Vertebral Body ◽  
Spinal Epidural

Spinal epidural hematomas (SEHs) are uncommon complications caused by traumatic injuries to the spine. Emergency surgical evacuation is the standard treatment. Although recognized in the literature, the possibility of nonsurgical treatment of traumatic SEHs is far from being codified. The authors report on the treatment of four patients whose traumatic SEHs were diagnosed by magnetic resonance (MRI) imaging and managed conservatively with excellent results. All patients had suffered severe spine injury with fracture of a lumbar vertebral body, were admitted within 12 hours of trauma, and exhibited only minimal neurological disturbances on admission. Magnetic resonance imaging studies were performed within 24 hours of trauma. Hematomas appeared isointense/slightly hyperintense on T1- and heterogeneous on T2-weighted MR images. Clot thickness varied between 0.8 cm and 1 cm, width between 1 cm and 1.8 cm, and length between 2.7 and 9 cm. In light of each patient's fairly good neurological condition a conservative approach was taken. In all cases serial MR imaging documented progressive clot resolution, which was completed within 8 to 10 days of trauma. At discharge all patients were neurologically intact. The conservative treatment option of traumatic SEH should be reserved for exceptional cases whose deficits are minimal, when neurological deterioration is followed by early and sustained spontaneous recovery, and when there are clear medical contraindications for surgery. The results of the present study confirm that nonsurgical treatment is feasible in a subgroup of minimally symptomatic patients who harbor moderate-sized SEHs. Although the authors' experience shows a good spontaneous outcome of some traumatic SEH, further studies are necessary to understand the real spectrum of nonsurgical treatment of such lesions.

scholarly journals Pure epidural spinal cavernous haemangioma

2021 ◽  
Vol 12 ◽  
pp. 523
Author(s):  
Ragavan Manoharan ◽  
Jonathon Parkinson
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Surgical Excision ◽  
Cavernous Haemangioma ◽  
Case Description ◽  
Resonance Imaging ◽  
Cavernous Hemangiomas ◽  
The Right ◽  
Spinal Epidural ◽  
Progressive Paraparesis

Background: Pure epidural spinal cavernous hemangiomas (SCH) account for only 4% of all spinal epidural lesions. Our literature review identified 61 publications reporting on, a total of 175 cases in the magnetic resonance imaging era. Here, we reviewed those cases, and have added our case of what appeared to be a multifocal SCH. Case Description: A 72-year-old male presented with a progressive paraparesis attributed to a T5/T6 dorsolateral extradural mass extending into the right T5/6 foramen. Surgical excision documented the lesion, histologically, was a SCH. A second similar lesion was noted involving the left C7/T1 foramen; as the patient was asymptomatic from this lesion, and no additional biopsy was performed. The patient returned to normal neurological function within 2 months postoperatively. Conclusions: Here, a 72-year-old male presented with a pathologically confirmed T5/T6 epidural SCH and a secondary C7/T1 foraminal lesion suspected to represent a secondary focus of an epidural SCH.

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