Infectious origins of cauda equina syndrome

2004 ◽  
Vol 16 (6) ◽  
pp. 1-10 ◽  
Author(s):  
David B. Cohen
Keyword(s):  
Cauda Equina Syndrome ◽  
Epidural Abscess ◽  
Clinical Course ◽  
Cauda Equina ◽  
Spinal Infection ◽  
Diagnosis And Treatment ◽  
Patient Demographics ◽  
Difficult Condition ◽  
Wide Range ◽  
Vertebral Involvement

Infections in the spine can lead to a wide range of problems for both the patient and physician. There is perhaps no more devastating complication than the neurological consequences of a cauda equina syndrome due to spinal infection. A variety of organisms and origins can make diagnosis and treatment of spinal infection a difficult task. Both pyogenic and nonpyogenic organisms can cause vertebral involvement and can result in an epidural abscess with neurological compromise. Nonetheless, these two types of infections vary greatly in terms of associated patient demographics, clinical course, and treatments. The purpose of this paper was to review these types of infections and summarize treatment recommendations for this difficult condition.

scholarly journals Epidemiology of spinal infections: retrospective review of the patients with osteomyelitis, discitis, and epidural abscesses

2015 ◽  
Vol 42 (S1) ◽  
pp. S50-S50 ◽  
Author(s):  
K Meguro ◽  
B Pirlot ◽  
T Ellchuk
Keyword(s):  
Neurological Deficit ◽  
Drug Users ◽  
Epidural Abscess ◽  
Retrospective Chart Review ◽  
University Hospital ◽  
Patient Demographics ◽  
Difficult Condition ◽  
Risk Patients ◽  
Poor Outcomes ◽  
Spinal Infections

Background: Spinal infections are one of the most difficult, complex, and multi-disciplinary health conditions. The purpose of this paper was to gather demographic information of the patients with spinal infections and to identify factors that would influence their management. Methods: Retrospective chart review of 146 adult patients with osteomyelitis, discitis or epidural abscesses admitted to the Royal University Hospital, Saskatchewan, from 2007-2014. Results: Patient demographics included 59% male, 41% female, mean age 53 years. 36% of patients required surgery, 44% were IV drug users, and 71% were managed by surgeons. Presence of a neurological deficit, higher white blood cell count, and longer hospital admission, in relation to poor outcomes, were statistically significant. Higher age and shorter duration between onset of symptoms and admission showed a trend toward a poorer outcome. Epidural abscess and presence of a neurological deficit are variables isolated as being statistically significant in relation to need for surgery. 57.1% of patients with epidural abscess and 51.7% with neurological deficit required surgery. Conclusions: We were able to identify high-risk patients as to the need for surgery and poor outcome. Based on this information, we can better tailor our management strategy of this difficult condition.

Epidural abscess and cauda equina syndrome after percutaneous intradiscal therapy in degenerative lumbar disc disease

2012 ◽  
Vol 12 (11) ◽  
pp. e1-e4 ◽  
Author(s):  
Brian R. Subach ◽  
Anne G. Copay ◽  
Marcus M. Martin ◽  
Thomas C. Schuler ◽  
Diana S. DeWolfe
Keyword(s):  
Cauda Equina Syndrome ◽  
Epidural Abscess ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Disc Disease ◽  
Lumbar Disc Disease

scholarly journals P31 Cauda equina syndrome – the importance of an early, accurate diagnosis and treatment in preventing bladder dysfunction

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Victoria Amy Porter ◽  
Victoria Porter
Keyword(s):  
Urinary Retention ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Accurate Diagnosis ◽  
Diagnostic Methods ◽  
Diagnosis And Treatment ◽  
Decompressive Surgery ◽  
Bladder Function ◽  
Urological Complications ◽  
Significant Difference

Abstract Introduction Cauda Equina Syndrome (CES), is a neurological emergency with many urological features. Delayed decompressive surgery can cause urinary retention, overflow incontinence, long term catherization and loss of sexual function. This article focusses on the accuracy of the initial diagnosis and the time taken before treatment is commenced. Methods In this systematic literature review, OneSearch and PubMed have been searched for articles which identify the main symptoms of CES, evaluate the effectiveness of several diagnostic methods and compare the postoperative results of bladder function following timely and delayed treatment. Results A total of 20 articles have been referenced, of which 9 studies have been reviewed. While no individual symptom is 100% indicative of CES, urinary retention (diagnostic accuracy 0.9), is the most consistent clinical finding. Therefore, MRI is necessary for an accurate diagnosis. Further 4 out of 5 studies state that treatment within 24-hours improves patient outcomes compared to 48-hours, one study showed no significant difference between 24 and 48 hours. All articles indicate beyond 48-hours, surgical intervention has little impact on the relief of symptoms. Conclusion The studies concluded that any patient presenting in the emergency department with lower back pain should be screened for CES. A thorough history and neurological examination should be performed; however, the evidence base for rectal examination to assess anal tone is poor. Decompressive surgery carried out within the first 24-hour period from the onset of symptoms is favourable. Overall, early accurate diagnosis and treatment is invaluable to preventing urological complications and improving prognosis.

scholarly journals A rare etiology of cauda equina syndrome

2010 ◽  
Vol 5 (01) ◽  
pp. 079-082 ◽  
Author(s):  
Sumit Batra ◽  
Sumit Arora ◽  
Hemant Meshram ◽  
Geetika Khanna ◽  
Shabnam B Grover ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
English Language ◽  
Medical Literature ◽  
Epidural Abscess ◽  
Fungal Infections ◽  
Cauda Equina ◽  
Immunocompetent Patient ◽  
Spinal Epidural Abscess ◽  
Oral Itraconazole ◽  
Spinal Epidural

Fungal infections of the spine are very rare and usually seen in immunocompromised patients. Acute cauda equina syndrome presenting in an immunocompetent patient is usually due to a prolapse of the intervertebral disc. Infective pathology caused by Mycobacterium tuberculosis with epidural collection can also have a similar presentation. We present a case of spinal epidural abscess caused by Aspergillus fumigatus, presenting as acute cauda equina syndrome. To the best of our knowledge, spinal aspergillosis presenting as cauda equina syndrome in an immunocompetent patient has not been reported before in the English-language based medical literature. Surgical decompression with antifungal treatment with oral itraconazole yielded a good recovery.

scholarly journals Tubercular spinal epidural abscess involving the dorsal-lumbar-sacral region without osseous involvement

2011 ◽  
Vol 5 (07) ◽  
pp. 544-549 ◽  
Author(s):  
Sumit Arora ◽  
Ramesh Kumar
Keyword(s):  
English Language ◽  
Medical Literature ◽  
Epidural Abscess ◽  
Cauda Equina ◽  
Uneventful Recovery ◽  
Spinal Epidural Abscess ◽  
Vertebral Level ◽  
Osseous Involvement ◽  
Vertebral Involvement ◽  
Spinal Epidural

Musculoskeletal tuberculosis is known for its ability to present in various forms and guises at different sites. Tubercular spinal epidural abscess (SEA) is an uncommon infectious entity. Its presence without associated osseous involvement may be considered an extremely rare scenario. We present a rare case of tubercular SEA in an immune-competent 35-year-old male patient. The patient presented with acute cauda equina syndrome and was shown to have multisegmental SEA extending from D5 to S2 vertebral level without any evidence of vertebral involvement on MRI. The patient made an uneventful recovery following surgical decompression and antitubercular chemotherapy. The diagnosis was confirmed by histopathological demonstration of Mycobacterium tuberculosis in drained pus. Such presentation of tubercular SEA has not been reported previously in the English language based medical literature to the best of our knowledge

Diagnosis and Treatment of Cauda Equina Syndrome

2013 ◽  
Vol 13 (9) ◽  
pp. S162
Author(s):  
Mark E. Tantorski ◽  
Scott G. Tromanhauser ◽  
Stephen Parazin ◽  
Brian Kwon ◽  
Eric P. Carkner ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Diagnosis And Treatment
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