EPIDURAL SPINAL INFECTIONS

Anterior cervical epidural abscess with pneumococcus in an infant

Spinal epidural abscess is a rare infection in childhood. We report the first documented case of pneumococcal epidural abscess in an infant and review the literature regarding this entity. In children, the signs and symptoms of spinal epidural abscess may not be as helpful as those in older patients. Furthermore, the offending organism may not be the usual Staphylococcus seen in adults. Infants may recover neurologic function even after prolonged cord compression; however, a high index of suspicion is needed to make the diagnosis in a timely fashion.

[Spinal epidural abscesses: report of 5 cases]

Five cases of acute spinal epidural abscess, all in male, two of them in children (6 and 7 years old) and the others in patients older than fifty years are reported. In four cases the pathology was related to skin infection and the staphylococcus was the main agent. All the patients had a severe infectious clinical picture, pain on the spine, radicular or spinal cord involvement or both. There was a delay in diagnosis showing that this pathology is still rather unknown. The cases were treated surgically. Two patients died, two had a complete recovery and the last one recovered with neurological deficit. The patients who died had impairment of the cervical cord and were operated on in very bad general and neurological conditions. Revision of literature was performed and the authors discussed the various aspects of this disease.

Acute spinal epidural abscess

A case of acute spinal epidural abscess is reported demonstrating many of the important features in the natural history of the disorder. The pathological changes in the cord at the level of the lesion are described. A series of 12 patients is reviewed. The average interval between the initial consultation and the onset of complete paralysis is 5 days and it is essential that the diagnosis is made during this period. Two indicators of prognosis are discussed--the duration of complete paralysis and the extent of sensory disturbance.

Spinal epidural abscess in children. Early diagnosis and immediate surgical drainage is essential to forestall paralysis

Spinal epidural abscess represents a surgical emergency because it rapidly leads to complete paralysis below the lesion. Early surgical drainage is essential to complete recovery. A review of the 46 cases in children reported in the English literature indicates that the sequence of first symptoms (fever, localized back pain, and radicular pain) should afford early diagnosis in most cases. Staphylococci are the most frequent bacteriologic invaders.