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Xu T, Du Y, Guo J, Li J, Shao C, Shi C, Ren X, Xi Y. Extensive Spinal Epidural Abscess Resulting in Complete Paraplegia Treated by Selective Laminectomies and Irrigation. Orthop Surg 2022; 14:2380-2385. [PMID: 35732468 PMCID: PMC9483064 DOI: 10.1111/os.13367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/11/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background Spinal epidural abscess (SEA) is an uncommon clinical entity that is often subject to delayed diagnosis and suboptimal treatment. Untreated disease leads to compression of the spinal cord, resulting in devastating complications. Case Presentation A 56‐year‐old man visited our hospital for progressive lower back and lower extremity pain of several days' duration. Significant pyrexia (39.5°C) and elevated C‐reactive protein (89.2 mg/L) were detected during admission, but no positive neurological examination findings were observed. Magnetic resonance imaging revealed pyogenic discitis at L3–4. Despite the administration of directed antibiotic therapy, the patient's condition rapidly deteriorated, culminating in complete paraplegia secondary to an extensive SEA from L4 to C7. Emergency spinal decompression surgery was canceled due to his poor clinical condition and refusal of informed consent. After further deterioration, he consented to two‐level selective laminectomies and irrigation. Conclusions In contrast with prior case reports, this case illustrates the natural history of an extensive SEA during conservative and late surgical treatment. Early diagnosis and timely surgical decompression are of great importance for extensive SEA.
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Affiliation(s)
- Tongshuai Xu
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yukun Du
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianwei Guo
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianyi Li
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cheng Shao
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Changfang Shi
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xianfeng Ren
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yongming Xi
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Proietti L, Ricciardi L, Noia G, Barone G, Valenzi E, Perna A, Giannelli I, Scaramuzzo L, Visocchi M, Papacci F, Tamburrelli FC. Extensive Spinal Epidural Abscesses Resolved with Minimally Invasive Surgery: Two Case Reports and Review of the Recent Literature. ACTA NEUROCHIRURGICA. SUPPLEMENT 2019; 125:345-353. [PMID: 30610344 DOI: 10.1007/978-3-319-62515-7_50] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE An extensive spinal epidural abscess is a rare condition and causes significant morbidity and mortality. Few authors have described this uncommon entity, which requires early diagnosis and optimal treatment to avoid devastating complications. The purpose of this study was to evaluate a minimally invasive technique for treatment of an extensive spinal epidural abscess by describing two cases. Furthermore, we conducted a review of the recent literature on the management of this rare condition. METHODS We report two cases of spinal abscesses extending to the whole epidural space, successfully treated by use of a minimally invasive technique consisting of multilevel laminotomy and catheter irrigation to decompress and drain the epidural space. RESULTS This technique is able to decompress the spinal cord, isolate the pathogen and evacuate the abscess. No complications, late spine deformity or dura penetration were observed in our patients. CONCLUSION Urgent surgical decompression, in combination with long-term antibiotic treatment, is generally considered the treatment of choice for an extensive spinal epidural abscess. A minimally invasive technique can be very useful as a surgical option.
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Affiliation(s)
- Luca Proietti
- Spine Surgery Division, Agostino Gemelli Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy
| | - Luca Ricciardi
- Institute of Neurological Surgery, Catholic University of the Sacred Heart of Rome, Agostino Gemelli Hospital, Rome, Italy
| | - Giovanni Noia
- Spine Surgery Division, Agostino Gemelli Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy.
| | - Giuseppe Barone
- Division of Orthopaedics and Traumatology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Eugenio Valenzi
- Spine Surgery Division, Agostino Gemelli Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy
| | - Andrea Perna
- Spine Surgery Division, Agostino Gemelli Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy
| | - Ilaria Giannelli
- Spine Surgery Division, Agostino Gemelli Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy
| | - Laura Scaramuzzo
- Spine Surgery Division 1, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Massimiliano Visocchi
- Institute of Neurological Surgery, Catholic University of the Sacred Heart of Rome, Agostino Gemelli Hospital, Rome, Italy
| | - Fabio Papacci
- Institute of Neurological Surgery, Catholic University of the Sacred Heart of Rome, Agostino Gemelli Hospital, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Spine Surgery Division, Agostino Gemelli Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy
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Ahuja K, Das L, Jain A, Meena PK, Arora SS, Kandwal P. Spinal holocord epidural abscess evacuated with double thoracic interval laminectomy: a rare case report with literature review. Spinal Cord Ser Cases 2019; 5:62. [PMID: 31632720 PMCID: PMC6786417 DOI: 10.1038/s41394-019-0206-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction Holocord spinal cord epidural abscess is an uncommon condition that may result in serious neurological complications. Prompt diagnosis and early treatment is of paramount importance for an optimum clinical outcome. This case report describes a novel technique of interval laminectomy at two sites in the thoracic spine and surgical decompression with the help of infant feeding tubes in a case of holocord spinal epidural abscess (HSEA). Case presentation An 18-year-old male presented to the emergency department with high-grade fever and low back ache of 2 weeks duration and loss of bowel and bladder control for 4 days. Neurological examination revealed intact motor power and sensation in all four limbs at presentation; however, there was a rapid deterioration to complete quadriplegia within 24 h. A diagnosis of holocord epidural abscess was made. Emergent decompression via interval thoracic laminectomy was done and appropriate antimicrobial therapy was instituted. At 10 months of follow-up, the individual showed complete neurological recovery. Discussion The technique used in this case is unique with respect to the level of laminectomy and the manoeuvre employed for pus evacuation. Complete neurological and functional recovery was achieved despite complete paralysis pre-operatively. The outcome indicates that there may be good prognosis for individuals with HSEA accompanied with neurological deficit and emergent surgical decompression.
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Affiliation(s)
- Kaustubh Ahuja
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 Uttarakhand India
| | - Lakshmana Das
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 Uttarakhand India
| | - Aakriti Jain
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 Uttarakhand India
| | - Pradeep Kumar Meena
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 Uttarakhand India
| | - Shobha S. Arora
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 Uttarakhand India
| | - Pankaj Kandwal
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 Uttarakhand India
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Kow CY, Chan P, Etherington G, Ton L, Liew S, Cheng AC, Rosenfeld JV. Pan-spinal infection: a case series and review of the literature. JOURNAL OF SPINE SURGERY 2016; 2:202-209. [PMID: 27757433 DOI: 10.21037/jss.2016.08.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Panspinal infection usually presents with fever, back pain, neurological deficit, and in advanced cases multi-organ failure and septic shock. The choice of treatment for panspinal infection is challenging because these patients are usually medically unstable with severe neurological compromise. The objective of this study is to review management and long term outcomes for patients with panspinal infection. METHODS A retrospective review of patients with panspinal infection treated in our center over a 5-year period [Jan 2010-Dec 2014] and a review of the current published literatures was undertaken. RESULTS We identified 4 patients with panspinal infection. One case was managed medically due to high perioperative risk, whilst the other three were managed surgically whilst on antibiotic therapy. All 3 cases managed surgically improved neurologically and infection subsided, whereas the patient managed medically did not change neurologically and infection subsided. CONCLUSIONS Patients with panspinal infection should be treated surgically unless the medical risk of surgery or anaesthesia is prohibitive.
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Affiliation(s)
| | | | | | - Lu Ton
- Department of Orthopaedics, Alfred Hospital
| | - Susan Liew
- Department of Orthopaedics, Alfred Hospital
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Hospital; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jeffrey V Rosenfeld
- Department of Neurosurgery, Alfred Hospital; ; Department of Surgery, Monash University, Melbourne, Australia
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Lee JS, Choi SM, Kim KW. Triparesis caused by gas-containing extensive epidural abscess secondary to Aeromonas hydrophila infection of a thoracic vertebroplasty: a case report. Spine J 2013; 13:e9-e14. [PMID: 23669124 DOI: 10.1016/j.spinee.2013.03.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 10/23/2012] [Accepted: 03/20/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Aeromonas hydrophila is a motile gram-negative non-sporeforming rod with facultative anaerobic metabolism. Except for gastrointestinal disease, skin and soft-tissue infections represent the second most common site of human Aeromonas infections. However, to our knowledge, A. hydrophila infection of the spine has not been reported to date. PURPOSE To report the first case of A. hydrophila spinal infection of the T7 vertebra after vertebroplasty. STUDY DESIGN Case report. METHODS A 72-year-old man was transferred to our emergency department with chief complaints of severe midthoracic pain and triparesis. He had undergone vertebroplasty for a painful vertebral fracture at T7 5 weeks before transfer. Magnetic resonance imaging showed an infection of the T7 vertebroplasty and an extensive epidural abscess. The epidural abscess originating from the infected T7 vertebroplasty extended from the T8 to the C4 epidural space. Computed tomography demonstrated sparsely scattered gas in the epidural abscess, strongly suggestive of an anaerobic infection. RESULTS Emergency multilevel laminectomies from C5 to T8 and a posterior instrumentation from T3 to T10 were performed. A. hydrophila was isolated from the blood cultures. The patient was treated with intravenous ampicillin/sulbactam. Posterior decompression and stabilization in combination with appropriate antibiotic treatment completely resolved the neurologic deficit and infection without the need for further anterior corpectomy of the infected T7 vertebroplasty. CONCLUSIONS This is the first reported case of spine infection caused by A. hydrophila. The infection developed after vertebroplasty for the management of a painful vertebral fracture. Triparesis occurred rapidly due to an extensive epidural abscess containing gas. Emergency decompression and stabilization in combination with appropriate antibiotic treatment achieved a successful clinical outcome.
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Affiliation(s)
- Jun-Seok Lee
- Department of Orthopedic Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 62 Yoido-dong, Youngdeungpo-ku, Seoul 150-010, Korea
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Tahir MZ, Hassan RU, Enam SA. Management of an extensive spinal epidural abscess from C-1 to the sacrum. Case report. J Neurosurg Spine 2011; 13:780-3. [PMID: 21121757 DOI: 10.3171/2010.5.spine09545] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report a rare case of extensive spinal epidural abscess in an immunocompromised young woman. The patient presented with low-grade fever, back pain, and progressive lower limb weakness. The MR imaging of her whole spine revealed an epidural abscess extending from C-1 to the sacrum. She was treated using a minimally invasive surgical technique and showed excellent recovery. The authors review the current literature along with different modes of surgical treatment available for this unusual clinical entity.
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Kim JS, Sung KH, Cho YW, Kim KH, Bae SD. Extensive Spinal Epidural Abscess: The Usefulness of Minimal Invasive Surgical Technique using Epidural Irrigation Catheter. KOREAN JOURNAL OF SPINE 2011. [DOI: 10.14245/kjs.2011.8.3.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Joon Soo Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University College of Medicine, Changwon, Korea
| | - Kang Hyun Sung
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University College of Medicine, Changwon, Korea
| | - Yong Woon Cho
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University College of Medicine, Changwon, Korea
| | - Kyu Hong Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University College of Medicine, Changwon, Korea
| | - Sang Do Bae
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University College of Medicine, Changwon, Korea
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Evacuation of a 14-vertebral-level cervico-thoracic epidural abscess and review of surgical options for extensive spinal epidural abscesses. J Clin Neurosci 2008; 15:483-6. [DOI: 10.1016/j.jocn.2006.12.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Revised: 12/11/2006] [Accepted: 12/17/2006] [Indexed: 11/20/2022]
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