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Hugues Dokponou YC, Ontsi Obame FL, Mohcine S, Saad ME, Abderrahmane H, Imbunhe N, Mandour C, Gazzaz M. Extensive Spinal Epidural Abscess: A Systematic Review of Risk Factors, Clinical Presentation, and Management with a Case Illustration. World Neurosurg 2024; 189:273-284. [PMID: 38906469 DOI: 10.1016/j.wneu.2024.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Extensive spinal epidural abscess (ESEA) is a rare clinical entity subject to delayed diagnosis, which can be explained by the extension of the epidural collection, thereby delaying the mass effect responsible for its clinical manifestations. METHODS We report a rare case of an extensive C7-T10 epidural abscess in a 54-year-old man treated with antibiotics, laminectomy, and abscess drainage. In addition, we conducted a systematic literature search according to the "Preferred Reporting Items for Systematic Reviews" guidelines. Relevant studies (1980-2023) reporting patients with ESEA were identified from PubMed databases. RESULTS A total of 48 studies reporting 55 patients were included in this study with a mean age of 55.7 ± 14.6 years with a male predominance of 61.8% (n = 34). The median duration of follow-up was 38 months (21.5-64.3). The mortality rate of ESEA was 1.8% for a 21.8% morbidity rate with 76.4% (n = 42) reported to have been improved after surgery. CONCLUSIONS Both single and multilevel laminectomy with abscess drainage for ESEA leads to patient recovery from this devastating condition. Evaluation of the outcome with data on time-to-Nadir and Nadir-to-surgery is needed to codify ESEA management.
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Affiliation(s)
| | | | - Salami Mohcine
- Department of Neurosurgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Moussa Elmi Saad
- Department of Neurosurgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Housni Abderrahmane
- Department of Neurosurgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Napoleão Imbunhe
- Department of Neurosurgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Cherkaoui Mandour
- Department of Neurosurgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Miloud Gazzaz
- Department of Neurosurgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
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2
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Papadakis SA, Ampadiotaki MM, Pallis D, Tsivelekas K, Nikolakakos P, Agapitou L, Sapkas G. Cervical Spinal Epidural Abscess: Diagnosis, Treatment, and Outcomes: A Case Series and a Literature Review. J Clin Med 2023; 12:4509. [PMID: 37445544 DOI: 10.3390/jcm12134509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Although recent diagnostic and management methods have improved the prognosis of cervical epidural abscesses, morbidity and mortality remain significant. The purpose of our study is to define the clinical presentation of cervical spinal epidural abscess, to determine the early clinical outcome of surgical treatment, and to identify the most effective diagnostic and treatment approaches. Additionally, we analyzed studies regarding cervical epidural abscesses and performed a review of the literature. In this study, four patients with spinal epidural abscess were included. There were three men and one woman with a mean age of 53 years. Three patients presented with motor deficits, and one patient was diagnosed incidentally through spinal imaging. All the patients had fever, and blood cultures were positive. Staphylococcus aureus was the most common organism cultured from abscesses. All patients underwent a surgical procedure, and three patients recovered their normal neurological functions, but one remained with mild neurological disability that was resolved two years postoperatively. The mean follow-up period was 12 months, and no deaths occurred in this series. Furthermore, we identified 85 studies in the literature review and extracted data regarding the diagnosis and management of these patients. The timely detection and effective management of this condition are essential for minimizing its associated morbidity and mortality.
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Affiliation(s)
| | | | - Dimitrios Pallis
- B' Orthopaedic Department, KAT General Hospital of Attica, 14561 Kifissia, Greece
| | | | - Petros Nikolakakos
- B' Orthopaedic Department, KAT General Hospital of Attica, 14561 Kifissia, Greece
| | - Labrini Agapitou
- B' Orthopaedic Department, KAT General Hospital of Attica, 14561 Kifissia, Greece
| | - George Sapkas
- Orthopaedic Department, Metropolitan Hospital, 18547 Athens, Greece
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3
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Balcescu C, Odeh K, Rosinski A, Nudelman B, Schlauch A, Shah I, Ungurean Jr. V, Prasad P, Leasure J, Stepansky F, Piple A, Kondrashov D. Pyogenic spinal infections warrant a total spine MRI. J Bone Jt Infect 2023; 8:1-9. [PMID: 36687464 PMCID: PMC9850241 DOI: 10.5194/jbji-8-1-2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/19/2022] [Indexed: 01/04/2023] Open
Abstract
Study design: retrospective case series. Objective: the presenting clinical symptoms of spinal infections are often nonspecific and a delay in diagnosis can lead to adverse patient outcomes. The morbidity and mortality of patients with multifocal spinal infections is significantly higher compared to unifocal infections. The purpose of the current study was to analyse the risk factors for multifocal spinal infections. Methods: we conducted a retrospective review of all pyogenic non-tuberculous spinal infections treated surgically at a single tertiary care medical center from 2006-2020. The medical records, imaging studies, and laboratory data of 43 patients during this time period were reviewed and analysed after receiving Institutional Review Board approval. Univariate and multivariate analyses were performed to identify factors associated with a multifocal spinal infection. Results: 15 patients (35 %) had multifocal infections. In univariate analysis, there was a significant association with chronic kidney disease ( p = 0.040 ), gender ( p = 0.003 ), a white blood cell count ( p = 0.011 ), and cervical ( p < 0.001 ) or thoracic ( p < 0 .001) involvement. In multivariate analysis, both cervical and thoracic involvement remained statistically significant ( p = 0.001 and p < 0.001 , respectively). Conclusions: patients with infections in the thoracic or cervical region are more likely to have a multifocal infection. Multifocal pyogenic spinal infections remain a common entity and a total spine MRI should be performed to aid in prompt diagnosis.
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Affiliation(s)
- Cristian Balcescu
- San Francisco Orthopaedic Residency Program, St. Mary's Medical
Center, San Francisco, CA 94117, USA
| | - Khalid Odeh
- San Francisco Orthopaedic Residency Program, St. Mary's Medical
Center, San Francisco, CA 94117, USA
| | - Alexander Rosinski
- San Francisco Orthopaedic Residency Program, St. Mary's Medical
Center, San Francisco, CA 94117, USA
| | - Brandon Nudelman
- San Francisco Orthopaedic Residency Program, St. Mary's Medical
Center, San Francisco, CA 94117, USA
| | - Adam Schlauch
- San Francisco Orthopaedic Residency Program, St. Mary's Medical
Center, San Francisco, CA 94117, USA
| | - Ishan Shah
- San Francisco Orthopaedic Residency Program, St. Mary's Medical
Center, San Francisco, CA 94117, USA
| | | | - Priya Prasad
- Department of Internal Medicine, University of California San
Francisco, San Francisco, CA 94143, USA
| | | | - Flora Stepansky
- Department of Radiology, St. Mary's Medical Center, San Francisco, CA
94117, USA
| | - Amit Piple
- The Taylor Collaboration, San Francisco, CA 94117, USA
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4
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Kotheeranurak V, Jitpakdee K, Singhatanadgige W, Limthongkul W, Yingsakmongkol W, Kim JS. Anterior transcorporeal full-endoscopic drainage of a long-span ventral cervical epidural abscess: A novel surgical technique. NORTH AMERICAN SPINE SOCIETY JOURNAL 2021; 5:100052. [PMID: 35141618 PMCID: PMC8820016 DOI: 10.1016/j.xnsj.2021.100052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/28/2021] [Accepted: 02/06/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND A long-span ventral cervical epidural abscess is a rare and devastating condition. Typically, extensive procedures are chosen to deal with this condition and usually end up with limited cervical motion. Here, we describe a novel minimally invasive anterior full-endoscopic transcorporeal approach for drainage of large ventral cervical epidural abscess. CASE DESCRIPTION A 33-year-old man presented with seizures and acute weakness in all extremities persistent for 2 hours. His motor power of the upper and lower extremities was rapidly declined from grade III to grade 0 within 12 hours. Magnetic resonance imaging (MRI) showed a long-span ventral epidural abscess extending from C2 to T1, cervical spinal cord, and a retropharyngeal abscess. A typical anterior cervical approach to the prevertebral space was performed to evacuate pus from the retropharyngeal abscess, after which anterior transcorporeal full-endoscopic drainage of the large ventral cervical epidural abscess was successfully performed. OUTCOME The patient's motor power recovered to grade IV within 2 weeks post-operation. He had no neck pain or instability following the operation. Postoperative MRI and computed tomography revealed diminished epidural abscess. CONCLUSIONS For managing cases with a ventral-type cervical epidural abscess, anterior transcorporeal full-endoscopic drainage is an alternative minimally invasive method that yields sufficient debridement and drainage.
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Affiliation(s)
- Vit Kotheeranurak
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Sriracha, Chonburi, Thailand
| | - Khanathip Jitpakdee
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Sriracha, Chonburi, Thailand
| | | | - Worawat Limthongkul
- Department of Orthopaedic, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wicharn Yingsakmongkol
- Department of Orthopaedic, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, Spine Center, College of medicine, The Catholic University of Korea, Seoul, South Korea
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5
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A rare case of isolated cauda equina Nocardia farcinica infection. J Neurovirol 2020; 26:615-618. [PMID: 32548751 DOI: 10.1007/s13365-020-00863-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/14/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
Nocardia is a Gram-positive, partially acid-fast, catalase-positive, and urease-positive bacterium that grows aerobically. We present an extremely rare case of cauda equina syndrome due to isolated intramedullary Nocardia farcinica infection. A 44-year-old male presented with low backache and gradually progressive weakness in bilateral lower limbs followed by paraplegia. He was found to have a well-defined, sharply demarcated ring-enhancing lesion located from T11-T12 to L3 vertebral body. He underwent laminectomy and decompression. The histopathological examination revealed a Gram-positive filamentous organism that looks like Nocardia. The culture report was suggestive of Nocardia farcinica. He was then treated with antibiotics and had a remarkable clinical and radiological improvement.
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6
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Kobayashi T, Morimoto T, Maeda K, Toda Y, Hirata H, Yoshihara T, Mawatari M. Transoral Mandibular Tongue-Splitting Approach in Upper Cervical Epidural Abscess: A Case Report and Review of the Literature. Spine Surg Relat Res 2020; 4:178-183. [PMID: 32405566 PMCID: PMC7217670 DOI: 10.22603/ssrr.2019-0090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/02/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction The transoral mandibular tongue-splitting approach is typically performed for the treatment of upper cervical tumor and instability but has not been performed for the treatment of upper cervical epidural abscess (UCEA). We report the first case of UCEA successfully treated with a transoral mandibular tongue-splitting approach. Technical Note A 62-year-old man who had medical histories of tracheotomy with intubation and dermatopathy due to radiation therapy for the treatment of nasopharyngeal carcinoma presented with neck pain and limb weakness. The imaging examination revealed bone erosion of C2-C4 vertebrae and abscess at the level of C2-C4, supporting a diagnosis of UCEA. The transcervical approach could not be used for treatment; therefore, the transoral mandibular tongue-splitting approach was used successfully to perform decompression, debridement, and iliac bone grafting. Subsequently, we reviewed the literature pertaining to the use of the transoral mandibular tongue-splitting approach. The approach can be invasive and cause some complications. However, no fatal complications have been reported, and all patients demonstrated a favorable neurological outcome with reduced neurological deficits. Conclusions This case and subsequent literature review suggest that the transoral mandibular tongue-splitting approach may be effective for the improvement of neurological outcomes without fatal complications in patients with UCEA. There may be an increasing number of patients with UCEA requiring the transoral mandibular tongue-splitting approach due to the increasing prevalence of immunocompromized status and the aging population.
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Affiliation(s)
- Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Kazumasa Maeda
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Yu Toda
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Hirohito Hirata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tomohito Yoshihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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7
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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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8
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Balcescu C, Odeh K, Rosinski A, Wang J, Prasad P, Leasure J, Ungurean V, Kondrashov D. High Prevalence of Multifocal Spine Infections Involving the Cervical and Thoracic Regions: A Case for Imaging the Entire Spine. Neurospine 2019; 16:756-763. [PMID: 31284339 PMCID: PMC6945002 DOI: 10.14245/ns.1836296.148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/27/2019] [Indexed: 12/18/2022] Open
Abstract
Objective Pyogenic spinal infections account for 2%–4% of orthopaedic infections. They are often difficult to diagnose, resulting in a delay in diagnosis. Risk factors for orthopaedic and spinal infection are well-documented in the literature, yet there is a paucity of studies examining risk factors specifically for multifocal spinal infections. The objective of this study was to identify predictors of multifocal spinal infections in comparison to unifocal spinal infections.
Methods The medical records, imaging studies, and bacteriology data of 20 patients treated surgically for pyogenic spinal infection over 6 years at a tertiary referral center were reviewed and analyzed after receiving Institutional Review Board approval. Univariate and multivariate analyses were performed to identify factors associated with a multifocal spinal infection.
Results Seven patients (35%) had multifocal infections. Three were bifocal, and 4 were trifocal. Patients with surgically treated cervical or thoracic spinal infections had a high rate of concomitant multifocal spinal infections (71% and 83%, respectively). Other potential predictors (e.g., patient age, body mass index, magnetic resonance image findings, etc.) did not reach statistical significance. Each of the multifocal infections involved the lumbar spine.
Conclusion In this study, the spinal region was the only statistically significant risk factor for multifocal infection. Patients who are diagnosed with a spinal infection that requires operative treatment should have their entire spine evaluated with magnetic resonance imaging to detect multifocal involvement promptly.
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Affiliation(s)
- Christian Balcescu
- St. Mary's Medical Center, San Francisco Orthopaedic Residency Program, San Francisco, CA, USA
| | - Khalid Odeh
- St. Mary's Medical Center, San Francisco Orthopaedic Residency Program, San Francisco, CA, USA
| | | | - Jonathan Wang
- St. Mary's Medical Center, San Francisco Orthopaedic Residency Program, San Francisco, CA, USA
| | - Priya Prasad
- The Taylor Collaboration, San Francisco, CA, USA
| | | | - Victor Ungurean
- St. Mary's Medical Center, San Francisco Orthopaedic Residency Program, San Francisco, CA, USA
| | - Dimitriy Kondrashov
- St. Mary's Medical Center, San Francisco Orthopaedic Residency Program, San Francisco, CA, USA
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9
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Kobayashi T, Ureshino H, Hotta K, Ikuta K. Timing of surgical interventions for upper cervical epidural abscess: a case report and review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1365-1366. [PMID: 30915554 DOI: 10.1007/s00590-019-02425-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 03/22/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Takaomi Kobayashi
- Department of Orthopedic Surgery, Karatsu Red Cross Hospital, 1-5-1 Futago, Karatsu, Saga, 847-8588, Japan.
| | - Hiroshi Ureshino
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Kensuke Hotta
- Department of Orthopedic Surgery, Karatsu Red Cross Hospital, 1-5-1 Futago, Karatsu, Saga, 847-8588, Japan
| | - Ko Ikuta
- Department of Orthopedic Surgery, Karatsu Red Cross Hospital, 1-5-1 Futago, Karatsu, Saga, 847-8588, Japan
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10
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Eltorai AEM, Naqvi SS, Seetharam A, Brea BA, Simon C. Recent Developments in the Treatment of Spinal Epidural Abscesses. Orthop Rev (Pavia) 2017; 9:7010. [PMID: 28713526 PMCID: PMC5505082 DOI: 10.4081/or.2017.7010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 04/04/2017] [Accepted: 04/14/2017] [Indexed: 12/19/2022] Open
Abstract
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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Affiliation(s)
- Adam E M Eltorai
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Syed S Naqvi
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Ashok Seetharam
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Bielinsky A Brea
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Chad Simon
- Warren Alpert Medical School, Brown University, Providence, RI, USA
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Oh GS, Abou-Al-Shaar H, Arnone GD, Barks AL, Hage ZA, Neckrysh S. Spinal epidural abscess in a patient with piriformis pyomyositis. Surg Neurol Int 2016; 7:S911-S913. [PMID: 28028447 PMCID: PMC5159689 DOI: 10.4103/2152-7806.194518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 07/23/2016] [Indexed: 11/26/2022] Open
Abstract
Background: Spinal epidural abscess resulting from piriformis pyomyositis is extremely rare. Such condition can result in serious morbidity and mortality if not addressed in a timely manner. Case Description: The authors describe the case of a 19-year-old male presenting with a 2-week history of fever, low back pain, and nuchal rigidity. When found to have radiographic evidence of a right piriformis pyomyositis, he was transferred to our institution for further evaluation. Because he demonstrated rapid deterioration, cervical, thoracic, and lumbar magnetic resonance imaging scans were emergently performed. They revealed an extensive posterior spinal epidural abscess causing symptomatic spinal cord compression extending from C2 to the sacrum. He underwent emergent decompression and abscess evacuation through a dorsal midline approach. Postoperatively, he markedly improved. Upon discharge, the patient regained 5/5 strength in both upper and lower extremities. Cultures from the epidural abscess grew methicillin-sensitive Staphylococcus aureus warranting a 6-week course of intravenous nafcillin. Conclusion: A 19-year-old male presented with a holospinal epidural abscess (C2 to sacrum) originating from piriformis pyomyositis. The multilevel cord abscess was emergently decompressed, leading to a marked restoration of neurological function.
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Affiliation(s)
- Gerald S Oh
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Gregory D Arnone
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ashley L Barks
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ziad A Hage
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sergey Neckrysh
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
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12
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Oblique corpectomy for treatment of cervical spine epidural abscesses: Report on four cases. Neurol Neurochir Pol 2016; 50:491-496. [PMID: 27576671 DOI: 10.1016/j.pjnns.2016.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/19/2016] [Accepted: 08/08/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Spinal epidural abscesses (SEAs) in cervical locations are particularly life-threatening. Currently, SEAs are widely treated with bony decompression, followed by internal stabilization in purulent osteomyelitis. However, recently, a growing number of studies have reported minimally invasive approaches without internal fixation. PURPOSE We describe four patients with cervical SEAs that were evacuated by oblique corpectomy (OC) without fusion. METHODS This study included two women and two men (aged 44-90) that received operations for removing ventral cervical SEAs. All patients presented with progressively increasing myelopathy, and 3 had severe comorbid conditions. In all cases, a multilevel OC without fusion was performed. The amount of bone resection was tailored to fit the needs of granulation removal, with an effort to retain as much of the vertebral bodies as possible. Then, pus was evacuated and debridement of granulation was performed, followed by rinsing and drainage. RESULTS The neurological status of 3 patients improved significantly after surgery. At the last follow-up examination, one showed full recovery, and in two a minor residual deficit persisted. During mean follow-up of 5.5 years, no internal stabilization was necessary. The oldest patient was tetraplegic, and had several concomitant diseases. That patient died from sudden cardiac arrest on the third postoperative day. Oblique corpectomy did not affect the anterior or posterior column. Additionally, it provided a broad view of the ventral aspect of the spinal canal. CONCLUSIONS Oblique corpectomy allows appropriate spinal cord decompression and granulation removal in the case of cervical spine epidural abscess, without sacrificing spinal stability.
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13
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Peeters I, Casselman JW, Vandecasteele SJ, Janssen A, Regaert B, Vantomme N, Vanopdenbosch LJ. Multiple nocardial abscesses of the brainstem and spinal cord diagnosed after an open biopsy through a cervical partial central corpectomy: case report. J Neurosurg Spine 2015; 23:290-3. [DOI: 10.3171/2014.12.spine14755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nocardiosis of the central nervous system is a challenging and difficult diagnosis for the clinician. The combination of infections of the brain and spinal cord is even more rare. The authors report on a patient with multiple lesions in the brainstem and cervical spinal cord. This 81-year-old immunocompetent woman presented with symptoms of progressive walking difficulty and ataxia. The results of an extensive workup with laboratory investigation, MRI, lumbar puncture, positron emission tomography (PET), and bone marrow biopsy remained inconclusive. Only after an open biopsy of a cervical lesion by an anterior approach through a partial central corpectomy of the cervical spine, was the diagnosis of nocardiosis made, allowing for specific antibiotic treatment.
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Affiliation(s)
| | | | | | | | - Bart Regaert
- 4Neurosurgery, Hospital AZ Sint-Jan, Brugge, Belgium
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14
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Abstract
Spinal epidural abscess is a rare bacterial infection located within the spinal canal. Early diagnosis and rapid treatment are important because of its potential to cause rapidly progressive spinal cord compression and irreversible paralysis. A staphylococcus bacterial infection is the cause in most cases. Treatment includes antibiotics and possible surgical drainage of the abscess. A favorable neurologic outcome correlates with the severity and duration of neurologic deficits before surgery and the timeliness of the chosen intervention. It is important for the critical care nurse to monitor the patient's neurologic status and provide appropriate interventions.
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