Cervical Spinal Epidural Abscess Research Articles

Incidental findings and safety events from magnetic resonance imaging simulation for head and neck radiation treatment planning: A single institution experience

PurposeHaving dedicated MRI scanners within radiation oncology departments may present unexpected challenges since radiation oncologists and radiation therapists are generally not trained in this modality and there are potential patient safety concerns. This study retrospectively reviews the incidental findings and safety events that were observed at a single institution during introduction of MRI sim for head and neck radiotherapy planning. MethodsConsecutive patients from March 1, 2020, to May 31, 2022, who were scheduled for MRI sim after having completed CT simulation for head and neck radiotherapy were included for analysis. Patients first underwent a CT simulation with a thermoplastic mask and in most cases with an intraoral stent. The same setup was then reproduced in the MRI simulator. Safety events were instances where scheduled MRI sims were not completed due to the MRI technologist identifying MRI-incompatible devices or objects at the time of sim. Incidental findings were identified during weekly quality assurance rounds as a joint enterprise of head and neck radiation oncology and neuroradiology. Categorical variables between completed and not completed MRI sims were compared using the Chi-Square test and continuous variables were compared using the Mann-Whitney U test with a p-value of < 0.05 considered to be statistically significant. Results148 of 169 MRI sims (88 %) were completed as scheduled and 21 (12 %) were not completed (Table 1). Among the 21 aborted MRI sims, the most common reason was due to safety events flagged by the MRI technologist (n = 8, 38 %) because of the presence of metal or a medical device that was not noted at the time of initial screening by the administrative coordinator. Patients who did not complete MRI sim were more likely to be treated for non-squamous head and neck primary tumor (p = 0.016) and were being treated post-operatively (p < 0.001). CT and MRI sim scans each had 17 incidental findings. CT simulation detected 3 cases of new metastases in lungs, which were outside the scan parameters of MRI sim. MRI sim detected one case of dural venous thrombosis and one case of cervical spine epidural abscess, which were not detected by CT simulation. ConclusionsRadiation oncology departments with dedicated MRI simulation scanners would benefit from diagnostic radiology review for incidental findings and having therapists with MRI safety credentialing to catch near-miss events.

A rare case\xa0as different cause of retropharyngeal and spinal epidural abscess: spondylodiscitis

BackgroundRetropharyngeal abscess (RPA) is a life-threatening, dangerous condition and uncommon in adults. The coexistence of RPA, cervical spinal epidural abscess (CSEA), and spondylodiscitis is extremely rare.Case presentationWe present a case with a retropharyngeal and epidural abscess caused by spondylodiscitis. A 61-year-old man was referred to our clinic with the complaints of sore throat, limitation in neck range of motion, numbness, and weakness in the left arm and the left ear for one month. The airway was not obstructed. Neurological deficits were detected in his left arm. Cervical computed tomography revealed a 50 × 30 × 15 mm retropharyngeal abscess. Cervical magnetic resonance imaging showed abscess, C5–6 spondylodiscitis and epidural abscess, and myelopathic signal changes in the C3–7 spinal cord. The abscess was drained, and C5–6 discectomy was performed. The patient was discharged with cervical collar and antibiotics.ConclusionsMultidisciplinary approach that consists of otolaryngologist, neurosurgeon, and infectious disease specialist is needed to avoid complications and any delay.

Full Endoscopic Removal of Cervical Spinal Epidural Abscess: Case Report and Technical Note.

Spinal epidural abscess is a rare disease that is less likely to occur in the cervical region. When it occurs here, cervical spondylodiscitis can develop. Surgical treatment is recommended because of possible life-threatening septic and neurological complications. We present a case of an 81-year-old man who suffered from right side paralysis and was subsequently diagnosed with a C4 to C7 epidural abscess. We utilized full endoscopic surgery for patient management. The traditional surgical methods for treating cervical epidural abscesses may cause spinal instability. There has only been one previous case report on the endoscopic-assisted method. Minimal invasive surgery by a full endoscopic method can be done with a small incision and is associated with minimal blood loss and muscle damage. This is the first report on cervical epidural abscess drainage utilization a full endoscopic method. We recommend this alternative minimally invasive method to manage cervical epidural abscess.

Diagnosis, and Treatment of Cervical Epidural Abscess and/or Cervical Vertebral Osteomyelitis with or without Retropharyngeal Abscess; A Review.

Background: Every year approximately 19.6 patients/100,000 per year are admitted to hospitals with spinal epidural abscesses (CSEA), 7.4/100,000 have vertebral osteomyelitis (VO)/100,000/year, while 4.1/100.000 children/year have cervical retropharyngeal abscesses (RPA) (i.e., data insufficient for adults).Methods: Here we evaluated 11 individual case studies, 6 multiple patient series, and looked at 9 general review articles focusing on CSEA, and/or VO, with/without RPA.Results: Of the 11 case studies involving 15 patients, 14 had cervical spinal epidural abscesses (CSEA: 10 CSEA/ VO/RPA, 2 CSEA/VO, 1 CSEA/TSEA, 1 CSEA/ TSEA/LSEA), 13 had cervical osteomyelitis (VO: 11 VO/CSEA, 2 VO/RPA), and 12 had cervical retropharyngeal abscesses (RPA: 10 RPA/CSEA/VO, 2 RPA/VO alone). When patients were treated surgically, they required 12 anterior, and 2 posterior approaches; 1 patient required no surgery. In the 6 larger cervical series involving 355 patients, 4 series involved CSEA (3 CSEA, 1 CSEA/VO), and 2 seires had cervical VO. Primary surgery was performed in 298 patients, while 57 were initially managed medically; 24 of these latter patients failed non-surgical therapy, and required delayed cervical surgery. Notably, all 17 clinical studies advocated early surgery where clinically appropriate for varying combinations of CSEA and/or VO with or without RPA. The 8 final articles reviewed all-levels of SEA and or VO, while also providing additional unique information regarding RPA.Conclusion: We analyzed 11 case studies and 6 multiple case series regarding the diagnosis and treatment of combinations of cervical CSEA, and/or VO with or without RPA. We also reviewed 8 articles on the evaluation/ management of all-level SEAs and/or VOs, along with the unique features of RPAs.

Management of cervical spine epidural abscess: a systematic review.

Background:Cervical spinal epidural abscess (CSEA) is a localized infection between the thecal sac and cervical spinal column which may result in neurological deficit and death if inadequately treated. Two treatment options exist: medical management and surgical intervention. Our objective was to analyze CSEA patient outcomes in order to determine the optimal method of treatment.Methods:An electronic literature search for relevant case series and retrospective reviews was conducted through June 2016. Data abstraction and study quality assessment were performed by two independent reviewers. A lack of available data led to a post hoc decision not to perform meta-analysis of the results; study findings were synthesized qualitatively.Results:927 studies were identified, of which 11 were included. Four studies were ranked as good quality, and seven ranked as fair quality. In total, data from 173 patients were included. Mean age was 55 years; 61.3% were male. Intravenous drug use was the most common risk factor for CSEA development. Staphylococcus aureus was the most commonly cultured pathogen. 140 patients underwent initial surgery, an additional 18 patients were surgically treated upon failure of medical management, and 15 patients were treated with antibiotics alone.Conclusion:The rates of medical management failure described in our review were much higher than those reported in the literature for thoracolumbar spinal epidural abscess patients, suggesting that CSEA patients may be at a greater risk for poor outcomes following nonoperative treatment. Thus, early surgery appears most viable for optimizing CSEA patient outcomes. Further research is needed in order to corroborate these recommendations.

Etiology and Surgical Management of Cervical Spinal Epidural Abscess (SEA):: A Systematic Review.

Study Design:Systematic analysis and review.Objective:Evaluation of the presentation, etiology, management strategies (including both surgical and nonsurgical options), and neurological functional outcomes in patients with cervical spinal epidural abscess (SEA).Methods:The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria were used to create a framework based on which articles pertaining to cervical SEA were chosen for review following a search of the Ovid and PubMed databases using the search terms “epidural abscess” and “cervical.” Included studies needed to have at least 4 patients aged 18 years or older, and to have been published within the past 20 years.Results:Database searches yielded 521 potential articles in PubMed and 974 potential articles in Ovid. After review, 11 studies were ultimately identified for inclusion in this systematic review. Surgery appears to be a well-tolerated management strategy with limited complications for patients with cervical SEA. However, the quantity of data comparing medical and surgical treatment of cervical SEA is limited and the bulk of the data is derived from low quality studies.Conclusion:Data reporting was heterogeneous among studies making it difficult to draw discrete conclusions. Early surgical intervention may be appropriate in selected patients with cervical epidural abscess, but it is not clear what distinguishes these patients from those who are successfully managed nonoperatively.

Cervical spinal epidural abscess following needle-knife acupotomy, with an initial presentation that mimicked an acute stroke: A case report

Introduction: A spinal epidural abscess is difficult to diagnose and it can sometimes mimic an acute ischemic stroke.Case presentation: We report a 69-year-old woman attended our emergency department because of gross hematuria for 1 week, with fever and bilateral flank pain. Two weeks earlier, she had received needle-knife acupotomy (a more invasive procedure than the traditional acupuncture) for chronic neck pain. Acute pyelonephritis was diagnosed; however, 4 h later, she developed weakness of both right limbs. Acute lacunar infarction was tentatively diagnosed. After admission, weakness of the left limbs developed, with a feeling of fullness and discomfort around the entire T6 dermatome with urinary retention. Neck magnetic resonance imaging showed extensive cervical epidural abscesses from C3 to T1. After an operation, her neck pain and the weakness of the four limbs gradually improved.Discussion: Spinal epidural abscess is a rare complication, and which should be considered for patients who have undergone invasive cervical procedures. Needle-knife acupotomy is a more invasive procedure than the traditional acupuncture. Conclusion: Although it is considered safe and effective for cervical spondylosis, it can be complicated by spinal infection. Careful disinfection should therefore be performed, and disposable needleknives should be used.

Gas-containing Cervical and Thoracic Spinal Epidural abscess secondary to Klebsiella Pneumonia infection (P5.090)

Gas-containing Cervical and Thoracic Spinal Epidural abscess secondary to Klebsiella Pneumonia infection (P5.090)

Erratum: Cervical spine epidural abscess: a single center analytical comparison to the literature.

[This corrects the article DOI: 10.1038/scsandc.2017.36.].

Cervical spine epidural abscess: a single center analytical comparison to the literature.

Retrospective review of patient charts. Cervical spine epidural abscess (CSEA) is uncommon. In this study, characteristics of CSEA patients are described through an institutional analysis and literature review. University-affiliated city hospital. The electronic medical record was searched from 01/2001 to 01/2012. Data on presentation, comorbidities, diagnostic modalities, pathogens, treatments, and neurological recovery were collected. Sixteen patients were identified with a mean age of 57.9 years (33-83). Nine were females. Common symptoms were neck/back pain (62.5%), neurological deficits (62.5%), and fever (31.3%). Comorbidities included cardiovascular disease (56.3%), renal disease (37.5%), and diabetes mellitus (37.5%). Lower levels were more likely afflicted (C5-C7). Microorganisms were commonly Staphylococcus and Streptococcus (68.8%). Eight (50.0%) received surgery (anterior [87.5%] and posterior [12.5%] cervical fusion and corpectomy [37.5%]) plus antibiotics and 8 (50.0%) were treated with antibiotics only. Patients with less comorbidities were more likely to receive surgery; more comorbidities were was associated with a poor prognosis. Eight patients (50%) made had full neurological recovery, 2 (12.5%) with had minimal recovery, 2 deaths died, and the remaining (25%) 1 was were sent to a skilled facility and 1or lost to follow-up. Cervical SEA can be problematic. The vast majority do not present classically and treatment does vary. It occurs more frequently in the lower cervical levels. Though antibiotics alone may suffice, surgery is frequently employed and a multitude of techniques are at the utility of the spine surgeon. Cardiovascular comorbidities are associated with a poorer outcome. In order to improve prognosis, management considerations should include both patient factors and multidisciplinary efforts.

A case of progressive tetraparesis due to cervical epidural abscess

Introduction: cervical epidural abscess (cEA) is a rare entity with varied clinical presentations. this can lead to significant delay in the timely diagnosis. case report: We report a rare case of sudden onset progressive tetra paresis in a 54-year-old male. Magnetic resonance imaging of cervical spine was suggestive of acute cervical spinal epidural abscess. Emergent surgical evacuation of the abscess resulted in gradual improvement of the neurological status in the patient. conclusion: spinal epidural abscess may present with constellation of signs and symptoms. timely diagnosis and intervention may prevent permanent deficits to the patients.

Surgical management in 40 consecutive patients with cervical spinal epidural abscesses: shifting toward circumferential treatment.

Retrospective database review of a prospectively maintained neurosurgical database. The surgical management of cervical spinal epidural abscesses (CSEA) is reviewed examining the shift from single to staged anteroposterior decompression and stabilization. CSEA management is guided by small case series. A retrospective review from 1997 to 2011 was conducted for patients with the diagnostic headings: cervical epidural abscess, infection, osteomyelitis, osteodiscitis, spondylodiscitis, and abscess. Comorbidities, risk factors, surgical approach, neurologic grade, and outcomes were recorded. Forty consecutive patients (mean age 53 years, age range 23-74, SD ±14, 10 female) were identified with CSEA in the operative database from 1997 to 2010. Twenty one patients had a body mass index more than 25 (53%), 6 (15%) had diabetes mellitus, 6 (15%) had a prior malignancy with 2 having prior neck irradiation, and 9 (23%) used tobacco products. The most common risk factor associated with CSEA was intravenous drug abuse, found in 10 patients (25%). The most common level of discitis involvement was C6-C7 in 12 (30%) followed by C5-C6 disc in 11 (28%) and least often at C1-C2 level in 2(5%) and C7-T1 in 2(5%). The most common neurologic grades at presentation were AIS D in 20 (50%) followed by AIS E in 9 (28%). All patients received magnetic resonance imaging identifying 17 (43%) with dorsal, 12 ventral (30%), and 11 circumferential epidural abscesses (28%). The majority of patients underwent anterior followed by posterior decompression and stabilization (n = 26, 65%); 8 (20%) underwent a ventral approach and six underwent a dorsal approach (15%). Fusion was achieved in 39 of 40 (97.5%) and not significantly influenced halo use in 10 patients. In this series, patients underwent acute evacuation and spinal cord decompression, and the shift toward staged treatment did not lead to an increased periprocedural complication rate. 3.

A rare complication of cervical spinal epidural abscess while receiving conservative treatment

Abstract Cervical spinal epidural abscess (CSEA) is a rare disease that requires prompt diagnosis and early surgical intervention with appropriate antibiotic therapy to ensure better neurologic outcome. However, some patients may forego surgery in some scenarios if they have prolonged neurologic deficits that are unlikely to improve with surgery. We present the first case of CSEA in which hydrocephalus developed while the patient was receiving medical treatment. A 55-year-old female with diabetes mellitus presented to our emergency department with progressive weakness and eventual paralysis. Spinal magnetic resonance imaging revealed CSEA with spinal cord compression. After 1 week of antibiotic treatment, hydrocephalus developed. The patient regained consciousness after emergent external ventricular drain. For sepsis source control, she received corpectomy with abscess drainage; however, there was no obvious neurological improvement. Emergency department crowding has become a widespread problem. Due to prolonged emergency department stay of patients, emergency physicians tend to face late response or complication of treatments, and witness the progression of diseases. This case demonstrates that hydrocephalus may occur in patients with CSEA receiving nonoperative treatment, and caregivers must be alert for any change in patient's consciousness.

Is there a difference in neurologic outcome in medical versus early operative management of cervical epidural abscesses?

Background contextThe ideal management of cervical spine epidural abscess (CSEA), medical versus surgical, is controversial. The medical failure rate and neurologic consequences of delayed surgery are not known. PurposeThe purpose of this study is to assess the neurologic outcome of patients with CSEA managed medically or with early surgical intervention and to identify the risk factors for medical failure and the consequences of delayed surgery. Study design/settingRetrospective electronic medical record (EMR) review. Patient sampleSixty-two patients with spontaneous CSEA, confirmed with advanced imaging, from a single tertiary medical center from January 5 to September 11. Outcome measuresPatient data were collected from the EMR with motor scores (MS) (American Spinal Injury Association 0–100) recorded pre/posttreatment. Three treatment groups emerged: medical without surgery, early surgery, and those initially managed medically but failed requiring delayed surgery. MethodsInclusion criteria: spontaneous CSEA based on imaging and intraoperative findings when available, age >18 years, and adequate EMR documentation of the medical decision-making process. Exclusion criteria: postoperative infections, Pott disease, isolated discitis/osteomyelitis, and patients with imaging findings suggestive of CSEA but negative intraoperative findings and cultures. ResultsOf the 62 patients included, 6 were successfully managed medically (Group 1) with MS increase of 2.3 points (standard deviation [SD] 4.4). Thirty-eight patients were treated with early surgery (Group 2) (average time to operating room 24.4 hours [SD 19.2] with average MS increase 11.89 points [SD 19.5]). Eighteen failed medical management (Group 3) requiring delayed surgery (time to OR 7.02 days [SD 5.33]) with a net MS drop of 15.89 (SD 24.9). The medical failure rate was 75%. MS change between early and delayed surgery was significant (p<.001) favoring early surgery. Risk factors and laboratory data did not predict medical failure or posttreatment MS because of the high number of medical failures when abscess involves the cervical epidural space. ConclusionsEarly surgery results in improved posttreatment MS compared with medical failure and delayed surgery. In our patients, the failure rate of medical management was high, 75%. Based on our results, we recommend early surgical decompression for all CSEA.

咽後膿瘍との鑑別を要した頸椎硬膜外膿瘍の2例

頸椎硬膜外膿瘍は脊椎管内硬膜外に膿瘍を形成し脊髄および脊髄根障害を引き起こす疾患である。咽後膿瘍との鑑別を要する2例を経験したので報告する。症例1は蝶形骨洞炎に対して抗生剤治療中に血行性感染を生じ，急速に進行する四肢麻痺が出現した症例，症例2は椎間板炎から椎前間隙に膿瘍を来した症例であった。2例ともMRIのT2強調画像で咽頭後壁に高信号を示す病変を認め，咽後膿瘍が疑われた。咽頭所見と合致せず造影CTを撮影することで鑑別が可能であった。頸椎硬膜外膿瘍は診断が遅れると予後不良な疾患であり，咽後膿瘍との鑑別疾患として重要であると考えられた。

Cervical spinal epidural abscess after oesophagoscopy

Spinal epidural abscess is an uncommon entity, especially in the cervical region. We report a patient with epidural abscess, vertebral osteomyelitis and discitis in the cervical spine that was caused by iatrogenic perforation of the pharynx during diagnostic oesophagoscopy, which has not been recorded previously in the literature. Cervical spinal epidural abscess may be caused by iatrogenic perforation of pharyngeal wall during diagnostic oesophagoscopy. Early diagnosis with an MRI and surgical treatment with antimicrobial chemotherapy are keys to successful management of this rare and life-threatening complication.

Surgical Management of Cervical Spinal Epidural Abscess Caused byBrucella Melitensis: Report of Two Cases and Review of the Literature

Spinal epidural abscess, if especially caused by Brucellosis is a very rare disease which is usually a consequence of spondylodiscitis. The spinal column can be affected at any joint; however, the lumbar spine is the most common region, especially at the level of the L4-5 and L5-S1. The frequency of spinal involvement usually seen at the lumbar, thoracic and cervical spine respectively. As an occupational disease in farmers, veterinaries, butchers, laboratory staff and shepherds, brucellosis can also occur by direct contact to animals and infected materials or ingestion of raw cheese, milk or unpasteurized milk products. In this study, we presented two cases with cervical spinal epidural abscess caused by brucella melitensis, which was successfully treated by surgical approach. Initial treatment was combined with antibiotic therapy after the surgery for 3 months.

Unusual fatal infections after anterior cervical spine surgeries.

We report two cases of cervical spinal epidural abscess (SEA), which are related to anterior cervical surgeries. The first case reveals a late postoperative infection without any predisposing factor. The second case reveals combined complication of infection and instrument failure (artificial disc). Both two cases manifested ascending infections that are unusual courses of anterior cervical infections. The abscess extended upwards and, finally, caused life threatening bacterial meningitis. We suggest aggressive surgical interventions with anti-bacterial therapies in such cases.

Anterior Cervical Discectomy, Drainage and Non-instrumented Cortico-Cancellous Allograft Fusion: A Treatment Option for Ventral Cervical Spinal Epidural Abscess

Ventral cervical spinal epidural abscess is a very rare clinical condition with a relatively high morbidity and mortality. Due to the paucity of reported cases there is heterogeneity and no clear "gold standard" in the treatment of these patients. The authors report four consecutive patients with ventral cervical spinal epidural abscess treated with anterior cervical discectomy, abscess drainage and original non-instrumented cortico-cancellous allograft spinal fusion. The authors retrospectively reviewed a series of four patients treated for ventral cervical epidural spinal abscess. All patients were treated with an urgent operation. Anterior cervical discectomy, abscess drainage, and non-instrumented cortico-cancellous allograft spinal fusion followed by cervical immobilization and systemic antibiotic treatment were utilized. The bone fusion occurred within a mean of 3.5 months of follow-up. No significant radiologic or clinical evidence of graft subsidence was noted after a minimum of 2.5 years follow-up. All patients resolved infection and were neurologically intact. No complications of treatment were noted. Urgent operative treatment with anterior cervical discectomy, abscess drainage and non-instrumented cortico-cancellous allograft spinal fusion, followed by immobilization and the appropriate systemic antibiotic treatment is an effective original modification for the treatment and resolution of ventral cervical epidural spinal abscess.

Midline trough corpectomies for the evacuation of an extensive ventral cervical and upper thoracic spinal epidural abscess

The author reports on a 59-year-old woman with a history of a chronic, nonhealing skin ulcer who presented with sepsis, neck pain, and rapidly progressive quadriparesis. Precontrast and postcontrast MR imaging studies revealed a multifocal ventral cervical and upper thoracic spinal epidural abscess. Compression of the spinal cord from the abscess was greatest behind the disc space of C2-3 and C7-T1. Because of the patient's tenuous medical status, the author elected to apply a technique that would allow expeditious decompression without necessitating concomitant fusion and instrumentation. Multilevel, contiguous trough corpectomies were performed for evacuation of the compressive lesions. A high-speed matchstick bur was used to create a 5- to 7-mm midline trough in the vertebrae and intervening disc spaces from C-2 to T-3. Rapid and successful decompression of the entire ventral cervical and upper thoracic epidural space was achieved using this technique. Understanding that the surgical treatment of discitis or osteomyelitis can often result in a kyphotic deformity or frank instability, the patient was immobilized in a cervical collar following surgery and underwent vigilant monitoring with serial plain radiographs, CT scans, and MR images. These neuroimaging studies confirmed complete resolution of the abscess and the slow development of a mild, stable kyphotic deformity. At the 1-year follow-up, the patient was ambulating and had returned to work. A trough corpectomy is a viable surgical approach that allows for rapid decompression of ventral cervical and upper thoracic epidural abscesses while obviating the need for same-setting fusion and fixation.