Extensive Spinal Epidural Abscess Research Articles

Extensive spinal epidural abscess after nerve root injection in a young non-immunocompromised Patient. Case Report and Literature Review.

Epidural injections are frequent and safe procedures. Severe complications are infrequent, and they have been reported in elderly comorbid patients with predisposing factors. The objectives of this work are to present a case of an extensive epidural lumbar abscess in a young non-comorbid male patient after a therapeutic L5-S1 injection and a literature review about this subject. An otherwise healthy 24-year-old man who present a case of an extensive epidural lumbar abscess after a therapeutic nerve root block due to a disc herniation. After 7 days of fever and low back pain, he required two surgical interventions and intravenous antibiotic therapy. We reviewed 18 patients with epidural abscess consequence of spinal injections. Their mean age was 54.5 y.o, 66.5% were male, and 66.5% had at least one predisposing risk factor. Symptoms Onset occurred at 8 days on average after the procedure, but the correct diagnosis was made at the 25th-day average. Only 22% presented the classic diagnostic triad, the most frequently isolated germ was Staphylococcus Aureus (66%) and 89% were treated surgically with a 33% rate of complete recovery, 17% mortality and 28% remained with neurological sequelae. Epidural abscesses are infrequent and serious, complication after spinal diagnostic and therapeutic injections, even in young patients without comorbidities. We consider it fundamental to maintain a diagnostic suspicion, even in this subgroup of patients.

Extensive Spinal Epidural Abscess: Cord Compression with Permanent Neurological Defects

Extensive Spinal Epidural Abscess: Cord Compression with Permanent Neurological Defects

Minimally Invasive Surgical Treatment of Extensive Spinal Epidural Abscess With Unilateral Laminotomy for Bilateral Decompression Using an Ultrasonic Bone Curette: A Technique Note

An extensive spinal epidural abscess is a devasting infection of the multiple-level epidural space. Emergent surgical decompression is required to remove the abscess and decompress the affected spinal cord. This study evaluated the efficacy of unilateral laminotomy for bilateral decompression (ULBD) in the treatment of extensive spinal epidural abscesses. Three patients with extensive spinal epidural abscesses (epidural abscess involving more than 5 vertebral levels) were treated with the ULBD technique between September 2019 and August 2020. An ultrasonic curette was used for over-the-top decompression. Surgical drainage of the epidural abscess was performed concurrently with sublaminar drilling on top of the dura sac by using cold saline to automatically maintain the effluent in the ultrasonic curettage device. The 3 patients were men, with a mean age of 65.7 years. Diabetes mellitus, fever, and paraplegia were reported in all 3 patients. Escherichia coli, Staphylococcus aureus, and Streptococcus intermedius were cultured separately. The mean operative time was 163 minutes, and the mean estimated blood loss was 160 mL. All patients fully recovered from neurologic deficits and returned to preinjury levels of functioning at the final follow-up. As a minimally invasive technique, ULBD is a safe and effective treatment for extensive spinal epidural abscesses in critically ill patients. Moreover, the use of an ultrasonic bone curette not only safely accelerates over-the-top decompression but also flushes the epidural abscess with copious amount of cold saline.

“Through and Through” Fluoroscopically Guided Catheter Drainage of Extensive Spinal Epidural Abscess: A Case Report

Purpose: We aimed to present a case of spondylodiscitis with extensive spinal epidural abscess (SEA) that was successfully treated using a minimally invasive technique supplemented with fluoroscopically guided catheter drainage and systemic antibiotic therapy. Methods: A 58-year-old man presented with severe back pain and high-grade fever. He had progressive radiating pain in the lower extremities, followed by sensory deficits in both the lower limbs. Laboratory investigations revealed leukocytosis and high C-reactive protein levels. Magnetic resonance imaging of the thoracic and lumbar regions revealed an extremely large posterior SEA that extends from T6 to S1. As the patient did not respond to intravenous antibiotics alone, he underwent skipped laminectomies with fluoroscopically guided catheter drainage and irrigation. Results: Escherichia coli were detected in purulent material from the abscess. His clinical symptoms were dramatically and immediately relieved after the procedure. The patient achieved complete neurological recovery after six weeks of antibiotic therapy. Conclusions: We suggest a limited approach to the spine with the use of small radio-opaque catheters, representing an interesting option to effectively drain extensive SEAs with less morbidity than the conventional open extensive surgical drainage.

Extensive spinal epidural abscess in an immunocompetent child: a case report of minimally invasive treatment and review of literature

Patel, Pratik G. FNB, DNB (Orth), DOrth; Bhambhu, Vivek FNB, MS (Orth); Mehendiratta, Dhanish MS (Orth); Dalvie, Samir MS (Orth), DOrth, FCPS, DNBE Author Information

Successful treatment of extensive spinal epidural abscess with fluoroscopy-guided percutaneous drainage: a case report

BackgroundSurgical drainage and antimicrobial therapy are the most accepted empirical treatments for spinal epidural abscess. However, surgery may not be indicated when patient’s general health condition is poor. Percutaneous drainage has been reported as a non-surgical treatment for children or patients with no or minor neurological deficits. Here we describe the successful treatment of an extensive spinal epidural abscess with fluoroscopy-guided percutaneous drainage in an elderly man with progressive muscle weakness who could not be operated because of a poor general health condition.Case presentationAn 81-year-old man presented with fever, back pain, and progressive muscle weakness in bilateral legs. Magnetic resonance imaging (MRI) showed extensive fluid retention in the spinal epidural space (Th6 to L3). Paraplegia due to an epidural abscess was suspected. We considered an emergency operation; however, the patient’s general condition was poor. Therefore, fluoroscopy-guided percutaneous epidural drainage was performed. After drainage, his back pain and muscle weakness gradually resolved. After 3 weeks, MRI showed that the abscesses had completely disappeared.DiscussionCompared with surgical drainage, fluoroscopy-guided percutaneous epidural drainage is a less invasive treatment option for patients with a poor general condition.

Catheter-based Minimally Invasive Evacuation of Extensive Spinal Epidural Abscess: A Technical Report.

Surgical treatment of extensive spinal epidural abscess (SEA) usually involves multilevel exposure of the dural sac with subsequent risk for iatrogenic instability. A minimally invasive technique using an epidural catheter inserted through a limited approach for distant irrigation and drainage of the abscess represents an interesting alternative. Most described techniques involve blind placement of the catheters, with the potential risk of damage to the spinal cord and incomplete abscess drainage. We present and analyze a new technique used in two cases of SEA. Those were successfully treated using a minimally invasive approach supplemented with fluoroscopically-guided catheter drainage. We suggest that fluoroscopic placement of the catheter is a safe and effective method that offers a more focused and potentially safer way to proceed to this technique.

Spinal epidural abscess caused by a community acquired extended spectrum beta lactamase producing Klebsiella pneumonia.

Spinal epidural abscess (SEA) can be a medical and surgical emergency. It is encountered in patients with epidural catheter placement, paraspinal injections, diabetes mellitus, alcoholism, HIV infection, trauma, contiguous bony or soft tissue infection, intravenous drug use, hemodialysis, or overt bacteremia, but may occur spontaneously associated with a presumed silent bacteremia. We report here, a case of extensive SEA due to a community-acquired extended spectrum beta lactamase (ESBL)-producing Klebsiella pneumoniae in a diabetic patient. This case highlights the importance of stringent antimicrobial stewardship and also the need for prompt diagnostic evaluation, and early surgical decompression in order to prevent morbidity and mortality.

Abcès épidural panrachidien : à propos d’un cas et revue de la littérature

Holocord spinal epidural abscess (SEA) is a rare condition. To our knowledge, five cases of SEA have been reported so far, and no consensus has The advent of antibiotic treatment and the recognition of surgical debridement have been important in searching for alternatives to recovery, so the patient was treated surgically together with systemic antibiotics. The patient remained neurologically stable and continued to be clinically in good condition without any low back pain after 1 year. Surgical drainage, together with systemic antibiotics, is the main treatment choice for extensive SEAs. Although treatment should be considered that highlights the importance of examining the factors related to the health and condition of the patients and the anatomy and extent of the abscess, early surgical treatment associated with prolonged antibiotic treatment is necessary.

Holocord spinal epidural abscess: Case report and literature review

Holocord spinal epidural abscess (SEA) is a rare condition. To our knowledge, five cases of SEA have been reported so far, and no consensus has been made on the treatment yet. In this article, we report a case of holocord SEA and review literature to further understanding of SEA. The advent of antibiotic treatment and the recognition of surgical debridement have been important in searching for alternatives to recovery, so the patient was treated surgically together with systemic antibiotics. The patient remained neurologically stable and continued to be clinically in good condition without any low back pain after 1 year. Surgical drainage, together with systemic antibiotics, is the main treatment choice for extensive SEAs. Although treatment should be considered that highlights the importance of examining the factors related to the health and condition of the patients and the anatomy and extent of the abscess, early surgical treatment associated with prolonged antibiotic treatment is necessary.

Extensive spinal epidural abscess complicated with hydrocephalus

Abstract Spinal epidural abscess is a rare but severe infection requiring prompt recognition in order to have a favorable outcome and appropriate treatment, mainly surgical. We present one of the largest extensions of such abscess in literature, involving the whole spine. No surgical treatment was tempted due to the involvement of 19 levels but antibiotics. The evolution of the lesion was complicated with hydrocephalus, by mechanism of cervical block of CSF flow, and needed first external derivation and later ventriculo-peritoneal drainage.

Spinal Epidural Abscess and Psoas Abscess Combined with Pyogenic Spondylodiscitis Following Vertebroplasty: A Case Report

Study Design: Case report. Objective: To report a case of extensive spinal epidural abscess and bilateral psoas abscesses combined with pyogenic spondylodiscitis after a L3 vertebroplasty. Summary of Literature Review: Infection after vertebroplasty or kyphoplasty is a rare medical complication. Few reports on spinal epidural abscess and bilateral psoas abscesses, coupled with pyogenic spondylodiscitis after vertebroplasty, are available in the English medical literature. Materials and Methods: The authors performed a clinical and radiographic case review. Results: A 74-year-old woman, without any existing medical illness, presented with a history of three weeks of lower back pain, fever, and neurologic deficits of both legs after vertebroplasty performed in another hospital. Magnetic resonance imaging demonstrated an extensive spinal epidural abscess from T10 to S1 and huge bilateral psoas abscesses combined with spondylodiscitis at L3-4. Urgent limited laminectomies and abscess drainage were performed from L1 to S1. The day after the operation, ultrasound-guided percutaneous drainage was performed to manage bilateral psoas abscesses. Methicillin-resistant Staphylococcus aureus was identified by intraoperative culture. Antibiotic therapy during hospitalization was maintained for six weeks with vancomycin and rifampicin. The infection was successfully treated without any neurologic deficit and spinal deformity. Conclusions: Vertebroplasty is relative safe and simple procedure; however, the procedure also may cause severe spinal infection. Aseptic techniques under sterile environment was required during surgery. It is important that early diagnosis and prompt surgical decompression in spinal epidural abscess with neurologic deficit. Limited surgery and antibiotic therapy could be a good treatment option in spinal epidural abscess combined with pyogenic spondylodiscitis.

Successful Use of Daptomycin and Linezolid, Without Surgical Intervention, in the Treatment of Extensive Epidural Abscess and Bacteremia Due to Methicillin-Resistant Staphylococcus aureus (MRSA)

Spinal epidural abscess infections have traditionally been treated with surgical drainage followed by prolonged administration of antibiotics. We present a case of multifocal methicillin-resistant Staphylococcus aureus infection in a patient with an extensive spinal epidural abscess spanning 11 vertebral bodies, bacteremia, left lower extremity cellulitis, and pneumonia. The infection resolved with combination antimicrobial therapy with daptomycin and linezolid and without drainage of the epidural abscess.

Extensive Spinal Epidural Abscess: The Usefulness of Minimal Invasive Surgical Technique using Epidural Irrigation Catheter

Spinal epidural abscess (SEA) is a rare infection but may be devastating and fatal. We describe a case of a42-year-old male who presented with a posteriorly located SEA extending from C2 to the sacrum with severe neurologic deficits. We had the emergency surgery with the minimal invasive technique using epidural irrigation catheter, and then obtained an excellent recovery. The purpose of this report introduces the usefulness of minimal invasive surgical technique for extensive SEA.

Management of an extensive spinal epidural abscess from C-1 to the sacrum

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.

A Rare Case of Extensive Spinal Epidural Abscess in a Diabetic Patient

Case report. We report a rare case of extensive spinal epidural abscess in a patient with diabetes. Spinal epidural abscess is a very uncommon infection that requires prompt recognition and proper management to avoid potentially disastrous complications. This lesion can expand to compress the spinal cord causing severe symptoms and complications. Combination of the patient clinical history, physical examination, laboratory results, radiologic and intraoperative findings along with brief related literature review. We present a rare case of spinal epidural abscess extending to the entire length of the spinal cord in a previously undiagnosed patient with diabetes. Diabetes is an important condition that can predispose an individual to the development of localized or extensive spinal epidural abscess.

Extensive spinal epidural abscess as a complication of Crohn’s disease

A spinal epidural abscess is a neurosurgical emergency. Successful treatment frequently requires decompression of the spinal canal in combination with intravenous antibiotics. We report a patient with Crohn’s disease who developed an extensive spinal epidural abscess communicating with an intra-abdominal collection.

An extensive spinal epidural abscess successfully treated conservatively

A spinal epidural abscess (SEA) is an uncommon condition, appearing in 0.2–2 cases per 10 000 hospital admissions. Urgent surgical decompression in combination with long term antibiotics is the common...

Evacuation of a 14-vertebral-level cervico-thoracic epidural abscess and review of surgical options for extensive spinal epidural abscesses

Spinal epidural abscess (SEA) is a rare infection of the spinal peridural space, usually from haematogenous spread of bacteria from a distant source of infection or from direct extension of an osteomyelitis or paravertebral abscess into the spinal canal. An extensive SEA with involvement of five or more levels is even more exceptional and is a very threatening condition. Different surgical strategies have been used in the typically posteriorly located extensive SEA: multi-level laminectomies at all involved levels; catheter procedures, in which suction (irrigation) catheters are pushed cranially and caudally through selected end-level and intermediate-level fenestrations or laminectomies; or multi-level interlaminar fenestrations at the involved levels. We report the evacuation of a 14-vertebral-level cervico-thoracic SEA by multi-level unilateral fenestrations with ‘over-the-top’ removal of contralateral abscess formations at all involved levels. We also discuss the surgical strategies for extensive SEA.

Spinaler Epiduralabszess nach rückenmarknaher Langzeitanalgesie

This case report describes a 63-year-old male patient with considerably impaired postoperative wound healing in the region of the lower extremities. After initial drug therapy for the pain was ineffectual, the patient was treated repeatedly through an epidural catheter. In the further course, an extensive spinal epidural abscess was diagnosed as an incidental finding without neurological symptoms. After taking into consideration the patient's age and the risk factors present as well as inclusion of the subspecialties involved for an interdisciplinary assessment, the patient was successfully treated with a conservative approach. Our contribution concludes with a detailed discussion and comparison of the literature.