Primary Spinal Epidural Abscess Research Articles

Primary spinal epidural abscess: magnetic resonance imaging characteristics and diagnosis

Rationale and objectiveTo investigate the MR characteristics of phlegmonous stage and abscess stage primary spinal epidural abscess.Materials and methodsThis study retrospectively analyzed the clinical and imaging characteristics of 27 cases of pathologically confirmed primary spinal epidural abscess. Predisposing conditions of all patients were collected. All patients underwent conventional magnetic resonance imaging, while fifteen patients also underwent post-contrast magnetic resonance imaging.ResultsThe initial symptoms included back pain in 25 patients, fever in 18, motor deficit in five, and sensory changes in 13. Underlying diseases included distant site of infection in seven, injection therapy in five, neoplasm in five, chronic inflammatory disease in five, diabetes mellitus in four, alcoholism in three, metabolic disorder in three, hepatopathy in three, and obesity in two. Abscess location was ventral epidural space in 15 patients (55.6%) and dorsal epidural space in 12 (44.4%). On T1-weighted image, the abscess was hypointense to the spinal cord in 23 patients (85%) and isointense in four (15%). All abscesses were hyperintense to the spinal cord on T2-weighted image. Among the 15 patients who underwent contrast-enhanced imaging, ring enhancement was present in 13 and homogeneous enhancement in two. Adjacent vertebrae body edema was present in four patients. The abscess was purely intraspinal in 25 patients (92.6%). Paraspinal extension was present in two (7.4%).ConclusionPrimary spinal epidural abscess patients have one or more predisposing conditions. Phlegmonous stage primary spinal epidural abscess appears isointense on T1WI and hyperintense on T2WI and enhancement is homogeneous. Abscess stage primary spinal epidural abscess hyperintense on T2WI and hypointense on T1WI and ring enhancement. Presence of vertebral body edema is an important sign to help diagnose primary spinal epidural abscess.

Nontubercular Primary Spinal Epidural Abscess – A Retrospective Study of 11 Culture-Positive Cases

Abstract Background: An epidural abscess that occurs in the absence of contiguous spread from vertebral osteomyelitis or following spinal surgery, spinal anesthesia, or open spinal injuries is considered to be a primary spinal epidural abscess (SEA). The triad of back pain, fever, and progressive neurological dysfunction has long been considered to be the hallmark of primary SEA. Objective: The vast majority of epidural abscesses in our country are either tubercular or associated with pyogenic spondylitis. Primary non tubercular spinal epidural abscesses are rare and also need a different paradigm of management in terms of need for stabilization and duration of antibiotic treatment that we wish to highlight. Material and Methods: Eleven consecutive cases of nontubercular primary SEA were operated by the corresponding author between 2010 and 2019. Their clinical presentation, magnetic resonance imaging (MRI) findings, blood investigations, bacteriological profile, and outcomes were extracted from the patient files and follow-up visits to the outpatient clinic and analyzed 5 years after the last case. Results: All patients had spinal pain at presentation. Seven patients had fever and ten had neurological deficits at presentation. Diabetes and renal failure were the most common comorbidities. All patients had elevated erythrocyte sedimentation rate and C-reactive protein at presentation. The total leukocyte count was not uniformly elevated. One patient who was human immunodeficiency virus positive with a low cell count could not be operated. Diagnosis in his case was established by computed tomography-guided aspirate of the pus. Of the remainder, one patient had no recovery following surgery and two patients had residual deficits. Gram-positive coverage was started empirically in all patients who were operated and based on cultures changed and later extended orally for 4 weeks after discharge till repeat MRI and blood cultures were satisfactory. Conclusions: SEA is a surgical emergency. The majority of cases are caused by Gram-positive bacteria, and many of the patients have comorbidities that need to be addressed. Patients with better preoperative neurological status and those with lumbar location of abscess tend to have a better recovery. Antibiotic treatment must be continued till postoperative radiological and hematological parameters are satisfactory.

Peculiarities of spinal epidural abscess in COVID-19 patients: a literature review

During the SARS-CoV-2 pandemic, some authors described an increased incidence of primary Spinal Epidural Abscess (SEA) in COVID-19 patients with clinical and radiological peculiarities. Early recognition of this disease remains challenging, resulting in delayed diagnosis and significant morbidity and mortality. The authors performed a systematic review of the literature in PubMed, Cochrane, and Scopus about the traditional form of SEA comparing the main features related to COVID-19 SEA. The search was performed from 1990 to 2020. Magnetic Resonance Imaging with contrast is mandatory to recognize this kind of lesion in order to obtain a differential diagnosis. COVID-19 SEAs are generally active abscesses, with a large cystic component. Gadolinium-enhanced MR images can aid in the definition of the age and consistency of the abscess. A rim of tissue that enhances after the injection of gadolinium represents granulation tissue; liquid pus is associated with an area of low signal intensity on T1-weighted images. This new type of SEA in COVID-19 patients showed several differences also in clinical features. No evidence of an external infective source was found (spondylodiscitis, surgery, or percutaneous treatment). None of the patients was a drug abuser and MSSA was the only responsible pathogen. The cervicothoracic spine was the most involved site. Further studies are needed to confirm these preliminary findings.

Socioeconomic Disparities in Outcomes Following Conservative Treatment of Spinal Epidural Abscesses.

Primary spinal epidural abscess (SEA) is a rare but serious pathology that may result in severe neurologic injury. While certain literature has identified medical risk factors for failure of conservative therapy, no current evidence has been published regarding socioeconomic risk factors associated with failure of medical therapy. A retrospective review was conducted of patients presenting with SEA from primary spinal infections. Patients presenting with magnetic resonance imaging evidence of SEA treated conservatively in the absence of neurologic deficits were included. Baseline clinical and socioeconomic characteristics were collected. Failure of medical management was defined as requiring surgical intervention despite maximal medical therapy due to the development of neurologic deficits or clinically significant deformity. A total of 150 patients were identified as presenting with magnetic resonance imaging evidence of SEAs without evidence of neurologic deficit. Of these patients, 42 required surgical intervention compared with 108 whose infection was successfully treated with medical therapy alone. Estimated average annual income was $64,746 vs $62,615 in those who successfully cleared their infection with medical management without requiring surgery, which was not statistically significant (P = 0.5). Insured patients were 5 times more likely to be successfully treated with antibiotics alone compared with uninsured patients (OR = 5.83, P = 0.008). Payer type, employment status, and incarceration status were not associated with failure of conservative therapy. In the treatment of primary SEA, absence of medical insurance is associated with failure of medical management. Payer status, employment status, average salary, and incarceration are not significant risk factors for failure of conservative management.

Spinal epidural abscess in COVID-19 patients.

ObjectiveTo report the peculiarity of spinal epidural abscess in COVID-19 patients, as we have observed an unusually high number of these patients following the outbreak of SARS-Corona Virus-2.MethodsWe reviewed the clinical documentation of six consecutive COVID-19 patients with primary spinal epidural abscess that we surgically managed over a 2-month period. These cases were analyzed for what concerns both the viral infection and the spinal abscess.ResultsThe abscesses were primary in all cases indicating that no evident infective source was found. A primary abscess represents the rarest form of spinal epidural abscess, which is usually secondary to invasive procedures or spread from adjacent infective sites, such as spondylodiscitis, generally occurring in patients with diabetes, obesity, cancer, or other chronic diseases.In all cases, there was mild lymphopenia but the spinal abscess occurred regardless of the severity of the viral disease, immunologic state, or presence of bacteremia. Obesity was the only risk factor and was reported in two patients. All patients but one were hypertensive. The preferred localizations were cervical and thoracic, whereas classic abscess generally occur at the lumbar level. No patient had a history of pyogenic infection, even though previous asymptomatic bacterial contaminations were reported in three cases.ConclusionWe wonder about the concentration of this uncommon disease in such a short period. To our knowledge, cases of spinal epidural abscess in COVID-19 patients have not been reported to date. We hypothesize that, in our patients, the spinal infection could have depended on the coexistence of an initially asymptomatic bacterial contamination. The well-known COVID-19-related endotheliitis might have created the conditions for retrograde bacterial invasion to the correspondent spinal epidural space.Furthermore, spinal epidural abscess carries a significantly high morbidity and mortality. It is difficult to diagnose, especially in compromised COVID-19 patients but should be kept in mind as early diagnosis and treatment are crucial.

A Rare Case of Primary Spinal Epidural Abscess Caused by Streptococcus mitis in an Immunocompetent Adult With Incidentally Diagnosed Allergic Bronchopulmonary Aspergillosis

A Rare Case of Primary Spinal Epidural Abscess Caused by <i>Streptococcus mitis</i> in an Immunocompetent Adult With Incidentally Diagnosed Allergic Bronchopulmonary Aspergillosis

Incidence, Morbidity, and Surgical Outcomes of Complex Spinal Inflammatory Syndromes in Adults.

Spondylodiscitis is a rare inflammatory syndrome affecting intervertebral discs and adjacent vertebral bodies. Without appropriate therapy, serious complications, such as secondary spinal epidural abscess (SEA), may prolong recovery time. In this study, we compared the main characteristics of our cohort of patients with spondylodiscitis with those of patients reported in the international literature and analyzed the impact of complications associated with spondylodiscitis on clinical outcomes. We designed a retrospective study based on the database of the National Institute of Clinical Neurosciences, Hungary, between 2008 and 2015. We collected 78 patients suffering from primary spondylodiscitis or primary spinal epidural abscess. Based on the main clinical characteristics of our population (demographic features, initial symptoms, concurrent diseases, laboratory findings, microbiological diagnosis, therapy and clinical outcome) we constructed a database. Odds ratio (OR) counting was used to define the correlation between etiology and stage of recovery. We found a mild increase in the incidence of spondylodiscitis compared with international standards, and main demographic and clinical characteristics in concordance with international trends. Primary, noncomplicated spondylodiscitis had the best outcome results (OR,1.25), and complicated spondylodiscitis had the worst, as well as the lowest OR for total recovery (0.6). The clinical characteristics of our study cohort did not differ from the international trends. Primary, noncomplicated spondylodiscitis has the highest odds for absolute recovery. Secondary spinal epidural abscess exacerbates ongoing spondylodiscitis, and thus should be considered a poor prognostic factor for spondylodiscitis. Early diagnosis and treatment may prevent serious complications and provide better outcomes.

Primary spinal epidural abscess.

Seven cases of primary spinal epidural abscess in children under age 12 have been reported; an additional case in a 2-year-old girl is presented. These infections, usually located in the dorsal epidural space of the mid thoracic or lower lumbar regions, are the result of hematogenous dissemination of bacteria, almost always penicillin-resistant<i>Staphylococcus aureus</i>, from foci of infection in the skin, or respiratory or urinary tracts. Early signs and symptoms are nonspecific, but eventually the patient shows signs of cord compression which vary with the location of the abscess. Laboratory studies suggest infection and the organism is sometimes isolated from blood cultures. Careful lumbar puncture should be done once the diagnosis of epidural abscess is suspected, followed by laminectomy and drainage as well as systemic antibiotics. Prognosis is excellent if surgery is performed before the development of neurologic deficit.