Spinal Subdural Abscess Research Articles

Case of successful treatment of spinal infection in a patient with high comorbidity and septic manifestations

The study presents a clinical case of complex treatment of a patient with high comorbidity (Charlson comorbidity index = 6 points) who had severe sepsis (SOFA score = 8 points) with multiple foci of pyogenic infection (spinal epiduritis, paravertebral and subdural abscesses, purulent meningitis, bilateral lower lobe pneumonia). The syndrome-based approach with the use of minimally invasive approaches in the early stages (no later than 12 hours from the onset of clinical manifestations of the disease) ensured a favorable outcome. Based on the results of surgical treatment, a conclusion was made about the tactics of surgical treatment in patients with spinal infection against the background of sepsis.

A case of successful treatment of a multimorphic form of nonspecific purulent-inflammator y disease of the spine

The article presents a clinical case of surgical treatment of a patient with a multimorphic form of nonspecific purulent-inflammatory lesions of the spine. This patient had spinal epiduritis, paraspinal and subdural abscesses, and purulent meningitis; the course was complicated by bilateral lower lobe pneumonia, systemic inflammatory response syndrome, and sepsis. The main stages of surgical correction were laminectomy, sanitation, and drainage of paraspinal, epidural and subdural abscesses, tracheostomy, puncture and drainage of the psoas abscess on the left side under ultrasound navigation. In addition, the patient received targeted antibiotic therapy. After treatment in the neurosurgical department, the patient was transferred to rehabilitation treatment. Based on the results of surgical treatment, a conclusion was made about the clinical validity of using a combination of methods for the treatment of patients with a multimorphic form of nonspecific purulent-inflammatory lesions of the spine.

Intramedullary Lesion- Aspetic subdural pyogenic abscess in dorsolumbar spinal cord with conus medularis cystic lesion with syringomelitis: A Case Report

Spinal subdural abscess/empyema is uncommon but serious condition with significant morbidity and mortality. Till date very few cases of spinal subdural abscess has been reported. Prognosis of Spinal Subdural Abscess is highly dependent on the timeliness of its diagnosis before neurological deficits develop. Risk factors, presenting symptoms, and characteristic findings on magnetic resonance imaging (MRI) findings should be properly considered and thoroughly evaluated. Symptoms include fever, back pain, and neurological symptoms, but this collection of symptoms is seen in only about 10% of cases. However, most patients complain of severe localized lower back pain. Gadolinium-enhanced MRI is the most sensitive, specific, and beneficial imaging modality for establishing a diagnosis While hematogenous spread of an extra-spinal infection is the most common cause of this condition, a significant number of cases result from iatrogenic mechanisms, including lumbar punctures, epidural injections, and surgery. In few cases there may be no organism isolated as in our case, possible reason being prior usage of antibiotics before surgery. Treatment should include prompt surgical exploration and decompression combined with appropriate prolonged antibiotic treatment with regular follow up and physiotherapy.

Pediatric Spinal Subdural Abscesses: A Report of Three Consecutive Patients

Background: Despite technological advances in medical treatment, the prognosis of the rarely reported spinal subdural abscesses (SSAs) has remained a serious entity largely unaffected, especially when they are diagnosed late. In this study, the authors aimed to present the surgical outcomes of 3 consecutive pediatric patients with SSA. Materials and Methods: We retrospectively reviewed the medical records of pediatric patients with spinal lesions who underwent surgery at 2 neurosurgical centers spanning 7 years, from 2012 to 2019. All pediatric patients who were diagnosed with SSA (n = 3) were selected as the core sample for this study. Results: Three pediatric patients (2 females and 1 male) with SSA were surgically treated. Holocord SSA was observed in 1 patient. The mean age was 7.1 ± 7.7 years. The most common presenting symptoms were gait disturbance and weakness of lower extremities (100%). The mean preoperative course was 5.7 ± 4.0 weeks. The causative pathogens were Escherichia coli (E. coli) and M. tuberculosis. In the 2nd case, the pathogen was non-tuberculosis mycobacterium in the extramedullary abscess. In the 44th postoperative month, she underwent surgery for intramedullary abscess. The causative pathogen was E. coli. Except for 1 male adolescent who presented with severe clinical status (paraplegic), the improvement was observed in all patients at their last follow-up after 50.3 ± 43.5 months of average. Conclusions: Drainage followed by appropriate antibiotics is the optimal treatment for SSAs. Early diagnosis and urgent surgical treatment are essential for a good prognosis. All surgically treated SSA patients with neurological deficits were rehabilitated with physical therapy postoperatively.

Spinal Subdural Abscess Mimicking An Intradural-Extramedullary Tumor- A Rare Case Scenario

Spinal subdural abscesses (SSA) are very rare disease. The etiologies of SSA are hematogenous spread, iatrogenic contamination, and local extension. Elevated WBC counts, ESR, and C-reactive protein are usually found in laboratory tests. But they are not sensitive indicators of SSA, especially chronic abscesses patient tend to have a less specific characteristic. We report the case of a healthy child with subdural abscess referred to our hospital as an intradural– extramedullary (IDEM) tumor

Infections of the Spine and Spinal Cord in Children

AbstractInfection of the spine and spinal cord are uncommon in children which if not diagnosed and treated early in the course of disease can lead to spinal instability and devastating neurological outcome. The spectrum of spinal infection ranges from discitis/osteomyelitis, spinal epidural abscess, subdural abscess, spinal meningitis, arachnoiditis, neuritis, myelitis, and intramedullary abscess. Inability of the children to express themselves and nonspecific clinical features like abdominal pain, walking/crawling difficulty, and fever can result in difficult and delayed diagnosis. Imaging plays a critical role in diagnosis of spinal infection; its complication and treatment follow-up. Magnetic resonance imaging with gadolinium contrast is considered as the imaging modality of choice for evaluation of spinal and cord infections. Infectious mimics like chronic recurrent multifocal osteomyelitis, pars articular defect with active inflammatory changes, spondyloarthritis, Guillain-Barre syndrome, transverse myelitis, acute disseminated encephalomyelitis, and multiple sclerosis can pose diagnostic challenge on imaging. The aim of this article is to briefly review the imaging appearances of infection involving various spinal compartments, pattern of infection spread, its complications and various mimics.

Isolated Spinal Subdural Empyema: A Case Report & Review of the Literature

Background: Spinal subdural empyema (SSE) is rare, with less than 70 case reports in adults. The pathomechanism of infection and vulnerable patient populations have yet to be delineated. Reported outcomes are varied. Case Description: Case report of an isolated spinal subdural empyema with no obvious source in a 65-year-old female presenting with an acute neurologic deficit requiring emergent surgical intervention. A Pub Med search of keywords “Spinal Subdural Empyema” and/or “Spinal Subdural Abscess” with review of all associated English language literature was conducted. Pertinent data were compiled, analyzed, and placed into chart and graph format. Conclusions: SSE is rare and often progresses in 3 separate chronologic stages; pain/fever, neurologic deficit, and paralysis. Tenderness to palpation is often absent. 3 methods of spread have been postulated: hematogenous, contiguous, and iatrogenic. Staphylococcus aureus is the most common infecting organism. The lumbar spine, followed closely by the thoracic spine, is most commonly affected. Contrasted MRI is the preferred diagnostic modality. Emergent surgical SSE evacuation followed by parenteral antibiotics is recommended, as surgical outcomes are far superior to non-surgical management. The patient featured in this case made a full neurologic recovery by 6-month follow-up.

Spinal subdural abscess following epidural steroid injection

The authors report the case of a 58-year-old man who presented with a cervicothoracolumbosacral spinal subdural abscess about a month after receiving an epidural steroid injection for management of low-back pain due to L5-S1 disc herniation. Although he presented with symptoms concerning for a spinal etiology, the subdural empyema was not evident on the initial MRI study and was observed on imaging 5 days later. This patient was successfully managed with surgical intervention and antibiotic treatment, and he is doing well more than 21 months after the operation. It is possible that a prior history of disc herniation or other spinal abnormality may increase a patient's risk of developing spinal subdural empyema. This case illustrates the risk of infection following spinal epidural steroid injections and the importance of early recognition and intervention to successfully treat an extensive subdural abscess.

Surgical treatment for thoracosacral concomitant spinal epidural and subdural abscess: a case report

The incidence of spinal infection seems to be on the rise owing to increases in the aging population, diabetes mellitus, intravenous drug abuse, epidural catheter use, and systemic immunodeficiency [1, 2]. Spinal epidural abscess (SEA) is an uncommon disease that was first described in 1761 [3]. The incidence was reported to be as high as 12.5 cases per 10,000 hospital admissions [4]. The most common source of infection is hematogenous spread. Spinal subdural abscess (SSA) is a rarer disease and was first described in 1927 [5]. The exact incidence is unknown [6, 7]. Almost 60 cases have been reported to date in PubMed. The route of spread is also usually hematogenous, and the most common source is the skin [6]. Either condition requires the administration of antibiotics, with additional surgical intervention in severe cases. The concomitant condition is very rare, and to our knowledge, this is the first report in English of thoracosacral concomitant spinal epidural and subdural abscess associated with arachnoiditis that was successfully treated by open decompression.

Spinal Subdural Abscess: A Rare Complication of Decubitus Ulcer

Spinal subdural abscess (SSA) is an uncommon entity. The exact incidence is unknown, with very few cases reported in the literature. This condition may result in spinal cord compression, thus constituting a medical and neurosurgical emergency. The pathogenesis of SSA is not well-described, and the available knowledge is based on case observations only. There is only one case report that describes direct seeding from decubitus ulcers as a possible mechanism for development of SSA. We report a case of subacute onset of quadriplegia in a male patient, age 55 years, due to spinal cord compression from SSA and superimposed spinal subdural hematoma. The direct seeding from decubitus ulcers is thought to be the cause of infection in our patient. We present this case of SSA to elucidate and review the predisposing factors, pathogenesis, clinical presentation, diagnostic modalities, and treatment regarding management of this rare disorder.

Thoracolumbosacral Spinal Subdural Abscess

Case report and review of relevant literature. To report a rare case of a thoracolumbosacral spinal subdural abscess (SSA) and highlight the magnetic resonance imaging (MRI) appearance and surgical management. SSA is rare, as most intraspinal abscesses are epidural in location. Extensive thoracolumbosacral SSA has only rarely been reported. The MRI features and options for limited surgical management are not well described. A case report of SSA is presented and relevant literature is reviewed. An elderly female presented with worsening back pain and sepsis. MRI demonstrated an extensive intraspinal abscess, extending from the upper thoracic spine to the sacrum. Both axial and sagittal images demonstrated a subdural location of the collection, with preservation of the dorsal epidural fat and mass effect on the spinal cord. Cord compression was most marked at the T8 level. Limited midthoracic laminectomies were performed. The epidural space seemed normal intraoperatively. A limited longitudinal durotomy yielded purulent fluid. After intraoperative irrigation, primary dural repair was performed. At 2-year follow-up, the patient had no clinical, radiographical, or laboratory evidence of residual or recurrent spinal infection. Careful review of MRI can localize an intraspinal abscess to the subdural space. Even for extensive subdural collections, limited operative management can achieve excellent clinical outcome. N/A.

Chronic spinal subdural abscess mimicking an intradural–extramedullary tumor

Spinal subdural abscesses (SSA) are very rare disease. The etiologies of SSA are hematogenous spread, iatrogenic contamination, and local extension. Elevated WBC counts, ESR, and C-reactive protein are usually found in laboratory tests. But they are not sensitive indicators of SSA, especially chronic abscesses patient tend to have a less specific characteristic. We report the case of a healthy man with chronic subdural abscess referred to our hospital as an intradural-extramedullary (IDEM) tumor. The patient presented with voiding difficulty and pain in the back and left leg. In a contrast MRI scan, a rim-enhanced mass-like lesion was seen at the L5/S1 level. But adjacent ill-defined epidural fat enhancement that are unusual imaging manifestation for IDEM tumors was seen. He had no fever and normal WBC, ESR, and CRP. In addition, the patient had no previous infection history or other disease, but he did have an epidural block for back pain at another hospital 2 years previously. So, we repeated the MRI with a high-resolution 3-T scanner. The newly taken MR images in our hospital revealed a clear enlargement of lesion size compared to the previous MRI taken 1 week before in other hospital. We suspected a chronic spinal subdural abscess with recent aggravation and immediately performed surgical evacuation. In the surgical field, tensed dura was observed and pus was identified after opening the abscess capsule. Because chronic spinal subdural abscesses are difficult to diagnose, we could differentiate with IDEM tumor exactly and an exact history taking, contrast MRI are required.

Tuberculous spinal subdural abscess in an infant with dermal sinus

Tuberculous spinal subdural abscess in an infant with dermal sinus

Intraspinal Abscess Associated with Congenital Dermal Sinus: Case Report

Dermal sinus tracts are remnants of incomplete neural tube closure. Dermal sinus tracts in the spine range from asymptomatic pits to tracts with significant disease. Congenital spinal dermal sinus tract can produce significant morbidity if not adequately managed. Spinal subdural abscess caused by the spread of an infection within the dermal sinus tract is rare in children. We now described a 3-year-old male who presented with extensive spinal subdural abscess resulting from dermal sinus tract that was low-lying in the sacral area.

Spinal Subdural Staphylococcus Aureus Abscess: case report and review of the literature

BackgroundOnly 65 cases (including our case) of spinal subdural abscesses have been reported to the literature, mostly to the lumbar spine. Staphylococcus aureus is the most common bacterial. The symptoms are not caracteristic and contrast – enhanced magnetic resonance imaging scan (MRI) is the imaging method of choice. The early diagnosis is crucial for the prognosis of the patient.Case presentationWe present a patient 75 years old who had a history of diabetes and suffered acute low back pain in the region of the lumbar spine for the last 4 days before his admission to the hospital. He also experienced lower leg weakness, fever and neck stiffness. After having a brain CT scan and a lumbar puncture the patient hospitalized with the diagnosis of meningitis. Five days after his admission the diagnosis of subdural abscess secured with contrast – enhanced MRI but meanwhile the condition of the patient impaired with respiratory failure and quadriplegia and he was admitted to the ICU. A laminectomy was performed eight days after his admission into the hospital but unfortunately the patient died.ConclusionEarly diagnosis and treatment are very important for the good outcome in patients with subdural abscess. Although morbidity and mortality are very high, surgical and antibiotic treatment should be established as soon as possible after the diagnosis has secured.

Early detection of spinal sepsis

Spinal sepsis (spinal epidural or subdural abscess) is a rare condition, which, if not diagnosed rapidly, can lead to paralysis or death. It is difficult to diagnose in its early stages as the symptoms are as yet non-specific. We aimed to identify predisposing factors and presenting symptoms that might aid in the early diagnosis of spinal sepsis. A case-control study was performed with non-pediatric patients who had been diagnosed with spinal sepsis from 1998 to 2007. Our control group comprised 80 randomly selected patients who had presented to the emergency department with back pain. We identified 72 patients with spinal sepsis. A multivariate analysis revealed that obesity (adjusted odds ratio [aOR] 21.4; 95% confidence interval [CI] 1.8–257.5) and alcoholism (aOR 6.5; 95% CI 1.3–32.8) were important predictive factors for spinal sepsis. To our knowledge, this is the first report that associates obesity and alcoholism with spinal sepsis.

Papilledema as a manifestation of a spinal subdural abscess

Papilledema is an uncommon presentation of spinal cord processes. Spinal subdural abscess (SSA) is a rare site of post-operative infection. We report a patient who developed papilledema as the primary manifestation of a post-operative lumbar subdural abscess. A spinal abscess should be considered in the post-operative spinal surgery patient who develops papilledema in the setting of persistent back pain. The increased intracranial pressure associated with lumbar spinal cord abscess most likely results from a markedly elevated cerebrospinal fluid (CSF) protein or the disruption of CSF flow in the spinal cul-de-sac.

Spinal subdural abscess: A rare cause of low back pain

Spinal subdural abscess (SSA) is a rare but well-described entity. It may occur secondary to a systemic infectious focus or following a surgical procedure. There are only two SSA cases in the literature that are unrelated to such conditions and without any well-documented etiology. SSA is a neurosurgical emergency and diagnosis may be difficult. Progressive neurological deficits and severe pain with fever suggest the diagnosis. Surgical drainage and subsequent prompt antimicrobial therapy should be performed without delay. We report a patient with SSA unrelated to any predisposing condition and discuss underlying mechanisms of this disease.

Infantile Lumbosacral Spinal Subdural Abscess With Sacral Dermal Sinus Tract

Clinical case report of a spinal subdural abscess in an infant presenting with sacral dermal sinus tract (DST). To suggest that sacral DST with caudal direction may require surgical resection as early as possible. DST may induce the formation of a spinal abscess. However, it is sometimes difficult to decide on early surgical resection for DST, especially in cases that are located at a lower level than the lumbar spine and directed caudally that is not accompanied by cerebrospinal fluid leakage. A 9-month-old girl was transferred due to intermittent fever and vomiting, with the midline sinus of the lower back at the second sacral spinal level. She showed mild tenderness of the lower back and slight weakness of both lower extremities with increased residual urine volume of the bladder. Magnetic resonance imaging (MRI) showed that the low-lying sacral DST traced into the subdural space with caudal orientation, and the presence of extensive subdural spinal abscess from the first lumbar spine to the fourth sacrum. Emergency resection of the sacral DST was performed after laminotomy from the first lumbar spine to the second sacrum, and the subdural spinal abscess was also surgically removed. After 8 weeks of intravenous antibiotic treatment, she showed no neurologic deficit and no evidence of residual abscess on MRI. We suggest that even low-lying sacral DST may require surgical resection as early as possible because it may result in indolent and extensive spinal abscesses.

Spinal subdural Staphylococcus aureus abscess: case report and review of the literature

Spinal subdural abscesses (SSA) are rare and to date only 57 cases have been reported. The exact incidence of the SSA is unknown. The most affected region is the thoraco-lumbar spine and the most common bacterial source is Staphylococcus aureus. The timing for magnetic resonance imaging is very important in these patients. Because early diagnosis and emergent treatment is vital to prevent the formation or progression of neurologic deficits.