Symptoms Of Spinal Epidural Abscess Research Articles

Lumbar spine epidural abscess and facet joint septic arthritis in a pediatric patient.

A 13-year-old girl presented with lower back pain that began 7 days earlier after a volleyball workout. She had no history of trauma or fever. On physical examination, a contraction of the left paravertebral muscles associated with pain on flexion-extension of the spine and a positive left Lasègue's sign were evident. She had no neurological deficits in the lower limbs. Chest and lumbosacral X-rays were unremarkable, and a laboratory investigation revealed neutrophilia and elevated C-reactive protein (75.7 mg/L; normal value < 5). Urine and blood cultures were carried out before starting ceftriaxone. She developed a fever (38.8 °C) 1 day after admission, and the blood culture was positive for methicillin-sensitive Staphylococcus aureus. A lumbosacral magnetic resonance imaging (MRI) scan was performed considering the clinical and microbiological evidence and suspecting an osteoarticular infection. The MRI revealed a small amount of interarticular fluid in the left L4-L5 hemivertebral region and a posterior spinal epidural abscess on the left side extending from L4 to L5-S1 (Fig. 1). The diagnosis was lumbar spine epidural abscess (SEA) and facet joint septic arthritis (SAFJ). As the girl did not present with neurological symptoms, no surgical treatment was indicated, and cefazolin was administered intravenously with rapid resolution of the fever and pain. She was discharged after 4 weeks of intravenous antimicrobial therapy, which was followed by 4 more weeks of oral antibiotic therapy with levofloxacin. The 3-month follow-up MRI showed complete regression of the epidural fluid and almost complete normalization of the signal abnormalities in the L4-L5 soft tissues (Fig. S1). Facet joint septic arthritis is a rare condition.1Mas-Atance J. Gil-García M.I. Jover-Sáenz A. Curià-Jové E. Jové-Talavera R. Charlez-Marco A. et al.Septi carthritis of a posteriorlumbarfacet joint in an infant: a case report.Spine (Phila Pa 1976). 2009; 34: E465-E468Crossref PubMed Scopus (10) Google Scholar Few pediatric cases have been described, mainly in immunosuppressed patients. The most commonly associated pathogen is S. aureus.2Cabet S. Perge K. Ouziel A. Vandergugten S. Guibaud L. Ferry T. et al.Septic arthritis of facet joint in children: a systematic review and a 10-year consecutive case series.Pediatr Infect Dis J. 2021; 40: 411-417Crossref PubMed Scopus (0) Google Scholar The mechanism of the spread of this infection is not understood, but contamination may originate from direct inoculation, contiguity, or hematogenous dissemination. In the present case, the patient had no history of lumbar or epidural injections, so the most likely origin was hematogenous dissemination. The coexistence of localized epidural, articular, and paravertebral abnormalities on an MRI examination acquired only a few days after symptom onset led us to speculate that the infection originated in the left L4-L5 zygoapophyseal joint and spread to contiguous tissues, both inside and outside the lumbar canal. The three most common presenting symptoms of spinal epidural abscess are back pain, fever, and neurological deficit; however, these symptoms do not always occur together, contributing to the delayed diagnosis, which is reported in 50%–75% of cases.3Reihsaus E. Waldbaur H. Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients.Neurosurg Rev. 2000; 23: 175-204Crossref PubMed Google Scholar Surgery is reserved for nonantibiotic responders or in cases of neurologic deficit. Lumbar SEA and SAFJ are clinical emergencies with significant morbidity and mortality, particularly when there is a delayed diagnosis. Therefore, early clinical suspicion, diagnosis, and treatment are essential to obtain a favorable outcome.4Davis D.P. Wold R.M. Patel R.J. Tran A.J. Tokhi R.N. Chan T.C. et al.The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess.J Emerg Med. 2004; 26: 285-291Abstract Full Text Full Text PDF PubMed Scopus (220) Google Scholar The authors declares that there is no conflict of interest regarding the publication of this paper. The following is the supplementary data to this article: Download .docx (2.14 MB) Help with docx files Multimedia component 1

Spinal Epidural Abscess: A Review Highlighting Early Diagnosis and Management.

Spinal epidural abscess (SEA) is still an uncommon but devastating infection of the spine. In recent years, a number of reported cases have risen. The most important prognostic factor for a favorable outcome is early diagnosis and appropriate treatment. However, a diagnosis of SEA is often delayed, particularly in the early stages of the disease before patients present with neurological symptoms. With enough knowledge of risk factors, clinical features, and appropriate diagnostic procedures, it may be possible to reduce diagnostic delay in the early stages of the disease. This review focuses on early diagnosis of SEA based on risk factors, presenting symptoms, and characteristic findings on magnetic resonance imaging (MRI), and also discusses the timing of surgical interventions. Traditionally, the symptoms of SEA are characterized by fever, back pain, and neurological symptoms, which are described as a classical triad of symptoms for this type of infection; 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 of SEA. Patients diagnosed prior to neurological deficits with a known causative microbial organism can be safely treated with antimicrobial therapy alone. However, about 30%–40% of the patients fail in conservative management without surgery. The best management and timing for surgical decompression in patients with or without mild neurological deficits should be established in the near future. Early diagnosis and management, before the occurrence of serious neurological symptoms, are the most important prognostic factors for good outcomes in patients with SEA. We proposed a simple algorithm for early diagnosis of SEA by selecting patients with severe back pain, leading to emergent MRI.

Spinal epidural abscess

Spinal epidural abscess (SEA) is a rare potentially life threatening condition caused by accumulation of infectious material adjacent to the dura in the spinal canal. Unrecognized and untreated cases progress to paralysis and death. While the incidence of this condition remains relatively low, recent evidence suggests the incidence is increasing. Early diagnosis and treatment are critical to successful outcomes. Signs and symptoms of SEA can be relatively nonspecific and can lead to diagnostic difficulty and delay. Awareness of presenting symptoms and a high index of suspicion are necessary to avoid morbidity and mortality. Magnetic resonance imaging with gadolinium is the gold standard in diagnosis of this condition. CT myelogram also may be used in patients who cannot undergo MRI. Immediate initiation of antibiotics and emergent surgical decompression is the appropriate treatment in almost all cases. Surgery is followed by treatment with long-term antibiotics based on the offending organism. Nonoperative medical management has been reported to be successful but should be reserved for selected cases.

Hydromyelia Secondary to Spinal Epidural Abscess

Spinal epidural abscess (SEA) is a rare condition that can be fatal if untreated. Risk factors are immunocompromised states as well as spinal procedures including epidural anesthesia and spinal surgery. The signs and symptoms of SEA are nonspecific and can range from low back pain to sepsis. The treatment of choice is surgical decompression followed by four to six weeks of antibiotic therapy. The most common causative organism in SEA is staphylococcus aureus and spread is usually haematogenous or contiguous from psoas, paraspinal or retropharyngeal abscesses. The exact mechanism by which an epidural abscess causes spinal cord damage is unclear. In fact, the damage is often out of proportion to the degree of compression demonstrated radiologically. There is only a report of a patient with syrinx formation secondary to epidural abscess. We describe the case of a 48-year-old woman with a two-week history of thoracic back pain and evidence of dorsal SEA probably from contiguous psoas abscess. Neurological examination revealed flaccid paraplegia and loss of sphincter control. A spinal MRI scan with Gd-enhancement revealed focal high intensity signal in the T2-weighted and FLAIR images at the level of the vertebral bodies in segments D3-D11. The patient was treated with posterior decompression and drainage of the SEA, but with a poor outcome. Six weeks after the onset of symptoms, an MRI scan showed a newly-formed hydromyelia formation from D4 to D8. The case reported is the second to describe hydromyelia formation secondary to epidural abscess and a poor outcome, experiencing partial improvement without recovery. For this reason, we confirmed that the essential problem of SEA lies in the need for early diagnosis, because the early signs and symptoms may be vague and the "classic" triad of back pain, fever and variable neurological deficits occur in only 13% of patients by the time of diagnosis. Only timely treatment will avoid or reduce permanent neurological deficits before massive neurological symptoms occur. The clear message is that a high index of suspicion and modern imaging techniques are essential.

Atypical Presentation of Spinal Epidural Abscess—Prolonged and Intractable Abdominal Pain

Despite advances in medicine, early diagnosis of spinal epidural abscess remains a challenge to clinicians. The most common symptoms of spinal epidural abscess include back pain, fever, and neuralgic deficits. However, spinal epidural abscess can also present with vague and nonspecific symptoms. In this case, a 68-year-old male had abdominal pain in the right upper quadrant lasting 3 weeks and was diagnosed with a gastric ulcer. After treatment, his symptoms did not resolve. Fever and back pain became evident as his disease progressed, followed by right lower limb weakness and the inability to walk. He was taken to the emergency department of our hospital, and the weakness of his lower extremities worsened during hospitalization. His right leg became completely paralyzed despite the use of intravenous antibiotics. A spinal computed tomography scan was performed emergently (magnetic resonance imaging was unavailable) and revealed an epidural abscess involving T5–6 with adjacent osteomyelitis. The patient underwent posterior decompressive laminectomy with pus drainage in the T4–7 region. His neuralgic examinations improved soon after the operation, but ambulation remained limited. Early diagnosis is crucial to the prognosis of spinal epidural abscess, because delayed diagnosis usually results in complete paralysis even death. Thus, clinicians should be aware of atypical presentations of spinal epidural abscess.

Spinal epidural abscess presenting as intra-abdominal pathology: a case report and literature review

Spinal epidural abscess is a rare infectious disease. However, if left unrecognized and untreated, the clinical outcome of spinal epidural abscess can be devastating. Correctly diagnosing a spinal epidural abscess in a timely fashion is often difficult, particularly if the clinician does not actively consider the diagnosis. The most common presenting symptoms of spinal epidural abscess include backache, radicular pain, weakness, and sensory deficits. However, early in its course, spinal epidural abscess can also present with vague and nondescript manifestations. In this report, we describe a case of spinal epidural abscess presenting as abdominal pain, and review the literature describing other cases of spinal epidural abscess presenting as intra-abdominal pathology.

Review Article: Anterior Cervical Epidural Abscess With Pneumococcus in an Infant

Spinal epidural abscess is a rare infection in childhood. We report the first documented case of pneumococcal epidural abscess in an infant and review the literature regarding this entity. In children, the signs and symptoms of spinal epidural abscess may not be as helpful as those in older patients. Furthermore, the offending organism may not be the usual Staphylococcus seen in adults. Infants may recover neurologic function even after prolonged cord compression; however, a high index of suspicion is needed to make the diagnosis in a timely fashion.