Hostname: page-component-7c8c6479df-xxrs7 Total loading time: 0 Render date: 2024-03-27T16:09:58.564Z Has data issue: false hasContentIssue false

Diagnosis and Management of Spinal Epidural Abscess

Published online by Cambridge University Press:  18 September 2015

Gary J. Redekop*
Affiliation:
Brain Research Laboratories, Clinical Investigational Unit, Division of Neurosurgery, Department of Clinical Neurological Sciences, University of Western Ontario, London
Rolando F. Del Maestro
Affiliation:
Brain Research Laboratories, Clinical Investigational Unit, Division of Neurosurgery, Department of Clinical Neurological Sciences, University of Western Ontario, London
*
Division of Neurosurgery, Department of Clinical Neurological Sciences, The University of Western Ontario, London, Ontario, Canada N6A 5A5
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Twenty-five patients with spinal epidural abscess were treated at the University of Western Ontario hospitals between July 1980 and July 1990. There were eighteen males (72%) and seven females (28%), with a median age of 60 years. Concurrent illness resulting in immunocompromise was present in 60%. Eleven presented with complete myelopathy, thirteen had limb weakness, and one had no neurological deficit. In twenty cases the abscess consisted of frankly purulent material, while in five the epidural collection consisted of chronic granulation tissue. Staphylococcus aureus was isolated in 64% of the abscesses. Twenty-seven surgical procedures were performed on 21 patients. Ten cases occurred in the cervical spine (40%), seven in the thoracic spine (28%), three in both the cervical and thoracic spine (12%) and five in the lumbosacral spine (20%). Fourteen patients (56%) retained or recovered ambulation and there were five deaths (20%). The progression from back and radicular pain to weakness and eventual paralysis continues to be characteristic of spinal epidural infection. Morbidity and mortality remain unacceptably high because of delay in diagnosis and treatment. Magnetic resonance imaging is the radiological investigation of choice for the diagnosis of spinal epidural abscess. Prompt intervention, before the development of severe neurological deficits, can improve outcome. Immediate surgical drainage combined with antibiotics remains the treatment of choice.

Type
Articles
Copyright
Copyright © Canadian Neurological Sciences Federation 1992

References

1.Dandy, WE.Abscesses and inflammatory tumours in the spinal epidural space (so-called pachymeningitis externa). Arch Surg 1926; 13:477494.Google Scholar
2.Baker, AS, Ojemann, RG, Swartz, MN, et al. Spinal epidural abscess. N Engl J Med 1975; 293: 463468.CrossRefGoogle ScholarPubMed
3.Curling, OD, Gower, DJ, McWhorter, JM.Changing concepts in spinal epidural abscess: a report of 29 cases. Neurosurgery 1990; 27: 185192.CrossRefGoogle ScholarPubMed
4.Danner, RL, Hartman, BJ.Update of spinal epidural abscess: 35 cases and review of the literature. Rev Infect Dis 1987; 9: 265274.Google ScholarPubMed
5.Hancock, DO.A study of 49 patients with acute spinal extradural abscess. Paraplegia 1973; 10: 285288.Google ScholarPubMed
6.Heusner, ARNontuberculous spinal epidural infections. N Engl J Med 1948; 239: 845854.CrossRefGoogle ScholarPubMed
7.Hlavin, ML, Kaminski, HJ, Ross, JS, et al. Spinal epidural abscess: a ten year perspective. Neurosurgery 1990; 27: 177184.CrossRefGoogle ScholarPubMed
8.Hulme, A, Dott, NM.Spinal epidural abscess. Br Med J 1954; 1: 6468.CrossRefGoogle ScholarPubMed
9.Kaufman, DM, Kaplan, JG, Litman, N.Infectious agents in spinal epidural abscess. Neurology 1980; 30: 844850.CrossRefGoogle Scholar
10.Phillips, GE, Jefferson, A.Acute spinal epidural abscess. Observations from fourteen cases. Postgrad Med J 1979; 55: 712715.CrossRefGoogle ScholarPubMed
11.Ravicovitch, MA, Spallone, A.Spinal epidural abscesses: surgical and parasurgical management. Eur Neurol 1982; 21: 347357.Google ScholarPubMed
12.Russell, NA, Vaughan, R, Morley, TP.Spinal epidural infection. Can J Neurol Sci 1979; 6: 325328.CrossRefGoogle ScholarPubMed
13.Yang, SY.Spinal epidural abscess. NZ Med J 1982; 95: 302304.Google ScholarPubMed
14.Aichner, F, Poewe, W, Rogalski, W, et al. Magnetic resonance imaging in the diagnosis of spinal cord disease. J Neurol Neurosurg Psychiatry 1985; 48: 12201229.CrossRefGoogle Scholar
15.Larsson, EM, Holtas, S, Conqvist, S.Emergency magnetic resonance examination of patients with spinal cord symptoms. Acta Radiol 1988; 29:6975.CrossRefGoogle ScholarPubMed
16.Modic, MT, Feiglin, DH, Pirains, DW, et al. Vertebral osteomyelitis: assessment using MR. Radiology 1985; 157: 157166.CrossRefGoogle ScholarPubMed
17.Fischer, EG, Green, CS, Winston, KR.Spinal epidural abscess in children. Neurosurgery 1981; 12: 859867.Google Scholar
18.Dus, V.Spinal pachymeningitis (epidural abscess). Report of eight cases. J Neurosurg 1960; 28: 972983.CrossRefGoogle Scholar
19.Abramovitz, JN, Batson, RA, Yablon, JS.Vertebral osteomyelitis. The surgical management of neurological complications. Spine 1986; 11:418420.CrossRefGoogle Scholar
20.Browder, J, Meyers, R.Infections of the spinal epidural space: an aspect of vertebral osteomyelitis. Am J Surg 1937; 37: 426.CrossRefGoogle Scholar
21.Browder, J, Meyers, R.Pyogenic infections of the epidural space. Surgery 1941; 10:296308.Google Scholar
22.LaRocca, H.Infections of the spine. Clin Neurosurg 1979; 26: 296304.Google Scholar
23.Lasker, BR, Harter, DH.Cervical epidural abscess. Neurology 1987; 37: 17471753.Google ScholarPubMed
24.Verner, EF, Musher, DM.Spinal epidural abscess. Med Clin N Am 1985; 69:375384.CrossRefGoogle ScholarPubMed
25.Koopman, CF, Miller, RW, Coulthard, SW.Retropharyngeal abscess associated with progressive quadriplegia, an epidural abscess, renal failure and jaundice. Case report. Otolarygol Head Neck Surg 1984; 92: 114118.CrossRefGoogle Scholar
26.Walters, DA, Moussa, SA, Buyukpomuku, N.Epidural abscess complicating Swenson procedure: a case report and review of the literature. J Ped Surg 1984; 19: 218220.CrossRefGoogle Scholar
27.Wanscher, M, Rhshede, L, Krogh, B.Fistula formation following epidural catheter. Case report. Acta Anaesthesiol Scand 1985; 29: 552553.CrossRefGoogle ScholarPubMed
28.Rustin, MH, Coones, EN, Flynn, MD.Acute sacral epidural abscess following local anesthetic injection. Postgrad Med J 1983; 59: 399400.CrossRefGoogle Scholar
29.Brian, JE, Westerman, GR, Chadduck, WM.Septic complications of chemonucleolysis. Neurosurgery 1984; 15: 730734.CrossRefGoogle ScholarPubMed
30.Bergman, I, Wald, E, Mayer, J, et al. Epidural abscess and vertebral osteomyelitis following serial lumbar punctures. Pediatrics 1983; 72: 476480.CrossRefGoogle ScholarPubMed
31.Lownie, S, Ferguson, G.Spinal subdural empyema complicating cervical discography. Spine 1989; 14: 14151417.CrossRefGoogle ScholarPubMed
32.Durity, F, Thompson, GB.Localized cervical epidural abscess. Case report. J Neurosurg 1968; 28: 387390.Google Scholar
33.Syrjanen, M, Hvahainen, M, Kallio, M, et al. Three different pathogenic mechanisms for paraparesis in association with bacterial infections. Ann Clin Res 1986; 18: 191194.Google ScholarPubMed
34.Feldenzer, JA, McKeever, PE, Schaberg, DR, et al. Experimental spinal epidural abscess: a pathophysiological model in the rabbit. Neurosurgery 1987; 9: 859867.CrossRefGoogle Scholar
35.Feldenzer, JA, McKeever, PE, Schaberg, DR, et al. The pathogenesis of spinal epidural abscess: microangiopathic studies in an experimental model. J Neurosurg 1988; 69: 110114.CrossRefGoogle Scholar
36.Burke, DR, Brant-Zawadski, M.CT of pyogenic spine infection. Neuroradiology 1985; 27: 131137.CrossRefGoogle ScholarPubMed
37.Masaryk, TJ, Modic, MT, Geisinger, MA, et al. Cervical myelopathy: a comparison of magnetic resonance and myelography. J Comput Assist Tomogr 1986; 10: 184194.CrossRefGoogle ScholarPubMed
38.Schmutzhard, E, Aichner, F, Dierckz, R, et al. New perspectives in acute spinal epidural abscess illustrated by two case reports. Acta Neurochir 1986; 80: 105108.CrossRefGoogle ScholarPubMed
39.Bouchez, B, Arnott, G, Delfosse, J.Acute spinal epidural abscess. J Neurol 1985; 231:343344.CrossRefGoogle ScholarPubMed
40.Messer, HD, Lenchner, GS, Brust, JC, et al. Lumbar spinal abscess managed conservatively. J Neurosurg 1977; 46: 825829.CrossRefGoogle ScholarPubMed
41.Leys, D, Lesoin, F, Viaud, C, et al. Decreased morbidity from acute bacterial spinal epidural abscess using computed tomography and nonsurgical management in selected patients. Ann Neurol 1985; 17:350355.CrossRefGoogle Scholar
42.Mampalam, TJ, Rosegay, H, Andrew, BT, et al. Nonoperative treatment of spinal epidural infections. J Neurosurg 1989; 71: 208210.CrossRefGoogle ScholarPubMed