Spinal Epidural Abscess

• Schwab JH, Ahah AA. Spinal epidural abscess: Diagnosis, management, and outcomes. J Am Acad Orthop Surg. 2020;28(21):e929–38. Misdiagnosis is very common due to variable presentation.; Prompt diagnosis is key because treatment delay can lead to paralysis or death.; Nonoperative management may represent an alternative in select cases.

Article  PubMed  Google Scholar 

Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev. 2000;23:175–204. https://doi.org/10.1007/PL00011954.

Article  CAS  PubMed  Google Scholar 

• Tetsuka S, Suzuki T, Ogawa T, Hashimoto R, Kato H. Spinal epidural abscess: A review highlighting early diagnosis and management. JMA J. 2023;3(1):29–40. https://doi.org/10.31662/jmaj.2019-0038. a. Gadolinium-enhanced MRI is the most sensitive, specific, and beneficial imaging modality for establishing a diagnosis of SEA.; b. Patients diagnosed prior to neurological deficits with a known causative microbial organism can be safely treated with antimicrobial therapy alone.; c. 30%-40% of the patients fail in conservative management without surgery.

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Darouiche RO, Hamill RJ, Greenberg SB, Weathers SW, Musher DM. Bacterial spinal epidural abscess. Review of 43 cases and literature survey. Medicine (Baltimore). 1992;71(6):369–85.

Article  CAS  PubMed  Google Scholar 

• Long B, Carlson J, Montrief T, Koyfman A. High risk and low prevalence diseases: spinal epidural abscess. Am J Emerg Med. 2022;53:168–72. https://doi.org/10.1016/j.ajem.2022.01.008. a. SEA is a challenging diagnosis due to its range of risk factors and variety of presentations with up to 90% of patients misdiagnosed on their first ED visit.; b. Factors associated with increased risk of SEA include immunocompromise, bacteremia, contiguous infection (e.g., psoas muscle abscess, osteomyelitis, skin infection), and spinal instrumentation.; c. The classic triad of back pain, fever, and neurologic deficit occurs in less than 8% of cases, though back pain is a common presenting symptom.; d. Up to half of patients experience a neurologic abnormality, but fever is absent in 50%.

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Talamonti G, Colistra D, Crisà F, Cenzato M, Giorgi P, D’Aliberti G. Spinal epidural abscess in COVID-19 patients. J Neurol. 2021;268(7):2320–6. https://doi.org/10.1007/s00415-020-10211-z. (Epub 2020 Sep 10).

Article  CAS  PubMed  Google Scholar 

Scalia G, Marrone S, Paolini F, et al. Spinal epidural abscess due to acute pyelonephritis. Surg Neurol Int. 2022;13:159. https://doi.org/10.25259/SNI_260_2022. Published 2022 Apr 22.

Article  PubMed  PubMed Central  Google Scholar 

Lee JY, Kim JW, Na YJ, Kim T, Han SH. Epidural abscess formation with an atypical pathogen following epidural steroid injection: a case report. Medicine (Baltimore). 2022;101(36):e30495. https://doi.org/10.1097/MD.0000000000030495. (PMID: 36086689).

Rule R, Mitton B, Govender NP, Hoffmann D, Said M. Spinal epidural abscess caused by Aspergillus spp masquerading as spinal tuberculosis in a person with HIV. Lancet Infect Dis. 2021;21(11):e356–62. https://doi.org/10.1016/S1473-3099(20)30979-8. (Epub 2021 Sep 29).

Article  PubMed  Google Scholar 

Shweikeh F, Zyck S, Sweiss F, Sangtani A, Shweikeh M, Issa H, Steinmetz MP, Markarian GZ. Aspergillus spinal epidural abscess: case presentation and review of the literature. Spinal Cord Ser Cases. 2018;7(4):19. https://doi.org/10.1038/s41394-018-0046-y.

Article  Google Scholar 

Gutiérrez-Montes C, Coenen W, Vidorreta M, Sincomb S, Martínez-Bazán C, Sánchez AL, Haughton V. Effect of normal breathing on the movement of CSF in the spinal subarachnoid space. AJNR Am J Neuroradiol. 2022;43(9):1369–74. https://doi.org/10.3174/ajnr.A7603.

Article  PubMed  PubMed Central  Google Scholar 

Kollmeier JM, Gürbüz-Reiss L, Sahoo P, et al. Deep breathing couples CSF and venous flow dynamics. Sci Rep. 2022;12:2568. https://doi.org/10.1038/s41598-022-06361-x.

Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

Savage JJ, Casey JN, McNeill IT, Sherman JH. Neurenteric cysts of the spine. J Craniovertebr Junction Spine. 2010;1(1):58–63. https://doi.org/10.4103/0974-8237.65484.

Article  PubMed  PubMed Central  Google Scholar 

Kricun R, Shoemaker EI, Chovanes GI, Stephens HW. Epidural abscess of the cervical spine: MR findings in five cases. AJR Am J Roentgenol. 1992;158(5):1145–9. https://doi.org/10.2214/ajr.158.5.1566681.

Article  CAS  PubMed  Google Scholar 

Danner RL, Hartman BJ. Update on spinal epidural abscess: 35 cases and review of the literature. Rev Infect Dis. 1987;9(2):265–74. https://doi.org/10.1093/clinids/9.2.265.

Article  CAS  PubMed  Google Scholar 

Czervionke LF. Chapter 28 - epidural abscess. In: Czervionke LF, Fenton DS, editors. Imaging painful spine disorders. W.B. Saunders; 2011. p. 210–5. https://doi.org/10.1016/B978-1-4160-2904-5.00028-8. (ISBN 9781416029045).

Chapter  Google Scholar 

Talbott JF, Shah VN, Uzelac A, Narvid J, Dumont RA, Chin CT, Wilson DM. Imaging-based approach to extradural infections of the spine. Semin Ultrasound CT MR. 2018;39(6):570–86. https://doi.org/10.1053/j.sult.2018.09.003. (Epub 2018 Sep 26).

Article  PubMed  PubMed Central  Google Scholar 

Leowattana W, Leowattana P, Leowattana T. Tuberculosis of the spine. World J Orthop. 2023;14(5):275–93. https://doi.org/10.5312/wjo.v14.i5.275.

Article  PubMed  PubMed Central  Google Scholar 

Arockiaraj J, AlDawood M, Al Mufarriji R, Attia WI, AlMusrea KN. Brucellosis of the spine - a global public health problem - an analysis of 37 patients from a ‘high risk’ region. J Clin Orthop Trauma. 2023;4(38):102124. https://doi.org/10.1016/j.jcot.2023.102124.

Article  Google Scholar 

Ali Adam A, Sheikh Hassan M, Adam OA. Spinal brucellosis causing spondylodiscitis. Ann Med Surg (Lond). 2022;23(82):104782. https://doi.org/10.1016/j.amsu.2022.104782.

Article  Google Scholar 

Singh SK, Hasbun R. Neuroradiology of infectious diseases. Curr Opin Infect Dis. 2021;34(3):228–37. https://doi.org/10.1097/QCO.0000000000000725.

Article  CAS  PubMed  Google Scholar 

Talamonti G, Colistra D, Crisà F, Cenzato M, Giorgi P, D’Aliberti G. Spinal epidural abscess in COVID-19 patients. J Neurol. 2021;268(7):2320–6. https://doi.org/10.1007/s00415-020-10211-z.

Article  CAS  PubMed  Google Scholar 

Shah AA, Karhade AV, Bono CM, Harris MB, Nelson SB, Schwab JH. Development of a machine learning algorithm for prediction of failure ofnonoperative management in spinal epidural abscess. Spine J. 2019;19(10):1657–65. https://doi.org/10.1016/j.spinee.2019.04.022. (Epub 2019 May 4.PMID: 31059819).

Article  PubMed  Google Scholar 

Patel AR, Alton TB, Bransford RJ, Lee MJ, Bellabarba CB, Chapman JR. Spinal epidural abscesses: risk factors, medical versus surgical management, a retrospective review of 128 cases. Spine J. 2014;14(2):326–30. https://doi.org/10.1016/j.spinee.2013.10.046. (Epub 2013 Nov 12 PMID: 24231778).

Article  PubMed  Google Scholar 

Tang HJ, Lin HJ, Liu YC, Li CM. Spinal epidural abscess–experience with 46 patients and evaluation of prognostic factors. J Infect. 2002;45(2):76–81. https://doi.org/10.1053/jinf.20021013. (PMID: 12217707).

Article  PubMed  Google Scholar 

Kim SD, Melikian R, Ju KL, Zurakowski D, Wood KB, Bono CM, Harris MB. Independent predictors of failure of nonoperative management of spinalepidural abscesses. Spine J. 2014;14(8):1673–9. https://doi.org/10.1016/j.spinee.2013.10.011. (Epub 2013 Oct 30).

Article  PubMed  Google Scholar 

Eroshkin A, Romanukha D, Voitsekhovskyi S. Surgical management of anextensive spinal epidural abscess: Illustrative cases.  J Neurosurg Case Lessons. 2021;1(2):CASE2050. https://doi.org/10.3171/CASE2050.

Article  PubMed  PubMed Central  Google Scholar 

Ghobrial GM, Beygi S, Viereck MJ, Maulucci CM, Sharan A, Heller J, Jallo J, Prasad S, Harrop JS. Timing in the surgical evacuation of spinal epidural abscesses. Neurosurg Focus. 2014;37(2):E1. https://doi.org/10.3171/2014.6.FOCUS14120. (PMID: 25081958).

Article  PubMed  Google Scholar 

Kamalapathy PN, Karhade AV, Groot OQ, Lin KE, Shah AA, Nelson SB, Schwab JH. Predictors of reoperation after surgery for spinal epidural abscess. Spine J. 2022;22(11):1830–6. https://doi.org/10.1016/j.spinee.2022.06.006. (Epub 2022 Jun 20 PMID: 35738500).

Article  PubMed  Google Scholar 

Houston R, Gagliardo C, Vassallo S, Wynne PJ, Mazzola CA. Spinal epidural abscess in children: case report and review of the literature. World Neurosurg. 2019;126:453–60. https://doi.org/10.1016/j.wneu.2019.01.294. (Epub 22 PMID: 30797918).

Article  PubMed  Google Scholar 

Ammar AA, Hamad MK, Obeidallah MS, Kobets AJ, Lee SK, Abbott IR. Successful treatment of pediatric holo-spinal epidural abscess with percutaneous drainage. Cureus. 2022;14(5): e24735. https://doi.org/10.7759/cureus.24735. (PMID:35673318; PMCID:PMC9165922).

Article  PubMed  PubMed Central  Google Scholar 

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