• breast cancer
• case report
• chemotherapy
• complication
• epidural abscess

• Staphylococcus aureus
• Cervical spondylodiscitis
• Kyphotic deformation
• Minimally invasive surgical treatment
• Spine instability

• Humans
• Discitis/surgery
• Male
• Middle Aged
• Female
• Cervical Vertebrae/surgery
• Retrospective Studies
• Adult
• Minimally Invasive Surgical Procedures/methods
• Aged
• Treatment Outcome
• Diskectomy/methods
• Anti-Bacterial Agents/therapeutic use

• Economics
• Epidural abscess
• Paralysis
• Prognosis
• Surgery

• Yeungnam University

• ACDF
• Age
• Cervical epidural abscess
• Corpectomy
• Motor deficit

• Humans
• Male
• Aged
• United States/epidemiology
• Middle Aged
• Female
• Medicare
• Length of Stay
• Health Care Costs
• Inpatients
• Osteomyelitis/surgery
• Retrospective Studies

• Comorbidities
• Intravenous drug abuse
• Spinal epidural abscess
• Surgery

• Humans
• Epidural Abscess/surgery
• Epidural Abscess/complications
• Epidural Abscess/drug therapy
• Retrospective Studies
• Follow-Up Studies
• Nervous System Diseases
• Osteomyelitis

• Medizinische Fakultät Heidelberg der Universität Heidelberg (9149)

• Spinal cord
• acute myelopathy
• emergency room
• magnetic resonance imaging

• Humans
• Retrospective Studies
• Spinal Cord Diseases/diagnostic imaging
• Spinal Cord Compression
• Magnetic Resonance Imaging/adverse effects
• Pain/complications

• Acute spinal cord injury
• Intra-spinal abscess
• Intra-spinal empyema
• Spinal surgery
• Spondylodiscitis
• Treatment costs

• Humans
• Aged
• Abscess
• Retrospective Studies
• Spinal Cord Injuries/complications
• Spinal Cord Injuries/therapy
• Empyema/complications
• Primary Health Care
• Treatment Outcome

• R01 NS118200 NINDS NIH HHS
• Charité - Universitätsmedizin Berlin (3093)

• Octogenarians
• Pyogenic vertebral osteomyelitis
• Spinal epidural abscess
• Surgery

• Aged
• Aged, 80 and over
• Humans
• Epidural Abscess/epidemiology
• Epidural Abscess/surgery
• Epidural Abscess/diagnosis
• Follow-Up Studies
• Retrospective Studies
• Osteomyelitis/surgery
• Disease Progression
• Treatment Outcome

Spinal epidural abscess (SEA) is a rare purulent infection of the central nervous system. Abscesses confined to the spinal canal can compress the spinal cord, causing nerve damage and even death in severe cases (1). Prompt diagnosis and treatment can relieve symptoms and prevent complications. To increase awareness of this rare disease, we report a case of a 58-year-old man with a cervical spinal epidural abscess combined with a soft tissue abscess in the neck and describe its clinical course, imaging feature, pathology, treatment, and patient prognosis.

A 58-year-old male Chinese patient was admitted to our hospital because of neck pain for 2 months, which worsened for 4 days. On the third day of admission, the muscle strength of the limbs decreased, and MRI of the spinal cord showed abnormal signal shadows in the spinal canal at the C1-C7 level and in the surrounding soft tissue on the right side of spine, suggesting the possibility of inflammatory lesions with local abscess formation. We immediately performed decompression of the spinal canal on the patient and performed incision and drainage of the cervical abscess. During the operation, we found a large amount of pus in the epidural space of the spinal canal, and there was a fistula between the cervical abscess and the epidural abscess of the spinal canal. The patient underwent continuous drainage and anti-infective treatment with sensitive antibiotics after operation. No recurrence of the abscess was observed and the patient recovered well.

Early diagnosis is the key to the treatment of SEA, so radiologists and neurosurgeons need to strengthen their understanding of this rare disease to avoid misdiagnosis. For SEA with definite diagnosis, decompression surgery should be performed in a timely manner when symptoms of nerve compression occur, continuous drainage should be performed after surgery, and sensitive antibiotics should be used for anti-infective treatment.

• case report
• decompression
• spinal epidural abscess
• surgery
• treatment

Spinal epidural abscess (SEA) is a rare condition with complex pathophysiology and highly variable clinical presentation. While it is known to cause focal peripheral nerve symptoms such as muscle weakness, paresthesia, or pain, these are typically accompanied by complaints of back or spine pain and systemic symptoms indicative of infection. In our case, a 53-year-old male initially presented with unilateral pain and swelling in his right hand, with no fever at presentation and no complaints of back pain. Blood culture confirmed methicillin-resistant Staphylococcus aureus (MRSA)for which he was given vancomycin. The patient later endorsed back pain and diagnostic imaging revealed a spinal epidural abscess spanning the T5-T9 vertebrae. The abscess was drained, and vancomycin was placed in the subfascial and epifascial compartments. The hand was debrided in the same operation and showed no gross purulence. Two days after the procedure, intraoperative cultures remained negative, and the patient was subsequently managed with daptomycin.

• Chronic kidney disease
• End-stage renal disease
• Spinal epidural abscess
• United States Renal Data System (USRDS)

• external drainage
• intervertebral disc infections with epidural abscess
• percutaneous lumbar discectomy

Spinal epidural abscess (SEA) is a rare condition associated with significant morbidity and mortality. Despite advances in diagnostic medicine, early recognition of SEAs remains elusive. The vague presentation of the disease, coupled with its numerous risk factors, the diagnostic requirement for obtaining advanced imaging, and the necessity of specialized care constitute extraordinary challenges to both diagnosis and treatment of SEA. Once diagnosed, SEAs require urgent or emergent medical and/or surgical management. As SEAs are a relatively rare pathology, high-quality data are limited and there is no consensus on their optimal management. This paper focuses on presenting the treatment modalities that have been successful in the management of SEAs and providing a critical assessment of how specific SEA characteristics may render one infection more amenable to primary surgical or medical interventions. This paper reviews the relevant history, epidemiology, clinical presentation, radiology, microbiology, and treatment of SEAs and concludes by addressing the medicolegal implications of delayed treatment of the disease.

• Infections
• Spinal epidural abscess
• Spine

• Antibiotics
• Non-operative management
• Spinal epidural abscess
• Spinal infection

• Anti-Bacterial Agents/therapeutic use
• Epidural Abscess/drug therapy
• Epidural Abscess/therapy
• Humans
• Risk Factors
• Staphylococcal Infections/drug therapy
• Staphylococcus aureus

Chronic neck pain is a common clinical problem. It has long been considered that degenerative cervical disc is an important source of chronic neck pain. In the clinic, cervical discography is thought to be a useful and safe method to distinguish aging discs from pathological discs, and the probability of complications caused by it is really rare. However, once complication occurs, it is likely to cause fatal consequences to patients. Therefore, accurate judgment and effective treatment are crucial.

A 45-year-old female was admitted to the department with a 5-year history of severe neck pain, dizziness, and tinnitus. In order to find the diseased disc, analgesic discography was performed on C4/5 and 6/7 discs successively. Unfortunately, Discitis with an epidural abscess was caused during the procedures. With the help of magnetic resonance imaging, an accurate diagnosis was made and an urgent anterior cervical operation was given subsequently. The patient ultimately recovered well.

Discitis with epidural abscess is a rare complication after cervical discography, which needs accurate diagnosis and effective antibiotic treatment.

• Discography
• Discitis
• Epidural abscess
• Diagnosis
• Treatment
• Magnetic resonance imaging

• AIS = American Spinal Injury Association Impairment Scale
• IVDA = intravenous drug abuse
• MRSA = methicillin-resistant Staphylococcus aureus
• MSSA = methicillin-sensitive S. aureus
• SEA = spinal epidural abscess
• epidural abscess
• intravenous drugs
• opioid crisis
• spine infection

• Adult
• Brain/diagnostic imaging
• Brain/pathology
• Disease Management
• Epidural Abscess/diagnosis
• Epidural Abscess/diagnostic imaging
• Epidural Abscess/therapy
• Humans
• Male
• Neuroimaging

• American Spinal Injury Association Impairment Scale
• Infection
• Paresis
• Spinal epidural abscess
• Surgery

• antibiotic therapy
• laminectomy
• magnetic resonance imaging
• misdiagnosis
• spinal epidural abscess
• spinal tuberculosis

• Anti-Bacterial Agents/therapeutic use
• Bone Diseases, Infectious/diagnosis
• Bone Diseases, Infectious/drug therapy
• Bone Diseases, Infectious/surgery
• Diagnosis, Differential
• Epidural Abscess/diagnosis
• Epidural Abscess/drug therapy
• Epidural Abscess/surgery
• Female
• Humans
• Laminectomy/methods
• Magnetic Resonance Imaging
• Thoracic Vertebrae
• Young Adult

• cervical spine
• epidural abscess
• neurological deficit

• Epidemiology
• Outcome
• Risk factors
• Spinal epidural abscess
• Treatment

• antibiotics
• cervical epidural abscess
• epidural analgesia

• Aged
• Analgesia, Epidural/adverse effects
• Cervical Vertebrae
• Epidural Abscess/etiology
• Female
• Humans
• Hypertension/complications
• Intervertebral Disc Displacement/complications
• Intervertebral Disc Displacement/drug therapy
• Neck Pain/drug therapy
• Neck Pain/etiology
• Spinal Puncture/adverse effects

Spinal epidural abscess (SEA) is a serious condition that can be challenging to diagnose due to nonspecific symptomology and delayed presentation. Despite this, it requires prompt recognition and management in order to prevent permanent neurologic sequelae. Several recent studies have improved our understanding of SEA. Herein, we summarize the recent literature from the past 10 years relevant to SEA diagnosis, management and outcome. While surgical care remains the mainstay of treatment, a select subset of SEA patients may be managed without operative intervention. Multidisciplinary management involves internal medicine, infectious disease, critical care, and spine surgeons in order to optimize care.

• Medicine
• Orthopedics
• Spine surgery

• CRP = C-reactive protein
• MALDI-TOF = matrix-assisted laser desorption ionization with time of flight
• PCR = polymerase chain reaction
• Streptobacillus moniliformis
• epidural abscess
• infection
• rat bite
• zoonosis

• Conservative management
• Epidural
• Outcome
• Spinal epidural abscess
• Spinal infection

Patients with spinal epidural abscesses (SEAs) may have a variable presentation. Such an infection has a typical appearance on magnetic resonance imaging (MRI) and enhances with gadolinium. We present a case that was a diagnostic challenge where pre- and intra-operative findings resulted in conflicting impressions. The mimicker was a spinal angiolipoma (SAL). The authors then provide a thorough review of this rare spinal neoplasm. A 55-year-old man presented with back pain, paresis, paresthesia, and urinary retention. MRI was indicative of a longitudinal epidural thoracic mass with a signal homogeneous to nearby fat, curvilinear vessels, and lack of enhancement. Although at emergent surgery, the lesion was found to contain abundant purulent material. Microbiology was positive for methicillin-resistant Staphylococcus aureus and consistent with SEA without evidence of neoplasia. While the imaging features were suggestive of an angiolipoma, the findings at surgery made SEA more likely, which were validated histopathologically. The diagnosis of SEA is often clear-cut, and the literature has reported only a few instances in which it masqueraded as another process such as lymphoma or myelitis. The case highlights SEA masquerading as an angiolipoma, and further demonstrates to clinicians that obtaining tissue diagnosis plays a crucial role diagnostically and therapeutically. SALs, on the other hand, are slow-growing tumors that can be infiltrating or noninfiltrating. They typically present with chronic symptoms and T1-MRI shows an inhomogeneous picture. Complete surgical excision is standard of care and patients tend to do well afterward.

• Angiolipoma
• back pain
• epidural abscess
• magnetic resonance imaging
• spinal cord compression
• spine neoplasms

• diagnosis
• fishbone
• management
• spinal epidural abscess
• surgery

• Animals
• Anti-Bacterial Agents/therapeutic use
• Back Pain/diagnosis
• Back Pain/etiology
• Bone and Bones
• Combined Modality Therapy
• Drainage/methods
• Emergency Service, Hospital
• Epidural Abscess/diagnosis
• Epidural Abscess/etiology
• Epidural Abscess/therapy
• Female
• Fishes
• Follow-Up Studies
• Foreign Bodies/complications
• Foreign Bodies/diagnosis
• Foreign Bodies/therapy
• Foreign-Body Migration/complications
• Foreign-Body Migration/diagnosis
• Foreign-Body Migration/surgery
• Humans
• Middle Aged
• Risk Assessment
• Spontaneous Perforation/diagnosis
• Spontaneous Perforation/therapy
• Thoracic Vertebrae
• Treatment Outcome

SEA incidence has increased more than three-fold over the past decade at a large, high-volume, academic medical center. This retrospective, case-control study identified several attributes that could inform the early recognition of this potentially highly morbid acute infection of the central nervous system.

Background. Delayed recognition of spinal epidural abscess (SEA) contributes to poor outcomes from this highly morbid and potentially lethal infection. We performed a case-control study in a regional, high-volume, tertiary care, academic medical center over the years 2005–2015 to assess the potential changing epidemiology, clinical and laboratory manifestations, and course of this disorder and to identify factors that might lead to early identification of SEA.

Methods. Diagnostic billing codes consistent with SEA were used to identify inpatient admissions for abstraction. Subjects were categorized as cases or controls based on the results of spinal imaging studies. Characteristics were compared using Fisher's exact or Kruskal-Wallis tests. All P values were 2-sided with a critical threshold of <.05.

Results. We identified 162 cases and 88 controls during the study period. The incidence of SEA increased from 2.5 to 8.0 per 10 000 admissions, a 3.3-fold change from 2005 to 2015 (P < .001 for the linear trend). Compared with controls, cases were significantly more likely to have experienced at least 1 previous healthcare visit or received antimicrobials within 30 days of admission; to have comorbidities of injection drug use, alcohol abuse, or obesity; and to manifest fever or rigors. Cases were also more likely to harbor coinfection at a noncontiguous site. When available, inflammatory markers were noted to be markedly elevated in cases. Focal neurologic deficits were seen with similar frequencies in both groups.

Conclusions. Based on our analysis, it appears that selected factors noted at the time of clinical presentation may facilitate early recognition of SEA.

• CNS infection
• spinal epidural abscess

• Acupuncture
• Cauda equina syndrome
• Spinal epidural abscess

• Spinal epidural abscess

In the article: Timing and prognosis of surgery for spinal epidural abscess (SEA): A review, Epstein raises one major point; it is imperative that spinal surgeons “take back decision-making” from our medical cohorts and reinstitute early surgery (<24 h) to better treat SEAs.

Spine surgeons recognize the clinical triad (e.g., fever [50%], spinal pain [92–100%], and neurological deficits [47%]) for establishing the diagnosis of an SEA. We also appreciate the multiple major risk factors for developing SEA; diabetes (15–30%), elevated white blood cell count (>12.5), high C-reactive protein (>115), positive blood cultures, radiographic cord compression, and significant neurological deficits (e.g., 19–45%).

Recognizing these risk factors should prompt early open surgery (<24 h from the onset of a neurological deficit). Open surgery better defines the correct/multiple organisms present, and immediately provides adequate/thorough neurological decompression (with fusion if unstable). Although minimally invasive surgery may suffice in select cases, too often it provides insufficient biopsy/culture/irrigation/decompression. Most critically, nonsurgical options result in unacceptably high failure rates (e.g., 41-42.5-75% requiring delayed surgery), while risking permanent paralysis (up to 22%), and death (up to 25%).

As spine surgeons, we need to “take back decision-making” from our medical cohorts and advocate for early surgery to achieve better outcomes for our patients. Why should anyone accept the >41-42.5 to up to the 75% failure rate that accompanies the nonsurgical treatment of SEA, much less the >25% mortality rate?

• Avoid medical management
• early surgery
• high morbidity/mortality
• spinal epidural abscesses
• spine surgeons

The nonsurgical versus surgical management of spinal epidural abscesses (SEAs) remains controversial. Even with the best preoperative screening for multiple risk factors, high nonoperative failure rates are attended by considerable morbidity (e.g., irreversible paralysis) and mortality. Therefore, the focus remains on early surgery.

Most papers promote early recognition of the clinical triad (e.g., fever [50%], spinal pain [92–100%], and neurological deficits [47%]) for SEA. They also identify SEA-related risk factors for choosing nonsurgical versus surgical approaches; advanced age (>65 or 80), diabetes (15–30%), cancer, intravenous drug abuse (25%), smoking (23%), elevated white blood cell count (>12.5), high C-reactive protein >115, positive blood cultures, magnetic resonance imaging/computed tomographic documented cord compression, and significant neurological deficits (e.g., 19–45%).

Surgical options include: decompressions, open versus minimally invasive biopsy/culture/irrigation, or fusions. Up to 75% of SEA involve the thoracolumbar spine, and 50% are located ventrally. Wound cultures are positive in up to 78.8% of cases and are often (60%) correlated with positive blood cultures. The most typical offending organism is methicillin resistant Staphylococcus aureus, followed by methicillin sensitive S. aureus. Unfortunately, the failure rates for nonoperative treatment of SEA remain high (e.g., 41–42.5%), contributing to significant morbidity (22% risk of permanent paralysis), and mortality (3–25%).

The vast majority of studies advocated early surgery to achieve better outcomes for treating SEA; this avoids high failure rates (41–42.5%) for nonoperative therapy, and limits morbidity/mortality rates.

• Medical management
• neurological deficit
• open surgery: Minimally invasive surgery
• paraplegia
• spinal epidural abscess
• surgical decompression
• timing