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.

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• 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.

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• 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).

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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).

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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).

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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).

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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.

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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).

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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).

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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).

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