Document Detail

Spinal epidural abscess: a report of 40 cases and review.
MedLine Citation:
PMID:  1359657     Owner:  NLM     Status:  MEDLINE    
Despite modern medical advances, the morbidity and mortality rates associated with spinal epidural abscess remain significant, and the diagnosis often is elusive. A retrospective study was undertaken to define better the incidence and clinical features of this infection, and to establish current diagnostic and therapeutic guidelines. Forty cases of spinal epidural abscess were encountered at our institution between July 1979 and March 1991. All medical records and radiological images were reviewed. We report a significant increase in the incidence of epidural abscess after June 1988 (p = 0.0195). Sixteen patients used drugs intravenously, and six had undergone spinal procedures. Twelve patients were misdiagnosed in various emergency rooms or clinics and discharged. Localized back pain, fever, and neurological deficit remained the typical clinical manifestations. Erythrocyte sedimentation rate was elevated uniformly when measured (21 cases). Magnetic resonance imaging was diagnostic specifically in 23 of 24 instances. The majority of patients underwent surgical drainage, but five selected patients were managed nonoperatively. The highly variable presentation of spinal epidural abscess may confuse the diagnosis and delay indicated surgical intervention. Localized back pain in a febrile patient at significant risk for epidural abscess warrants erythrocyte sedimentation rate measurement. The presence of erythrocyte sedimentation rate elevation or evidence of spinal cord compression on physical examination are indications for immediate magnetic resonance imaging examination with contrast enhancement. Surgical drainage with sustained intravenous antibiotic treatment remains the cornerstone of therapy. Nonoperative management may be considered in selected cases.
E S Nussbaum; D Rigamonti; H Standiford; Y Numaguchi; A L Wolf; W L Robinson
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Surgical neurology     Volume:  38     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  1992 Sep 
Date Detail:
Created Date:  1992-12-11     Completed Date:  1992-12-11     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  225-31     Citation Subset:  IM    
Department of Surgery, University of Maryland Medical Systems, Baltimore.
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MeSH Terms
Child, Preschool
Diagnosis, Differential
Empyema, Subdural* / complications,  diagnosis,  microbiology,  therapy
Middle Aged
Retrospective Studies
Spinal Cord Diseases* / complications,  diagnosis,  microbiology,  therapy
Treatment Outcome

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