Cargando…

Spinal Epidural Abscess: A Review Highlighting Early Diagnosis and Management

Spinal epidural abscess (SEA) is still an uncommon but devastating infection of the spine. In recent years, a number of reported cases have risen. The most important prognostic factor for a favorable outcome is early diagnosis and appropriate treatment. However, a diagnosis of SEA is often delayed,...

Descripción completa

Detalles Bibliográficos
Autores principales: Tetsuka, Syuichi, Suzuki, Tomohiro, Ogawa, Tomoko, Hashimoto, Ritsuo, Kato, Hiroyuki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Japan Medical Association 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733760/
https://www.ncbi.nlm.nih.gov/pubmed/33324773
http://dx.doi.org/10.31662/jmaj.2019-0038
_version_ 1783622338334425088
author Tetsuka, Syuichi
Suzuki, Tomohiro
Ogawa, Tomoko
Hashimoto, Ritsuo
Kato, Hiroyuki
author_facet Tetsuka, Syuichi
Suzuki, Tomohiro
Ogawa, Tomoko
Hashimoto, Ritsuo
Kato, Hiroyuki
author_sort Tetsuka, Syuichi
collection PubMed
description Spinal epidural abscess (SEA) is still an uncommon but devastating infection of the spine. In recent years, a number of reported cases have risen. The most important prognostic factor for a favorable outcome is early diagnosis and appropriate treatment. However, a diagnosis of SEA is often delayed, particularly in the early stages of the disease before patients present with neurological symptoms. With enough knowledge of risk factors, clinical features, and appropriate diagnostic procedures, it may be possible to reduce diagnostic delay in the early stages of the disease. This review focuses on early diagnosis of SEA based on risk factors, presenting symptoms, and characteristic findings on magnetic resonance imaging (MRI), and also discusses the timing of surgical interventions. Traditionally, the symptoms of SEA are characterized by fever, back pain, and neurological symptoms, which are described as a classical triad of symptoms for this type of infection; but this collection of symptoms is seen in only about 10% of cases. However, most patients complain of severe localized lower back pain. Gadolinium-enhanced MRI is the most sensitive, specific, and beneficial imaging modality for establishing a diagnosis of SEA. Patients diagnosed prior to neurological deficits with a known causative microbial organism can be safely treated with antimicrobial therapy alone. However, about 30%–40% of the patients fail in conservative management without surgery. The best management and timing for surgical decompression in patients with or without mild neurological deficits should be established in the near future. Early diagnosis and management, before the occurrence of serious neurological symptoms, are the most important prognostic factors for good outcomes in patients with SEA. We proposed a simple algorithm for early diagnosis of SEA by selecting patients with severe back pain, leading to emergent MRI.
format Online
Article
Text
id pubmed-7733760
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Japan Medical Association
record_format MEDLINE/PubMed
spelling pubmed-77337602020-12-14 Spinal Epidural Abscess: A Review Highlighting Early Diagnosis and Management Tetsuka, Syuichi Suzuki, Tomohiro Ogawa, Tomoko Hashimoto, Ritsuo Kato, Hiroyuki JMA J Review Article Spinal epidural abscess (SEA) is still an uncommon but devastating infection of the spine. In recent years, a number of reported cases have risen. The most important prognostic factor for a favorable outcome is early diagnosis and appropriate treatment. However, a diagnosis of SEA is often delayed, particularly in the early stages of the disease before patients present with neurological symptoms. With enough knowledge of risk factors, clinical features, and appropriate diagnostic procedures, it may be possible to reduce diagnostic delay in the early stages of the disease. This review focuses on early diagnosis of SEA based on risk factors, presenting symptoms, and characteristic findings on magnetic resonance imaging (MRI), and also discusses the timing of surgical interventions. Traditionally, the symptoms of SEA are characterized by fever, back pain, and neurological symptoms, which are described as a classical triad of symptoms for this type of infection; but this collection of symptoms is seen in only about 10% of cases. However, most patients complain of severe localized lower back pain. Gadolinium-enhanced MRI is the most sensitive, specific, and beneficial imaging modality for establishing a diagnosis of SEA. Patients diagnosed prior to neurological deficits with a known causative microbial organism can be safely treated with antimicrobial therapy alone. However, about 30%–40% of the patients fail in conservative management without surgery. The best management and timing for surgical decompression in patients with or without mild neurological deficits should be established in the near future. Early diagnosis and management, before the occurrence of serious neurological symptoms, are the most important prognostic factors for good outcomes in patients with SEA. We proposed a simple algorithm for early diagnosis of SEA by selecting patients with severe back pain, leading to emergent MRI. Japan Medical Association 2019-10-24 2020-01-15 /pmc/articles/PMC7733760/ /pubmed/33324773 http://dx.doi.org/10.31662/jmaj.2019-0038 Text en Copyright © Japan Medical Association http://creativecommons.org/licenses/by/4.0/ JMA Journal is an Open Access journal distributed under the Creative Commons Attribution 4.0 International License. To view the details of this license, please visit (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review Article
Tetsuka, Syuichi
Suzuki, Tomohiro
Ogawa, Tomoko
Hashimoto, Ritsuo
Kato, Hiroyuki
Spinal Epidural Abscess: A Review Highlighting Early Diagnosis and Management
title Spinal Epidural Abscess: A Review Highlighting Early Diagnosis and Management
title_full Spinal Epidural Abscess: A Review Highlighting Early Diagnosis and Management
title_fullStr Spinal Epidural Abscess: A Review Highlighting Early Diagnosis and Management
title_full_unstemmed Spinal Epidural Abscess: A Review Highlighting Early Diagnosis and Management
title_short Spinal Epidural Abscess: A Review Highlighting Early Diagnosis and Management
title_sort spinal epidural abscess: a review highlighting early diagnosis and management
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733760/
https://www.ncbi.nlm.nih.gov/pubmed/33324773
http://dx.doi.org/10.31662/jmaj.2019-0038
work_keys_str_mv AT tetsukasyuichi spinalepiduralabscessareviewhighlightingearlydiagnosisandmanagement
AT suzukitomohiro spinalepiduralabscessareviewhighlightingearlydiagnosisandmanagement
AT ogawatomoko spinalepiduralabscessareviewhighlightingearlydiagnosisandmanagement
AT hashimotoritsuo spinalepiduralabscessareviewhighlightingearlydiagnosisandmanagement
AT katohiroyuki spinalepiduralabscessareviewhighlightingearlydiagnosisandmanagement