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Spinal epidural empyema.
S A Pilkington1, S A Jackson, G R Gillett
1Department of Neurosurgery, Dunedin Hospital, Dunedin, New Zealand.
British Journal of Neurosurgery
|June 25, 2003
Summary
Spinal epidural empyema, a rare condition, presents diagnostic challenges. Prompt diagnosis and treatment, often involving surgery and antibiotics for Staphylococcus aureus infections, are crucial to prevent paralysis and mortality.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Radiology
Background:
- Spinal epidural empyema (SEE) is a rare condition with an incidence of approximately 1 in 10,000 hospital admissions.
- SEE poses diagnostic challenges, often leading to delayed treatment and potentially severe outcomes like paralysis and high mortality.
- Early diagnosis and intervention are critical for managing SEE effectively.
Purpose of the Study:
- To present a series of nine cases of spinal epidural empyema.
- To discuss the diagnostic and treatment features of these cases in the context of current literature.
- To highlight the importance of prompt management in spinal epidural empyema.
Main Methods:
- Retrospective review of nine patients diagnosed with spinal epidural empyema over a 3-year period.
- Diagnosis confirmed using gadolinium-enhanced MRI in eight out of nine cases.
- Analysis of causative pathogens, treatment strategies (antibiotics, surgery), and patient outcomes.
Main Results:
- Staphylococcus aureus was identified as the causative pathogen in all nine cases.
- Gadolinium-enhanced MRI proved effective for diagnosis in most cases.
- Eight patients underwent surgical debridement and spinal decompression, while one was successfully treated with antibiotics alone.
Conclusions:
- Spinal epidural empyema requires urgent diagnosis and treatment to mitigate risks of neurological deficit and mortality.
- Antibiotic therapy, often in conjunction with surgical intervention, is the mainstay of treatment.
- Staphylococcus aureus is a common pathogen in spinal epidural empyema.