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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
PubMed
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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.

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  • 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.