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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

631
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
631

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Updated: Dec 21, 2025

Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis
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Primary Spinal Epidural Abscesses Not Associated With Pyogenic Infectious Spondylodiscitis: A New Pathogenetic

Lorenzo Magrassi1, Marco Mussa2, Andrea Montalbetti1,3

  • 1Neurosurgery, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS San Matteo Hospital Foundation, Pavia, Italy.

Frontiers in Surgery
|May 20, 2020
PubMed
Summary

Spinal epidural abscesses (SEAs) without associated spondylodiscitis often present with pain and neurological deficits. Urgent surgical drainage is beneficial, with less need for spinal instrumentation to prevent deformities.

Keywords:
epidural spacelaminectomylymphatic vesselspercutaneous treatmentpyogenic infectious spondylodiscitisspinal cord decompressionspinal epidural abscess

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Area of Science:

  • Neurosurgery
  • Infectious Diseases
  • Spinal Surgery

Background:

  • Rising incidence of spinal epidural abscesses (SEAs).
  • Lack of differentiation between SEAs with and without pyogenic spondylodiscitis (PS).
  • Need to understand characteristics and outcomes of SEAs not associated with PS.

Purpose of the Study:

  • To characterize patients with SEAs not associated with PS.
  • To evaluate the clinical presentation, treatment, and outcomes for this specific group of SEA patients.

Main Methods:

  • Retrospective review of patients diagnosed with SEA without PS (January 2013 - December 2018).
  • Analysis of medical records and radiological images.
  • Comparison of outcomes based on treatment (surgery vs. aspiration) and need for instrumentation.

Main Results:

  • Seven patients identified; five were intravenous drug users.
  • Common presentation: pain with acute motor and sensory deficits.
  • Staphylococcus aureus was the most common pathogen; urgent surgery was effective, with neurological improvement in most cases and no delayed deformities in patients without instrumentation.

Conclusions:

  • SEAs without PS typically present with pain and motor deficits, benefiting from urgent drainage.
  • These patients may require less spinal instrumentation to prevent long-term deformities compared to SEA with PS.
  • Origin may involve epidural lymphatic vessels due to the lack of initial bone/disc involvement.