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Spinal Epidural Abscess in Children With Anatomical Anomalies of the Spine: Case Series and Literature Review
Asaf Regev1,2, Li-Tal Pratt2,3, Jonathan Roth2,4
1From the Pediatric Infectious Disease Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Insights
Children with spinal dysraphism (SD) face a higher risk of spinal epidural abscess (SEA), often presenting at a younger age. Early diagnosis and surgical intervention are crucial for better outcomes in pediatric SEA cases.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Spinal epidural abscess (SEA) is a rare but serious condition with potentially severe outcomes if not treated promptly.
- Spinal dysraphism (SD) represents a group of congenital vertebral malformations that may predispose individuals to infections.
Purpose of the Study:
- To investigate the characteristics and outcomes of pediatric patients with spinal epidural abscess (SEA) associated with spinal dysraphism (SD).
- To highlight the increased risks and challenges in diagnosing and managing SEA in children with underlying SD.
Main Methods:
- Retrospective analysis of clinical and laboratory data from children (<18 years) diagnosed with SEA and SD.
- Inclusion criteria: diagnosis of SEA with available imaging findings of SD between January 2010 and August 2024 at a tertiary pediatric hospital.
- Data reviewed included clinical presentation, physical findings, diagnostic methods, pathogens, treatment, and neurological sequelae.
Main Results:
- Eight pediatric patients with SD and SEA were identified.
- Common symptoms included fever (100%) and dermal sinus (50%).
- Diagnosis was delayed (mean 27 days from onset). Magnetic resonance imaging confirmed SEA in all cases. Treatment involved antibiotics and surgery, with 50% experiencing neurological sequelae (e.g., neurogenic bladder).
Conclusions:
- This is the first case series detailing SEA in pediatric patients with SD.
- Children with SD are at higher risk for SEA, often at a younger age, and face increased risks of delayed diagnosis, meningeal involvement, and long-term neurological deficits.
- Timely diagnosis, surgical intervention, and appropriate antibiotic therapy are critical for improving outcomes in pediatric SEA associated with SD.
Background:
Spinal epidural abscess (SEA) is a rare pathology with potentially devastating consequences if not treated expeditiously.
Methods:
We retrospectively analyzed clinical and laboratory data retrieved from the medical records of children (age <18 years) admitted to a tertiary pediatric hospital with a diagnosis of SEA and available imaging findings of spinal dysraphism (SD) between 1/2010 and 8/2024.
Results:
Eight children diagnosed with SD or other anatomical spinal anomaly prior or at the presentation of an SEA were included. The most common clinical presentation was fever (n = 8). Dermal sinus (n = 4) was the most common physical finding. The clinical diagnosis of SEA was made with a mean of 27 days after symptom onset. Escherichia coli and Enterococcus faecalis were the most cultured pathogens. The diagnosis of SEA was made by magnetic resonance imaging in all cases. All 8 children were treated with systemic antibiotics and all had undergone surgical interventions. Four patients remained with a neurologic sequelae, most commonly neurogenic bladder (n = 4).
Conclusions:
Our report is the first case series of SEA due to SD in a pediatric population described to date. Children with SD are at increased risk for SEA and usually develop this complication at a younger age compared to those with SEA without anatomical risk factors. They are also at increased risk for delayed diagnosis, concomitant meningeal involvement and long-term neurologic sequelae. The most significant variables influencing outcome are timely diagnosis and surgical intervention, followed by appropriate antibiotic administration.
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