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CT-guided minimally invasive treatment for an extensive spinal epidural abscess: a case report and literature review

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Abstract

Purpose

We present a case involving an extensive epidural abscess that was successfully treated with computed tomography (CT)-guided percutaneous needle drainage and systemic antibiotic therapy.

Methods

A 44-year-old woman with a history of spine injection procedures complained of severe backache and progressive radiating pain in her right lower extremity followed by sensory deficits in her right lower limb. A laboratory examination revealed leukocytosis and hyperglycemia. Magnetic resonance imaging of the lumbar region revealed an extremely large posterior spinal epidural abscess (SEA) extending from L2 to S2. Because the patient did not respond to intravenous antibiotics alone, she underwent CT-guided percutaneous needle drainage and irrigation.

Results

Staphylococcus aureus was detected in the purulent material from this abscess. Her clinical symptoms were dramatically and immediately relieved after this procedure. She achieved complete neurological recovery after 2 months of antibiotic therapy.

Conclusion

CT-guided percutaneous needle drainage and irrigation may be a rational treatment choice for patients with SEA with the exception of patients with a chronic abscess, an anterior abscess or discitis.

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References

  1. Baker AS, Ojemann RG, Swartz MN, Richardson EP Jr (1975) Spinal epidural abscess. N Engl J Med 293(10):463–468

    Article  PubMed  CAS  Google Scholar 

  2. Johnson KG (2013) Spinalepiduralabscess. Crit Care Nurs Clin N Am 25(3):389–397

    Article  Google Scholar 

  3. Soehle M, Wallenfang T (2002) Spinal epidural abscess: clinical manifestations, prognostic factors, and outcomes. Neurosurgery 51:79–87

    Article  PubMed  Google Scholar 

  4. Reihsaus E, Waldbaur H, Seeling W et al (2000) Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev 232:175–204

    Article  Google Scholar 

  5. Thanos L, Mylona S, Kalioras V et al (2004) Percutaneous CT-guided interventional procedures in musculoskeletal system (our experience). Eur J Radiol 50(3):273–277

    Article  PubMed  Google Scholar 

  6. Cassagnou M, Notteghem B, Cotten A et al (1996) Percutaneous drainage of a presacral and spinal extra-dural abscess complicating Crohn’s disease. Gastroenterol Clin Biol 20(8–9):689–692

    PubMed  CAS  Google Scholar 

  7. Lyu RK, Chen CJ, Tang LM et al (2002) Spinal epidural abscess successfully treated with percutaneous, computed tomography-guided, needle aspiration and parenteral antibiotic therapy: case report and review of the literature. Neurosurgery 51(2):509–512

    Article  PubMed  Google Scholar 

  8. Rust TM, Kohan S, Steel T et al (2005) CT guided aspiration of a cervical spinal epidural abscess. J Clin Neurosci 12(4):453–456

    Article  PubMed  CAS  Google Scholar 

  9. Siddiq F, Malik AR, Smego RA Jr (2006) Percutaneous computed tomography-guided needle aspiration drainage of spinal epidural abscess. South Med J 99(12):1406–1407

    Article  PubMed  Google Scholar 

  10. González-López JJ, Górgolas M, Muñiz J et al (2009) Spontaneous epidural abscess: analysis of 15 cases with emphasis on diagnostic and prognostic factors. Eur J Int Med 20(5):514–517

    Article  Google Scholar 

  11. Moatz B, Michael K, Rhee JM (2016) Spinal epidural abscess: diagnosis and current treatment options. Semin Spine Surg 3(28):143–149

    Article  Google Scholar 

  12. Spernovasilis N, Demetriou S, Bachlitzanaki M et al (2017) Characteristics and predictors of outcome of spontaneous spinal epidural abscesses treated conservatively: a retrospective cohort study in a referral center. Clin Neurol Neurosurg 156:11–17

    Article  PubMed  Google Scholar 

  13. Sima SS, Suna JT, Linb CK et al (2015) A rare complication of cervical spinal epidural abscess while receiving conservative treatment. J Acute Med 3(5):69–71

    Article  Google Scholar 

  14. Savage K, Holtmom OD, Zalavras CG (2005) Spinal epidural abscess: early clinical outcome in patients treated medically. Clin Orthop Relat Res 439:56–60

    Article  PubMed  Google Scholar 

  15. Arko L, Quach E, Nguyen V et al (2014) Medical and surgical management of spinal epidural abscess: a systematic review. Neurosurg Focus 37(2):E4

    Article  PubMed  Google Scholar 

  16. Kim SD, Melikian R, Ju KL et al (2014) Independent predictors of failure of nonoperative management of spinal epidural abscesses. Spine J 14(8):1673–1679

    Article  PubMed  Google Scholar 

  17. Gallucci PM, D’Orazio F (2015) Image guided interventions in spinal infections. Neuroimaging Clin N Am 25(2):281–294

    Article  PubMed  Google Scholar 

  18. Tabo E, Ohkuma Y, Kimura S et al (1994) Successful percutaneous drainage of epidural abscess with epidural needle and catheter. Anesthesiology 80:1393–1395

    Article  PubMed  CAS  Google Scholar 

  19. Walter RS, King JC Jr, Manley J et al (1991) Spinal epidural abscess in infancy: successful percutaneous drainage in a nine-month-old and review of the literature. Pediatr Infect Dis J 10(11):860–864

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Pain Department, The First Affiliated Hospital of GanNan Medical University, No. 23, Qingnian Road, Ganzhou, China

    Bing Ran, XinRong Chen, Qiong Zhong, Min Fu & Jun Wei

Authors
  1. Bing Ran
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  2. XinRong Chen
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  3. Qiong Zhong
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  4. Min Fu
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  5. Jun Wei
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Contributions

Author contributions

RB wrote the draft of the manuscript and participated in the follow-up examination of the patient and clinical material. CXR, ZQ and FM participated in the surgical and medical treatment and followed up the patient. They also have been involved in drafting the manuscript or revising it critically. WJ performed the surgery, coordinated and helped to draft and finalize the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jun Wei.

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Conflict of interest

There are no conflicts of interest for any authors and no sponsorship regarding this manuscript.

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Ran, B., Chen, X., Zhong, Q. et al. CT-guided minimally invasive treatment for an extensive spinal epidural abscess: a case report and literature review. Eur Spine J 27 (Suppl 3), 380–385 (2018). https://doi.org/10.1007/s00586-017-5307-0

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  • DOI: https://doi.org/10.1007/s00586-017-5307-0

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