Abstract
Spinal subdural abscess (or empyema) is a focal suppurative collection within the subdural space between the dura and the arachnoid layer. This rare infection of the central nervous system has high neurologic morbidity and even mortality and may be seen in both children and adults. Clinically, the triad of fever, back or radicular pain, and neurologic deficits are suggestive of the disease, though chronic forms tend to have less-specific symptoms that mimic those of spinal cord tumors. MRI with gadolinium injection is the investigation of choice. Staphylococcus aureus, Streptococcus species, and Mycobacterium tuberculosis are the microorganisms most likely to be found. The classic treatment of spinal subdural abscesses is surgical drainage of the suppurative collection followed by the administration of adequate antibiotic drugs. Conservative management is not appropriate. Good clinical recovery is correlated with prompt diagnosis, rapid surgical decompression and drainage, and appropriate antimicrobial therapy. Common complications include paraplegia, sphincter dysfunctions, recurrence, meningitis, sepsis, and even death.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Suggested Reading
Agarwal N, Shah J, Hansberry DR, Mammis A, Sharer LR, Goldstein IM. Presentation of cauda equina syndrome due to an intradural extramedullary abscess: a case report. Spine J. 2014;14:e1–6. doi:10.1016/j.spinee.2013.09.029.
Akhaddar A, El Hassani MY, Gazzaz-Rifi M, Chakir N, El Khamlichi A, Jiddane M. MR imaging in the diagnosis of intradural extramedullary tuberculoma. Report of a case and review of the literature. J Neuroradiol. 2000;27:107–11.
Diehn FE. Imaging of spine infection. Radiol Clin N Am. 2012;50:777–98. doi:10.1016/j.rcl.2012.04.001.
Hasan MY, Kumar KK, Lwin S, Lau LL, Kumar N. Cervical intradural abscess masquerading as an epidural collection. Global Spine J. 2013;3:249–52. doi:10.1055/s-0033-1337123.
Khalil JG, Nassr A, Diehn FE, Campeau NG, Atkinson JL, Sia IG, et al. Thoracolumbosacral spinal subdural abscess: magnetic resonance imaging appearance and limited surgical management. Spine (Phila Pa 1976). 2013;38:E844–7. doi:10.1097/BRS.0b013e31828d5f30.
Kraeutler MJ, Bozzay JD, Walker MP, John K. Spinal subdural abscess following epidural steroid injection. J Neurosurg Spine. 2015;22:90–3. doi:10.3171/2014.9.SPINE14159.
Lim HY, Choi HJ, Kim S, Kuh SU. Chronic spinal subdural abscess mimicking an intradural-extramedullary tumor. Eur Spine J. 2013;22(Suppl 3):497–500. doi:10.1007/s00586-013-2700-1.
Manchikanti L, Atluri S, Kaye AD, Hirsch JA. A report of spinal subdural abscess provides incomplete and inaccurate information. J Neurosurg Spine. 2016;24:675–7. doi:10.3171/2015.7.SPINE15846.
Moritani T, Kim J, Capizzano AA, Kirby P, Kademian J, Sato Y. Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections. Br J Radiol. 2014;87:20140011. doi:10.1259/bjr.20140011.
Nadkarni T, Shah A, Kansal R, Goel A. An intradural-extramedullary gas-forming spinal abscess in a patient with diabetes mellitus. J Clin Neurosci. 2010;17:263–5. doi:10.1016/j.jocn.2009.05.019.
Ozates M, Ozkan U, Kemaloglu S, Hosoglu S, Sari I. Spinal subdural tuberculous abscess. Spinal Cord. 2000;38:56–8.
Park SW, Yoon SH, Cho KH, Shin YS, Ahn YH. Infantile lumbosacral spinal subdural abscess with sacral dermal sinus tract. Spine (Phila Pa 1976). 2007;32:E52–5.
Sandler AL, Thompson D, Goodrich JT, van Aalst J, Kolatch E, El Khashab M, et al. Infections of the spinal subdural space in children: a series of 11 contemporary cases and review of all published reports. A multinational collaborative effort. Childs Nerv Syst. 2013;29:105–17. doi:10.1007/s00381-012-1916-4.
Sathi S, Schwartz M, Cortez S, Rossitch E Jr. Spinal subdural abscess: successful treatment with limited drainage and antibiotics in a patient with AIDS. Surg Neurol. 1994;42:424–7.
Usoltseva N, Medina-Flores R, Rehman A, Samji S, D'Costa M. Spinal subdural abscess: a rare complication of decubitus ulcer. Clin Med Res. 2014;12:68–72. doi:10.3121/cmr.2013.1174.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
Akhaddar, A. (2017). Spinal Subdural Abscesses. In: Atlas of Infections in Neurosurgery and Spinal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-60086-4_19
Download citation
DOI: https://doi.org/10.1007/978-3-319-60086-4_19
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-60085-7
Online ISBN: 978-3-319-60086-4
eBook Packages: MedicineMedicine (R0)