STUDY DESIGN: Retrospective database review of a prospectively maintained neurosurgical database. OBJECTIVE: The surgical management of cervical spinal epidural abscesses (CSEA) is reviewed examining the shift from single to staged anteroposterior decompression and stabilization. SUMMARY OF BACKGROUND DATA: CSEA management is guided by small case series. METHODS: A retrospective review from 1997 to 2011 was conducted for patients with the diagnostic headings: cervical epidural abscess, infection, osteomyelitis, osteodiscitis, spondylodiscitis, and abscess. Comorbidities, risk factors, surgical approach, neurologic grade, and outcomes were recorded. RESULTS: Forty consecutive patients (mean age 53 years, age range 23-74, SD ±14, 10 female) were identified with CSEA in the operative database from 1997 to 2010. Twenty one patients had a body mass index more than 25 (53%), 6 (15%) had diabetes mellitus, 6 (15%) had a prior malignancy with 2 having prior neck irradiation, and 9 (23%) used tobacco products. The most common risk factor associated with CSEA was intravenous drug abuse, found in 10 patients (25%). The most common level of discitis involvement was C6-C7 in 12 (30%) followed by C5-C6 disc in 11 (28%) and least often at C1-C2 level in 2(5%) and C7-T1 in 2(5%). The most common neurologic grades at presentation were AIS D in 20 (50%) followed by AIS E in 9 (28%). All patients received magnetic resonance imaging identifying 17 (43%) with dorsal, 12 ventral (30%), and 11 circumferential epidural abscesses (28%). The majority of patients underwent anterior followed by posterior decompression and stabilization (n = 26, 65%); 8 (20%) underwent a ventral approach and six underwent a dorsal approach (15%). Fusion was achieved in 39 of 40 (97.5%) and not significantly influenced halo use in 10 patients. CONCLUSIONS: In this series, patients underwent acute evacuation and spinal cord decompression, and the shift toward staged treatment did not lead to an increased periprocedural complication rate. LEVEL OF EVIDENCE: 3.
STUDY DESIGN: Retrospective database review of a prospectively maintained neurosurgical database. OBJECTIVE: The surgical management of cervical spinal epidural abscesses (CSEA) is reviewed examining the shift from single to staged anteroposterior decompression and stabilization. SUMMARY OF BACKGROUND DATA: CSEA management is guided by small case series. METHODS: A retrospective review from 1997 to 2011 was conducted for patients with the diagnostic headings: cervical epidural abscess, infection, osteomyelitis, osteodiscitis, spondylodiscitis, and abscess. Comorbidities, risk factors, surgical approach, neurologic grade, and outcomes were recorded. RESULTS: Forty consecutive patients (mean age 53 years, age range 23-74, SD ±14, 10 female) were identified with CSEA in the operative database from 1997 to 2010. Twenty one patients had a body mass index more than 25 (53%), 6 (15%) had diabetes mellitus, 6 (15%) had a prior malignancy with 2 having prior neck irradiation, and 9 (23%) used tobacco products. The most common risk factor associated with CSEA was intravenous drug abuse, found in 10 patients (25%). The most common level of discitis involvement was C6-C7 in 12 (30%) followed by C5-C6 disc in 11 (28%) and least often at C1-C2 level in 2(5%) and C7-T1 in 2(5%). The most common neurologic grades at presentation were AIS D in 20 (50%) followed by AIS E in 9 (28%). All patients received magnetic resonance imaging identifying 17 (43%) with dorsal, 12 ventral (30%), and 11 circumferential epidural abscesses (28%). The majority of patients underwent anterior followed by posterior decompression and stabilization (n = 26, 65%); 8 (20%) underwent a ventral approach and six underwent a dorsal approach (15%). Fusion was achieved in 39 of 40 (97.5%) and not significantly influenced halo use in 10 patients. CONCLUSIONS: In this series, patients underwent acute evacuation and spinal cord decompression, and the shift toward staged treatment did not lead to an increased periprocedural complication rate. LEVEL OF EVIDENCE: 3.
Authors: Faris Shweikeh; Mohammed Hussain; Ajleeta Sangtani; Husam Issa; Asif Bashir; J Patrick Johnson; Georges Z Markarian Journal: Spinal Cord Ser Cases Date: 2017-07-06
Authors: George M Ghobrial; James S Harrop; Rick C Sasso; Chadi A Tannoury; Tony Tannoury; Zachary A Smith; Wellington K Hsu; Paul M Arnold; Michael G Fehlings; Thomas E Mroz; Anthony F De Giacomo; Bruce C Jobse; Ra'Kerry K Rahman; Sara E Thompson; K Daniel Riew Journal: Global Spine J Date: 2017-04-01
Authors: Gabrielle G Tardieu; Christian Fisahn; Marios Loukas; Marc Moisi; Jens Chapman; Rod J Oskouian; R Shane Tubbs Journal: Cureus Date: 2016-09-13