Faris Shweikeh1,2, Mohammed Hussain3, Ajleeta Sangtani1, Husam Issa4, Asif Bashir3, J Patrick Johnson2, Georges Z Markarian1. 1. Summa Health System, College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA. 2. Department of Neurosurgery, Cedars-Sinai Medical Center, Maxine Dunitz Neurosurgical Institute, Advanced Health Sciences Pavilion, Los Angeles, CA, USA. 3. New Jersey Neuroscience Institute, JFK Medical Center, Edison, NJ, USA. 4. Memorial Hermann Hospital, University of Texas Health Science Center, Houston, TX, USA.
Abstract
STUDY DESIGN: Retrospective review of patient charts. OBJECTIVES: Cervical spine epidural abscess (CSEA) is uncommon. In this study, characteristics of CSEA patients are described through an institutional analysis and literature review. SETTING: University-affiliated city hospital. METHODS: The electronic medical record was searched from 01/2001 to 01/2012. Data on presentation, comorbidities, diagnostic modalities, pathogens, treatments, and neurological recovery were collected. RESULTS: Sixteen patients were identified with a mean age of 57.9 years (33-83). Nine were females. Common symptoms were neck/back pain (62.5%), neurological deficits (62.5%), and fever (31.3%). Comorbidities included cardiovascular disease (56.3%), renal disease (37.5%), and diabetes mellitus (37.5%). Lower levels were more likely afflicted (C5-C7). Microorganisms were commonly Staphylococcus and Streptococcus (68.8%). Eight (50.0%) received surgery (anterior [87.5%] and posterior [12.5%] cervical fusion and corpectomy [37.5%]) plus antibiotics and 8 (50.0%) were treated with antibiotics only. Patients with less comorbidities were more likely to receive surgery; more comorbidities were was associated with a poor prognosis. Eight patients (50%) made had full neurological recovery, 2 (12.5%) with had minimal recovery, 2 deaths died, and the remaining (25%) 1 was were sent to a skilled facility and 1or lost to follow-up. CONCLUSIONS: Cervical SEA can be problematic. The vast majority do not present classically and treatment does vary. It occurs more frequently in the lower cervical levels. Though antibiotics alone may suffice, surgery is frequently employed and a multitude of techniques are at the utility of the spine surgeon. Cardiovascular comorbidities are associated with a poorer outcome. In order to improve prognosis, management considerations should include both patient factors and multidisciplinary efforts.
STUDY DESIGN: Retrospective review of patient charts. OBJECTIVES: Cervical spine epidural abscess (CSEA) is uncommon. In this study, characteristics of CSEA patients are described through an institutional analysis and literature review. SETTING: University-affiliated city hospital. METHODS: The electronic medical record was searched from 01/2001 to 01/2012. Data on presentation, comorbidities, diagnostic modalities, pathogens, treatments, and neurological recovery were collected. RESULTS: Sixteen patients were identified with a mean age of 57.9 years (33-83). Nine were females. Common symptoms were neck/back pain (62.5%), neurological deficits (62.5%), and fever (31.3%). Comorbidities included cardiovascular disease (56.3%), renal disease (37.5%), and diabetes mellitus (37.5%). Lower levels were more likely afflicted (C5-C7). Microorganisms were commonly Staphylococcus and Streptococcus (68.8%). Eight (50.0%) received surgery (anterior [87.5%] and posterior [12.5%] cervical fusion and corpectomy [37.5%]) plus antibiotics and 8 (50.0%) were treated with antibiotics only. Patients with less comorbidities were more likely to receive surgery; more comorbidities were was associated with a poor prognosis. Eight patients (50%) made had full neurological recovery, 2 (12.5%) with had minimal recovery, 2 deaths died, and the remaining (25%) 1 was were sent to a skilled facility and 1or lost to follow-up. CONCLUSIONS: Cervical SEA can be problematic. The vast majority do not present classically and treatment does vary. It occurs more frequently in the lower cervical levels. Though antibiotics alone may suffice, surgery is frequently employed and a multitude of techniques are at the utility of the spine surgeon. Cardiovascular comorbidities are associated with a poorer outcome. In order to improve prognosis, management considerations should include both patient factors and multidisciplinary efforts.
Authors: Benjamin A Howie; Iyooh U Davidson; Joseph E Tanenbaum; Markian A Pahuta; Avery L Buchholz; Michael P Steinmetz; Thomas E Mroz Journal: Global Spine J Date: 2018-12-13
Authors: Zachary Tuvya Sharfman; Yaroslav Gelfand; Pryiam Shah; Ari Jacob Holtzman; Joseph Roy Mendelis; Merritt Drew Kinon; Jonathan David Krystal; Allan Brook; Reza Yassari; David Claude Kramer Journal: Asian Spine J Date: 2020-07-29