Article
Spontaneous and post-interventional spinal abscess : An underestimated danger!
Spontane und post-interventionelle spinale Abszesse: eine wenig ernst genommene Gefahr!
Search Medline for
Authors
-
Erik Fritzsche
- Neurochirurgische Klinik, Universitäts-Klinikum Hamburg-Eppendorf, Hamburg
-
J. Flitsch
- Neurochirurgische Klinik, Universitäts-Klinikum Hamburg-Eppendorf, Hamburg
-
L. Papavero
- Neurochirurgische Klinik, Universitäts-Klinikum Hamburg-Eppendorf, Hamburg
| Published: | April 23, 2004 |
|---|
Outline
Text
Objective
A retrospective study of 35 patients (25 referred) treated within the last 5 years for spontaneous or post-interventional epidural and paraspinal infections.
Methods
The charts of 35 patients (20 female, average age 65 years) were reviewed. Cause and localization of infections, clinical presentation, treatment modalities, co-morbidities, and outcome are reported.
Results
Eleven patients (31%) developed post-surgical abscesses: microdiscectomy (28%), decompression for spinal canal stenosis (3%) had been performed with prophylactic single-shot antibiotics. In nine cases (26%) an epidural catheterization for pain therapy was removed. Seven patients (20%) had a history of repeated paraspinal injections of steroids. In three dermatological infections were found, one suffered from occult endocarditis, and four infections were of unknown origin. Staph. aureus was detected in 14 cases. The lumbar spine was involved in most of the cases (23). Cervical (3), thoracic (2) and multisegmental localization (7) was also found. Sixteen patients (46%) presented with pain as the leading symptom, 9 (26%) showed paraparesis and 6 (17%) had a monoradicular palsy. Meningitis (2), cervical myelopathy (1), and tetraparesis (1) were a more rare clinical pattern. Thirty-one patients (88%) required surgery combined with i.v. antibiotics, four (12%) were treated by i.v. antibiotics alone. The mean duration of hospitalization was 24 days (range 05 – 121). The costs ranged from 5000 € to 60000 € (add: hospitalization+antibiotics!). Risk factors were diabetes mellitus (8), concomitant malignant disease (5) and renal disease (2). Clinical outcome (4 patients lost for follow-up): Only six patients out of 31 recovered completely. Two patients died because of sepsis and multi-organ failure. Persistent pain (15), paraparesis (5), monoradicular palsy (1), cervical myelopathy (1) and tetraparesis (1) were severe sequelae.
Conclusions
Spinal abscess formation is an underestimated complication of “minimally-invasive” open or percutaneous procedures. The high morbidity along with the huge treatment costs demand for a particular awareness of this potential complication. Early surgical intervention combined with long-term antibiotics is mandatory in the treatment of this dangerous disease.
