CASE REPORTS   

Journal of Neurosurgical Sciences 1999 March;43(1):63-7

Copyright © 1999 EDIZIONI MINERVA MEDICA

language: English

Cervical spinal epidural abscess. A report on five cases

Piccolo R., Passanisi M., Chiaramonte I., Tropea R., Mancuso P.

Department of Neurosurgery, “Garibaldi, S. Carrò, San Luigi, Ascoli Tomaselli” Hospital, Catania, Italy

The ­authors ­report a ­series of ­five cas­es of ­non tuber­cu­lous cer­vi­cal spi­nal epi­du­ral abscess­es. ­There ­were nei­ther ­patients suf­fer­ing ­from immu­no­def­i­cien­cy syn­dromes ­nor ­drug ­addicts; ­all ­the ­patients ­were in ­their sev­enth ­decade; ­two ­patients ­were affect­ed by dia­betes mel­lit­us ref­ra­to­ry to med­i­cal treat­ment. Ret­ro­pha­ryn­geal ­abscess ­was ­the ­main etio­log­ical ­risk fac­tor (­two cas­es); Sta­phyl­o­coc­cus aure­us ­was col­tured in ­two cas­es. Gad­o­lin­ium ­MRI ­was nec­es­sary ­for a pre­op­er­a­tive diag­no­sis, plan­ning sur­gi­cal ­approach ­and post­op­er­a­tive prog­no­sis. Sur­gi­cal debrid­ment ­was per­formed ­via an ante­ri­or ­approach in ­those cas­es ­where ­the col­lec­tion ­was locat­ed low­er ­than C4 ­and ­did ­not ­span ­more ­than ­three ver­te­bral seg­ments; pos­te­ri­or ­approach, ­via a lam­i­nec­to­my, ­was per­formed in a ­case of C1-C2 loca­tion of ­the ­lesion ­and in a ­case of involve­ment of ­the ­whole cer­vi­cal ­spine. Sur­gi­cal ­results ­were ­poor in ­those ­patients affect­ed by dia­betes mel­lit­us, a ­lesion involv­ing ­the ­high cer­vi­cal seg­ments (high­er ­than C4) or a ­lesion span­ning ­more ­than ­three lev­els. Med­i­cal treat­ment ­with ­MRI fol­low-up ­was ­not under­tak­en in ­any of ­the ­patients ­and we opt­ed ­for sur­gi­cal drain­age in ­all ­the cas­es ­due to ­the pos­sibil­ity of a sud­den neu­ro­log­i­cal dete­ri­ora­tion, ­caused ­both by spi­nal ­cord mechan­i­cal com­pres­sion ­and vas­cu­lar com­pro­mis­sion.