Management of cervical spine epidural abscess: a systematic review.
cervical spine
epidural abscess
surgery
treatment outcome
Journal
Therapeutic advances in infectious disease
ISSN: 2049-9361
Titre abrégé: Ther Adv Infect Dis
Pays: England
ID NLM: 101606715
Informations de publication
Date de publication:
Historique:
received:
14
11
2018
accepted:
24
06
2019
entrez:
2
8
2019
pubmed:
2
8
2019
medline:
2
8
2019
Statut:
epublish
Résumé
Cervical spinal epidural abscess (CSEA) is a localized infection between the thecal sac and cervical spinal column which may result in neurological deficit and death if inadequately treated. Two treatment options exist: medical management and surgical intervention. Our objective was to analyze CSEA patient outcomes in order to determine the optimal method of treatment. An electronic literature search for relevant case series and retrospective reviews was conducted through June 2016. Data abstraction and study quality assessment were performed by two independent reviewers. A lack of available data led to a post hoc decision not to perform meta-analysis of the results; study findings were synthesized qualitatively. 927 studies were identified, of which 11 were included. Four studies were ranked as good quality, and seven ranked as fair quality. In total, data from 173 patients were included. Mean age was 55 years; 61.3% were male. Intravenous drug use was the most common risk factor for CSEA development. The rates of medical management failure described in our review were much higher than those reported in the literature for thoracolumbar spinal epidural abscess patients, suggesting that CSEA patients may be at a greater risk for poor outcomes following nonoperative treatment. Thus, early surgery appears most viable for optimizing CSEA patient outcomes. Further research is needed in order to corroborate these recommendations.
Sections du résumé
BACKGROUND
BACKGROUND
Cervical spinal epidural abscess (CSEA) is a localized infection between the thecal sac and cervical spinal column which may result in neurological deficit and death if inadequately treated. Two treatment options exist: medical management and surgical intervention. Our objective was to analyze CSEA patient outcomes in order to determine the optimal method of treatment.
METHODS
METHODS
An electronic literature search for relevant case series and retrospective reviews was conducted through June 2016. Data abstraction and study quality assessment were performed by two independent reviewers. A lack of available data led to a post hoc decision not to perform meta-analysis of the results; study findings were synthesized qualitatively.
RESULTS
RESULTS
927 studies were identified, of which 11 were included. Four studies were ranked as good quality, and seven ranked as fair quality. In total, data from 173 patients were included. Mean age was 55 years; 61.3% were male. Intravenous drug use was the most common risk factor for CSEA development.
CONCLUSION
CONCLUSIONS
The rates of medical management failure described in our review were much higher than those reported in the literature for thoracolumbar spinal epidural abscess patients, suggesting that CSEA patients may be at a greater risk for poor outcomes following nonoperative treatment. Thus, early surgery appears most viable for optimizing CSEA patient outcomes. Further research is needed in order to corroborate these recommendations.
Identifiants
pubmed: 31367375
doi: 10.1177/2049936119863940
pii: 10.1177_2049936119863940
pmc: PMC6643182
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
2049936119863940Déclaration de conflit d'intérêts
Conflict of interest statement: The authors declare that there is no conflict of interest.
Références
Spinal Cord. 1999 Feb;37(2):103-9
pubmed: 10065748
Surg Neurol. 1999 Aug;52(2):189-96; discussion 197
pubmed: 10447289
J Neurosurg Sci. 1999 Mar;43(1):63-7
pubmed: 10494668
Neurosurg Rev. 2000 Dec;23(4):175-204; discussion 205
pubmed: 11153548
Clin Neurol Neurosurg. 2002 Sep;104(4):306-10
pubmed: 12140094
Neurosurgery. 2002 Jul;51(1):79-85; discussion 86-7
pubmed: 12182438
J Emerg Med. 2004 Apr;26(3):285-91
pubmed: 15028325
J Am Acad Orthop Surg. 2004 May-Jun;12(3):155-63
pubmed: 15161168
Arch Intern Med. 2004 Dec 13-27;164(22):2409-12
pubmed: 15596629
Surg Neurol. 2005 Apr;63(4):364-71; discussion 371
pubmed: 15808726
N Engl J Med. 2006 Nov 9;355(19):2012-20
pubmed: 17093252
J Neurosurg Spine. 2006 Nov;5(5):392-7
pubmed: 17120887
Med J Aust. 1991 Jul 1;155(1):14-7
pubmed: 1829780
Minim Invasive Neurosurg. 2008 Feb;51(1):36-42
pubmed: 18306130
Acta Neurochir (Wien). 2009 Nov;151(11):1537-41
pubmed: 19756355
Neurosurgery. 2009 Nov;65(5):919-23; discussion 923-4
pubmed: 19834405
Neurosurgery. 2010 May;66(5):910-6
pubmed: 20404695
Curr Infect Dis Rep. 2010 Nov;12(6):484-91
pubmed: 21308559
J Neurosurg Spine. 2013 Jul;19(1):119-27
pubmed: 23662888
Crit Care Nurs Clin North Am. 2013 Sep;25(3):389-97
pubmed: 23981455
Spine J. 2014 Feb 1;14(2):326-30
pubmed: 24231778
Global Spine J. 2011 Dec;1(1):1-8
pubmed: 24353930
J Neurosurg Spine. 2014 Mar;20(3):344-9
pubmed: 24359002
Spine J. 2014 Aug 1;14(8):1673-9
pubmed: 24373683
Spine J. 2015 Jan 1;15(1):10-7
pubmed: 24937797
Neurosurg Focus. 2014 Aug;37(2):E4
pubmed: 25081964
Syst Rev. 2015 Jan 01;4:1
pubmed: 25554246
Spine (Phila Pa 1976). 2015 Sep 1;40(17):E949-53
pubmed: 25893350
Global Spine J. 2016 Jun;6(4):383-93
pubmed: 27190742
World Neurosurg. 2016 Sep;93:20-8
pubmed: 27262655
J Neurosurg Spine. 2017 Jan;26(1):81-89
pubmed: 27636865
Global Spine J. 2018 Dec;8(4 Suppl):68S-84S
pubmed: 30574442
Global Spine J. 2018 Dec;8(4 Suppl):85S-95S
pubmed: 30574443
Neurology. 1987 Nov;37(11):1747-53
pubmed: 3313100
Mt Sinai J Med. 1994 Sep;61(4):357-62
pubmed: 7969230
Neurosurgery. 1996 Nov;39(5):958-64
pubmed: 8905751
Eur J Med Res. 1997 May 28;2(5):201-5
pubmed: 9153344