Surgical Outcome of Spinal Subdural Abscesses: A Report of Four Consecutive Patients and Brief Review of the Literature

Abstract

Background and Study Aims Spinal subdural abscesses (SSAs) are rare and have a poor prognosis, especially when they are diagnosed late. In the literature, most cases of SSAs have been reported as case reports and small case series. In this study, we aimed to evaluate the surgical outcomes of four consecutive SSA patients.

Material and Methods In this retrospective study, we reviewed the medical charts of four SSA patients who underwent surgical intervention at two neurosurgical centers from September 2012 to September 2019.

Results Our series comprised four patients (three females and one male) with SSA (intradural–extramedullary) who were treated surgically. Holocord SSA was observed in two patients. The mean age was 15.1 ± 17.1 years. Unsteady gait and weakness of legs was the presenting symptom in all patients. The mean preoperative course was 5.3 ± 3.4 weeks. The causative pathogens were methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli, and Mycobacterium tuberculosis. In the fourth case, the pathogen was non–M. tuberculosis. In the 44th postoperative month, the patient underwent surgery for an intramedullary abscess. The causative pathogen was E. coli. Except for one adolescent male who was paraplegic at presentation, improvement was observed in all patients at their last follow-up after 54.0 ± 35.9 months after surgery.

Conclusion Early diagnosis and urgent surgical intervention are essential for a good prognosis in SSA cases. We recommend drainage followed by appropriate antibiotics.

Keywords

spinal subdural abscess - holocord abscess - emergent surgical intervention - antibiotic - physical therapy and rehabilitation

Note

This retrospective study was approved under decision number 532/2015 by the medical ethics committee of Bakırköy Research and Training Hospital for Neurology Neurosurgery, and Psychiatry (BRSHH), University of Health Sciences in Istanbul, Turkey.

Statement of Authorship

AA was responsible for conceptualization, methodology, software, supervision, formal analysis, literature review, visualization, investigation, writing the original draft, and review of the manuscript. EE, BGA, İÇ, and RA were responsible for validation. EE was also responsible for supervision and writing and review of the manuscript. Writing, reviewing, editing, literature review, and formal analysis were done by BGA. DÖ also participated in the literature review. İÇ was involved in validation, supervision, writing, and reviewing of the manuscript.

Publication History

Received: 23 January 2021

Accepted: 23 April 2021

Article published online:
18 January 2022

• References

• 1 Vural M, Arslantaş A, Adapinar B. et al. Spinal subdural Staphylococcus aureus abscess: case report and review of the literature. Acta Neurol Scand 2005; 112 (05) 343-346
• 2 Schneider P, Givens TG. Spinal subdural abscess in a pediatric patient: a case report and review of the literature. Pediatr Emerg Care 1998; 14 (01) 22-23
• 3 Al Barbarawi M, Khriesat W, Qudsieh S, Qudsieh H, Loai AA. Management of intramedullary spinal cord abscess: experience with four cases, pathophysiology and outcomes. Eur Spine J 2009; 18 (05) 710-717
• 4 Abdallah A, Emel E, Abdallah BG, Asiltürk M, Sofuoğlu ÖE. Factors affecting the surgical outcomes of tethered cord syndrome in adults: a retrospective study. Neurosurg Rev 2018; 41 (01) 229-239
• 5 Klekamp J, Samii M. Introduction of a score system for the clinical evaluation of patients with spinal processes. Acta Neurochir (Wien) 1993; 123 (3–4): 221-223
• 6 Abdallah A. Spinal seeding metastasis of myxopapillary ependymoma: report of three pediatric patients and a brief literature review. Pediatr Neurosurg 2020; 55 (03) 127-140
• 7 Abdallah A, Emel E, Gündüz HB, Sofuoğlu ÖE, Asiltürk M, Abdallah BG. Long-term surgical resection outcomes of pediatric myxopapillary ependymoma: Experience of two centers and brief literature review. World Neurosurg 2020; 136: e245-e261
• 8 Walker A, Bucy PC. Congenital dermal sinuses: a source of spinal meningeal infection and subdural abscesses. Brain 1934; 57: 401-421
• 9 Sandler AL, Thompson D, Goodrich JT. et al. Infections of the spinal subdural space in children: a series of 11 contemporary cases and review of all published reports. A multinational collaborative effort. Childs Nerv Syst 2013; 29 (01) 105-117
• 10 van Aalst J, Beuls EAM, Cornips EMJ. et al. Anatomy and surgery of the infected dermal sinus of the lower spine. Childs Nerv Syst 2006; 22 (10) 1307-1315
• 11 Mount LA. Congenital dermal sinuses as a cause of meningitis, intraspinal abscess and intracranial abscess. J Am Med Assoc 1949; 139 (18) 1263-1268
• 12 Hirson C. Spinal subdural abscess. Lancet 1965; 2 (7424): 1215-1217
• 13 Achouri M, Hilmani S, Sami A. et al. Intradural extramedullary tuberculous abscess. Apropos of a case. Neurochirurgie 1996; 42 (06) 306-308
• 14 Chen CY, Lin KL, Wang HS, Lui TN. Dermoid cyst with dermal sinus tract complicated with spinal subdural abscess. Pediatr Neurol 1999; 20 (02) 157-160
• 15 Desai KI, Muzumdar DP, Goel A. Holocord intramedullary abscess: an unusual case with review of literature. Spinal Cord 1999; 37 (12) 866-870
• 16 Ozates M, Ozkan U, Kemaloglu S, Hosoglu S, Sari I. Spinal subdural tuberculous abscess. Spinal Cord 2000; 38 (01) 56-58
• 17 Sorar M, Er U, Seçkin H, Ozturk MH, Bavbek M. Spinal subdural abscess: a rare cause of low back pain. J Clin Neurosci 2008; 15 (03) 292-294
• 18 Velissaris D, Aretha D, Fligou F, Filos KS. Spinal subdural Staphylococcus aureus abscess: case report and review of the literature. World J Emerg Surg 2009; 4: 31
• 19 Nadkarni T, Shah A, Kansal R, Goel A. An intradural-extramedullary gas-forming spinal abscess in a patient with diabetes mellitus. J Clin Neurosci 2010; 17 (02) 263-265
• 20 Gul S, Celebı G, Kalayci M, Acikgoz B. Syringomyelia and intradural extramedullary tuberculoma of the spinal cord as a late complication of tuberculous meningitis. Turk Neurosurg 2010; 20 (04) 561-565
• 21 Lim HY, Choi HJ, Kim S, Kuh SU. Chronic spinal subdural abscess mimicking an intradural-extramedullary tumor. Eur Spine J 2013; 22 (Suppl. 03) S497-S500
• 22 Tono V, Bertoletti S, Maltese F. et al. A girl with life threatening meningitis caused by an infected dermoid cyst derived from an occult dermal sinus. Case Rep Clin Med 2014; 3: 450-456
• 23 Cheon JE, Yang HJ, Chung YN, Park SB. Pyogenic Intradural Abscess of Lumbar Spine: A Case Report. Korean J Neurotrauma 2015; 11 (01) 18-21
• 24 Karatay M, Koktekir E, Celik H, Erdem Y, Sertbas I, Bayar MA. Spinal intradural abscess caused by hematogenous spread of Prevotella oralis in a 3-year-old child with an asymptomatic congenital spinal abnormality. Spinal Cord 2015; 53 (Suppl. 01) S13-S15
• 25 Ramos AD, Rolston JD, Gauger GE, Larson PS. Spinal subdural abscess following laminectomy for symptomatic stenosis: a report of 2 cases and review of the literature. Am J Case Rep 2016; 17: 476-483
• 26 Wewel JT, Kumar V, Kasliwal MK, Fontes RB. Coexistent panspinal subdural abscess and isolated leptomeningeal myeloma relapse presenting as rapid-onset paraparesis. J Emerg Med 2016; 51 (06) 729-731
• 27 Sahin A, Kilic M, Dalgic N. A case report of a 4-year-old boy with intradural spinal cord abscess successfully treated with adjuvant hyperbaric oxygen therapy. Turk Neurosurg 2019; 29 (05) 789-792
• 28 Sorenson TJ, Lanzino G. Intradural Staphylococcus aureus abscess of the Cauda equina in an otherwise healthy patient. Case Rep Surg 2019; 2019: 4860420
• 29 Kim M, Simon J, Mirza K. et al. Spinal intradural Escherichia coli abscess masquerading as a neoplasm in a pediatric patient with history of neonatal E. coli meningitis: a case report and literature review. World Neurosurg 2019; 126: 619-623
• 30 Akhaddar A, Boulahroud O, Boucetta M. Chronic spinal cord abscess in an elderly patient. Surg Infect (Larchmt) 2011; 12 (04) 333-334
• 31 Chen MH, Chen MH, Huang JS. Cervical subdural empyema following acupuncture. J Clin Neurosci 2004; 11 (08) 909-911
• 32 Bartels RH, de Jong TR, Grotenhuis JA. Spinal subdural abscess. Case report. J Neurosurg 1992; 76 (02) 307-311
• 33 Abdallah A. Pediatric spinal subdural abscesses: a report of three consecutive patients. Pediatr Neurosurg 2021; 56 (01) 17-34