A Clinical Review on Spinal Epidural Abscess: Epidemiology, Pathophysiology, Diagnosis, and Management for Emergency Medicine and Hospitalist Physicians.

HCA healthcare journal of medicine Pub Date : 2024-08-01 eCollection Date: 2024-01-01 DOI:10.36518/2689-0216.1676
Madeline A Guy, Jeffrey S Guy
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Abstract

Description Spinal epidural abscess (SEA), a critical surgical emergency, demands prompt recognition and intervention to prevent severe complications and fatalities. The incidence of SEA is notably increasing, particularly among individuals with diabetes, intravenous drug use, or a history of invasive spinal procedures. Although SEA can manifest through various clinical symptoms, the presence of its classic triad-back pain, fever, and neurological deficits-is noteworthy despite its occurrence in only 10% to 13% of cases. Identifying this triad is vital due to its high specificity for SEA, which is essential to guiding swift diagnostic and therapeutic actions in a condition where early intervention is critical. Magnetic resonance imaging is pivotal in diagnosing SEA, offering unmatched sensitivity and specificity compared to other imaging techniques. Immediate empirical antibiotic therapy and timely neurosurgical consultation, when required, form the foundation of SEA treatment. The prognosis significantly depends on the patient's initial neurological status, underlying health conditions, and the timeliness of their presentation, diagnosis, and treatment initiation. Given the complexity of SEA and the high risk of diagnostic delays, managing this condition involves substantial medicolegal considerations. Enhanced comprehension of SEA is imperative for improving patient outcomes and reducing health care resource burdens. Prompt and accurate diagnosis and appropriate interventions are essential for effectively managing this urgent condition.

脊髓硬膜外脓肿临床综述:流行病学、病理生理学、诊断和处理,供急诊科和住院医生使用。
描述 脊柱硬膜外脓肿(SEA)是一种严重的外科急症,需要及时识别和干预,以防止严重并发症和死亡。脊髓外膜脓肿的发病率正在显著上升,尤其是在患有糖尿病、静脉注射毒品或有脊髓侵入性手术史的患者中。尽管 SEA 可通过各种临床症状表现出来,但值得注意的是,尽管仅有 10% 到 13% 的病例会出现背痛、发热和神经功能缺损这典型的三联征。由于三联征对 SEA 具有高度特异性,因此识别三联征至关重要,这对指导迅速诊断和治疗至关重要,因为早期干预对病情至关重要。磁共振成像是诊断 SEA 的关键,与其他成像技术相比,它具有无与伦比的敏感性和特异性。必要时,立即进行经验性抗生素治疗和及时的神经外科会诊是 SEA 治疗的基础。预后在很大程度上取决于患者最初的神经系统状况、潜在的健康状况,以及就诊、诊断和开始治疗的及时性。鉴于 SEA 的复杂性和诊断延误的高风险,管理这种疾病需要考虑大量的医疗法律问题。加强对 SEA 的理解是改善患者预后和减少医疗资源负担的当务之急。及时准确的诊断和适当的干预措施对于有效管理这种紧急状况至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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