Morphological Aspects of Pyogenic Spinal Epidural Abscess
Article Sidebar
Published:
Apr 24, 2023
Keywords:
Infection, epidural, abscess, osteomyelitis, spondylodiscitis, classification, magnetic resonance
Main Article Content
Abstract
Introduction: A pyogenic spinal epidural abscess is an infectious collection inside the spinal canal, outside the dural sac. The diagnosis is difficult and the consequences are devastating due to compression or vascular compromise. MRI has a high diagnostic sensitivity and specificity, which improves when a contrast medium is used.
Objectives: To determine the inter- and intra-observer reproducibility, and to discriminate the different parameters and differences between specialties.
Materials and Methods: Twenty-seven independent observers evaluated 5 parameters: region, location, involvement, association, and perivertebral, anterior, lateral, or posterior extravertebral abscess. The kappa coefficient was used to analyze 35 cases on three occasions.
Results: The overall intra- and inter-observer global agreement level is kappa 0.76, with the following values obtained: region 0.94; location 0.88; involvement 0.55; association 0.67 and perivertebral abscess 0.77. The first three parameters indicate volume, while the final two indicate the presence of vertebral infectious foci outside the canal.
Conclusions: The proposed morphological classification is simple to use and has high intra- and inter-observer reproducibility. The most reproducible parameters are region and location(>0.87).
Objectives: To determine the inter- and intra-observer reproducibility, and to discriminate the different parameters and differences between specialties.
Materials and Methods: Twenty-seven independent observers evaluated 5 parameters: region, location, involvement, association, and perivertebral, anterior, lateral, or posterior extravertebral abscess. The kappa coefficient was used to analyze 35 cases on three occasions.
Results: The overall intra- and inter-observer global agreement level is kappa 0.76, with the following values obtained: region 0.94; location 0.88; involvement 0.55; association 0.67 and perivertebral abscess 0.77. The first three parameters indicate volume, while the final two indicate the presence of vertebral infectious foci outside the canal.
Conclusions: The proposed morphological classification is simple to use and has high intra- and inter-observer reproducibility. The most reproducible parameters are region and location(>0.87).
Downloads
Download data is not yet available.
Metrics
Metrics Loading ...
Article Details
How to Cite
Bazán, P. L., Godoy Adaro, A. O., Padini, E., Casco, E. A., & Maruñak, M. (2023). Morphological Aspects of Pyogenic Spinal Epidural Abscess. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(2), 148-155. https://doi.org/10.15417/issn.1852-7434.2023.88.2.1513
Issue
Section
Clinical Research
Copyright (c) 2023 Revista de la Asociación Argentina de Ortopedia y Traumatología
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
References
1. Pradilla G, Ardila GP, Hsu W, Rigamonti D. Epidural abscesses of the CNS. Lancet Neurol 2009;8(3):292-300. https://doi.org/10.1016/S1474-4422(09)70044-4
2. DeFroda SF, DePasse JM, Eltorai AEM, Daniels AH, Palumbo MA. Evaluation and management of spinal epidural abscess. J Hosp Med 2016;11(2):130-5. https://doi.org/10.1002/jhm.2506
3. Bond A, Manian FA. Spinal epidural abscess: A review with special emphasis on earlier diagnosis. BioMed Res Int 2016;2016:1614328. https://doi.org/10.1155/2016/1614328
4. Babic M, Simpfendorfer CS, Berbari EF. Update on spinal epidural abscess. Curr Opin Infect Dis 2019;32(3):265-71. https://doi.org/10.1097/QCO.0000000000000544
5. Pradilla G, Nagahama Y, Spivak AM, Bydon A, Rigamonti D. Spinal epidural abscess: current diagnosis and management. Curr Infect Dis Rep 2010;12(6):484-91. https://doi.org/10.1007/s11908-010-0140-1
6. Rutges JPHJ, Kempen DH, van Dijk M, Oner FC. Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review. Eur Spine J 2016;25(3):983-99.
https://doi.org/10.1007/s00586-015-4318-y
7. Eltorai AE, Naqvi SS, Seetharam A, Brea BA, Simon C. Recent developments in the treatment of spinal epidural abscesses. Orthop Rev (Pavia) 2017;9(2):7010. https://doi.org/10.4081/or.2017.7010
8. Cornett CA, Vincent SA, Crow J, Hewlett A. Bacterial spine infections in adults: Evaluation and management. J Am Acad Orthop Surg 2016;24(1):11-8. https://doi.org/10.5435/JAAOS-D-13-00102
9. Kumar Y, Gupta N, Chabra A, Fukuda T, Soni N, Hayashi D. Magnetic resonance imaging of bacterial and tuberculous spondylodiscitis with associated complications and non-infectious spinal pathology mimicking infections: a pictorial review. BMC Musculoskelet Disord 2017;18(1):224.
https://doi.org/10.1186/s12891-017-1608-z
10. Raghavan M, Lazzeri E, Palestro CJ. Imaging of spondylodiscitis. Semin Nucl Med 2017;48(2):131-47.
https://doi.org/10.1053/j.semnuclmed.2017.11.001
11. Alerhand S, Wood S, Long B, Koyfman A. The time-sensitive challenge of diagnosing spinal epidural abscess in the emergency department. Intern Emerg Med 2017;12(8):1179-83. https://doi.org/10.1007/s1739-017-1718-5
12. Petrova AS, Zhelyazkov CB, Kitov, BD. Spontaneous spondylodiscitis – Epidemiology, clinical features, diagnosis and treatment. Folia Medica (Plovdiv) 2017;59(3):254-60. https://doi.org/10.1515/folmed-2017-0024
13. Pola E, Autore G, Formica VM, Pambianco V, Colangelo D, Cauda R, et al. New classification for the treatment of pyogenic spondylodiscitis: validation study on a population of 250 patients with a follow-up of 2 years. Eur Spine J 2017;26(Suppl 4):479-88. https://doi.org/10.1007/s00586-017-5043-5
14. Almansour H, Pepke W, Akbar M. Pyogenic spondylodiscitis. The quest towards a clinical-radiological classification. Der Orthopade 2020;49(6):482-93. https://doi.org/10.1007/s00132-019-03836-0
15. Bilsky MH, Laufer I, Fourney DR, Groff M, Schmidt MH, Varga P, et al. Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine 2020;13(3):324-8. https://doi.org/10.3171/2010.3.SPINE09459
16. Shah AA, Yang H, Harris MB, Schwab JH. A Classification system for spinal cord compression and its association with neurological deficit in spinal epidural abscess. Clin Spine Surg 2019;32(3):E126-E132.
https://doi.org/10.1097/BSD.0000000000000746
17. Uchida K, Nakajima H, Yayama T, Sato R, Kobayaski S, Chen KB, et al. Epidural abscess associated with pyogenic spondylodiscitis of the lumbar spine; evaluation of a new MRI staging classification and imaging findings as indicators of surgical management: a retrospective study of 37 patients. Arch Orthop Trauma Surg 2010;130(1):111-8. https://doi.org/10.1007/s00402-009-0928-3
18. Bazán PL, Soria Adaro JC, Godoy Adaro AO, Ciccioli NM, Avero Gonzalez RA. Morphological aspect of pyogenic spinal epidural abscesses. Part I. Coluna/Columna 2022;21(1). https://doi.org/10.1590/S1808-185120222101260738
19. Camino Willhuber G, Guiroy A, Zamorano J, Astur N, Valacco M. Independent reliability analysis of a new classification for pyogenic spondylodiscitis. Global Spine J 2021;11(5):669-73. https://doi.org/10.1177/2192568220919091
2. DeFroda SF, DePasse JM, Eltorai AEM, Daniels AH, Palumbo MA. Evaluation and management of spinal epidural abscess. J Hosp Med 2016;11(2):130-5. https://doi.org/10.1002/jhm.2506
3. Bond A, Manian FA. Spinal epidural abscess: A review with special emphasis on earlier diagnosis. BioMed Res Int 2016;2016:1614328. https://doi.org/10.1155/2016/1614328
4. Babic M, Simpfendorfer CS, Berbari EF. Update on spinal epidural abscess. Curr Opin Infect Dis 2019;32(3):265-71. https://doi.org/10.1097/QCO.0000000000000544
5. Pradilla G, Nagahama Y, Spivak AM, Bydon A, Rigamonti D. Spinal epidural abscess: current diagnosis and management. Curr Infect Dis Rep 2010;12(6):484-91. https://doi.org/10.1007/s11908-010-0140-1
6. Rutges JPHJ, Kempen DH, van Dijk M, Oner FC. Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review. Eur Spine J 2016;25(3):983-99.
https://doi.org/10.1007/s00586-015-4318-y
7. Eltorai AE, Naqvi SS, Seetharam A, Brea BA, Simon C. Recent developments in the treatment of spinal epidural abscesses. Orthop Rev (Pavia) 2017;9(2):7010. https://doi.org/10.4081/or.2017.7010
8. Cornett CA, Vincent SA, Crow J, Hewlett A. Bacterial spine infections in adults: Evaluation and management. J Am Acad Orthop Surg 2016;24(1):11-8. https://doi.org/10.5435/JAAOS-D-13-00102
9. Kumar Y, Gupta N, Chabra A, Fukuda T, Soni N, Hayashi D. Magnetic resonance imaging of bacterial and tuberculous spondylodiscitis with associated complications and non-infectious spinal pathology mimicking infections: a pictorial review. BMC Musculoskelet Disord 2017;18(1):224.
https://doi.org/10.1186/s12891-017-1608-z
10. Raghavan M, Lazzeri E, Palestro CJ. Imaging of spondylodiscitis. Semin Nucl Med 2017;48(2):131-47.
https://doi.org/10.1053/j.semnuclmed.2017.11.001
11. Alerhand S, Wood S, Long B, Koyfman A. The time-sensitive challenge of diagnosing spinal epidural abscess in the emergency department. Intern Emerg Med 2017;12(8):1179-83. https://doi.org/10.1007/s1739-017-1718-5
12. Petrova AS, Zhelyazkov CB, Kitov, BD. Spontaneous spondylodiscitis – Epidemiology, clinical features, diagnosis and treatment. Folia Medica (Plovdiv) 2017;59(3):254-60. https://doi.org/10.1515/folmed-2017-0024
13. Pola E, Autore G, Formica VM, Pambianco V, Colangelo D, Cauda R, et al. New classification for the treatment of pyogenic spondylodiscitis: validation study on a population of 250 patients with a follow-up of 2 years. Eur Spine J 2017;26(Suppl 4):479-88. https://doi.org/10.1007/s00586-017-5043-5
14. Almansour H, Pepke W, Akbar M. Pyogenic spondylodiscitis. The quest towards a clinical-radiological classification. Der Orthopade 2020;49(6):482-93. https://doi.org/10.1007/s00132-019-03836-0
15. Bilsky MH, Laufer I, Fourney DR, Groff M, Schmidt MH, Varga P, et al. Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine 2020;13(3):324-8. https://doi.org/10.3171/2010.3.SPINE09459
16. Shah AA, Yang H, Harris MB, Schwab JH. A Classification system for spinal cord compression and its association with neurological deficit in spinal epidural abscess. Clin Spine Surg 2019;32(3):E126-E132.
https://doi.org/10.1097/BSD.0000000000000746
17. Uchida K, Nakajima H, Yayama T, Sato R, Kobayaski S, Chen KB, et al. Epidural abscess associated with pyogenic spondylodiscitis of the lumbar spine; evaluation of a new MRI staging classification and imaging findings as indicators of surgical management: a retrospective study of 37 patients. Arch Orthop Trauma Surg 2010;130(1):111-8. https://doi.org/10.1007/s00402-009-0928-3
18. Bazán PL, Soria Adaro JC, Godoy Adaro AO, Ciccioli NM, Avero Gonzalez RA. Morphological aspect of pyogenic spinal epidural abscesses. Part I. Coluna/Columna 2022;21(1). https://doi.org/10.1590/S1808-185120222101260738
19. Camino Willhuber G, Guiroy A, Zamorano J, Astur N, Valacco M. Independent reliability analysis of a new classification for pyogenic spondylodiscitis. Global Spine J 2021;11(5):669-73. https://doi.org/10.1177/2192568220919091