British journal of neurosurgery · 2026
Holospinal epidural abscess: a review of clinical characteristics, outcomes and prognostic factors.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Halalmeh Dia R, Vrana Antonia, Singh Sujay, Roy Joanna, Jader Arwa, Ansari Yusuf-Zain, Moisi Marc D
Аннотация
BACKGROUND: Holospinal epidural abscess (HEA) is a rare, serious infection associated with substantial morbidity. Evidence is limited to case reports and small series, with heterogeneous presentation, management and outcomes. Prognostic factors remain poorly defined. This study aimed to characterize the features of HEA and describe associations with outcomes.
METHODS: A systematic review of MEDLINE, PubMed, Cochrane and Google Scholar identified cases of HEA involving three or more contiguous spinal regions. Eligible studies included cases and case series reporting outcomes. Because of heterogeneity, missing data and likely non-independence among pooled cases, findings were summarized descriptively.
RESULTS: Sixty-one studies encompassing 77 patients were analyzed; 46.7% originated from the United States. The mean age was 48.7 ± 20.0 years, and 75.3% were male. Diabetes mellitus was the most frequent comorbidity (29.8%). Concurrent abscesses were present in 9%, often involving the psoas muscle (85.7%). Presenting symptoms included neurological deficits (70.1%), back pain (69.2%) and fever (41.5%). Methicillin-susceptible Staphylococcus aureus (40.1%) and methicillin-resistant S. aureus (24.3%) were the predominant pathogens. All patients underwent surgical evacuation. Circumferential abscesses were most common (54.5%), followed by dorsal (32.5%). Subdural extensions requiring durotomy were reported in two cases. Postoperative complications occurred in 19.5%. At a mean follow-up of 8.8 months, outcome reporting was heterogeneous; approximately half of the patients were described as having a complete recovery, about two-fifths had a partial recovery, and 4 patients had no recovery. An exploratory review suggested that complete recovery was reported in younger patients, whereas bladder dysfunction was more often associated with incomplete recovery.
CONCLUSION: HEA is an uncommon but high-risk manifestation of spinal infection. Surgical evacuation remains a mainstay of treatment, given the severity of the presentation. In this pooled literature, younger age and absence of bladder dysfunction were associated with more favorable reported outcomes; however, these observations should be interpreted cautiously as descriptive and exploratory findings rather than independent prognostics.
METHODS: A systematic review of MEDLINE, PubMed, Cochrane and Google Scholar identified cases of HEA involving three or more contiguous spinal regions. Eligible studies included cases and case series reporting outcomes. Because of heterogeneity, missing data and likely non-independence among pooled cases, findings were summarized descriptively.
RESULTS: Sixty-one studies encompassing 77 patients were analyzed; 46.7% originated from the United States. The mean age was 48.7 ± 20.0 years, and 75.3% were male. Diabetes mellitus was the most frequent comorbidity (29.8%). Concurrent abscesses were present in 9%, often involving the psoas muscle (85.7%). Presenting symptoms included neurological deficits (70.1%), back pain (69.2%) and fever (41.5%). Methicillin-susceptible Staphylococcus aureus (40.1%) and methicillin-resistant S. aureus (24.3%) were the predominant pathogens. All patients underwent surgical evacuation. Circumferential abscesses were most common (54.5%), followed by dorsal (32.5%). Subdural extensions requiring durotomy were reported in two cases. Postoperative complications occurred in 19.5%. At a mean follow-up of 8.8 months, outcome reporting was heterogeneous; approximately half of the patients were described as having a complete recovery, about two-fifths had a partial recovery, and 4 patients had no recovery. An exploratory review suggested that complete recovery was reported in younger patients, whereas bladder dysfunction was more often associated with incomplete recovery.
CONCLUSION: HEA is an uncommon but high-risk manifestation of spinal infection. Surgical evacuation remains a mainstay of treatment, given the severity of the presentation. In this pooled literature, younger age and absence of bladder dysfunction were associated with more favorable reported outcomes; however, these observations should be interpreted cautiously as descriptive and exploratory findings rather than independent prognostics.