Infections of the Spinal Subdural Space in Children: A Series of 11 Contemporary Cases and Review of all Published Reports. A Multinational Collaborative Effort

Adam L. Sandler, Dominic Thompson, James Tait Goodrich, Jasper Van Aalst, Eliezer Kolatch, Mostafa El Khashab, Farideh Nejat, Erwin Cornips, Sandeep Mohindra, Rahul Gupta, Reza Yassari, Lawrence B. Daniels, Arundhati Biswas, Ira Richmond Abbott, III

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Introduction: Positioned anatomically between the spinal epidural space and the intramedullary compartment, the spinal subdural space remains the least common area of localized infection in the central nervous system. Infectious processes of the subdural spinal space include subdural spinal empyema, subdural spinal abscess, infected spinal subdural cyst, and infectious spinal subdural cyst. To date, there has been no systematic review of these entities in children, with the cumulative knowledge of the pathophysiologic, microbiologic, and demographic characteristics of these infections relegated solely to few small series and case reports. Methods: A series of 11 recent cases culled from the collaboration of international authors are presented. In addition, an exhaustive MEDLINE search and manual review of the international literature was performed, identifying a total of 73 cases of spinal subdural infections in patients under the age of 21. Data of interest include the age, sex, signs, and symptoms at presentation, spinal location of infection, presence of spinal dysraphism, and other comorbidities, offending organism, treatment, outcome, and follow-up. Results: Patients ages ranged from 4 weeks to 20 years (mean, 6.5 years). Males outnumbered females by a ratio of 2:1. Over half (53 %) of spinal subdural infections in children were associated with spinal dysraphism or other congenital abnormalities of the spine. The commonest organism to infect the spinal subdural space in children is mycobacterium tuberculosis and the thoracic spinal region was most commonly infected. Conclusions: The disease is usually treated surgically, although a more expectant approach consisting of antibiotics and observation has also been proposed.

Original languageEnglish (US)
Pages (from-to)105-117
Number of pages13
JournalChild's Nervous System
Volume29
Issue number1
DOIs
StatePublished - Jan 2013

Fingerprint

Subdural Space
Spinal Dysraphism
Infection
Cysts
Subdural Empyema
Epidural Space
Central Nervous System Infections
Mycobacterium tuberculosis
MEDLINE
Abscess
Signs and Symptoms
Comorbidity
Spine
Thorax
Observation
Demography
Anti-Bacterial Agents

Keywords

  • Children
  • Spinal intradural abscess
  • Spinal subdural abscess
  • Spinal subdural infection

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Infections of the Spinal Subdural Space in Children : A Series of 11 Contemporary Cases and Review of all Published Reports. A Multinational Collaborative Effort. / Sandler, Adam L.; Thompson, Dominic; Goodrich, James Tait; Van Aalst, Jasper; Kolatch, Eliezer; El Khashab, Mostafa; Nejat, Farideh; Cornips, Erwin; Mohindra, Sandeep; Gupta, Rahul; Yassari, Reza; Daniels, Lawrence B.; Biswas, Arundhati; Abbott, III, Ira Richmond.

In: Child's Nervous System, Vol. 29, No. 1, 01.2013, p. 105-117.

Research output: Contribution to journalArticle

Sandler, Adam L. ; Thompson, Dominic ; Goodrich, James Tait ; Van Aalst, Jasper ; Kolatch, Eliezer ; El Khashab, Mostafa ; Nejat, Farideh ; Cornips, Erwin ; Mohindra, Sandeep ; Gupta, Rahul ; Yassari, Reza ; Daniels, Lawrence B. ; Biswas, Arundhati ; Abbott, III, Ira Richmond. / Infections of the Spinal Subdural Space in Children : A Series of 11 Contemporary Cases and Review of all Published Reports. A Multinational Collaborative Effort. In: Child's Nervous System. 2013 ; Vol. 29, No. 1. pp. 105-117.
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abstract = "Introduction: Positioned anatomically between the spinal epidural space and the intramedullary compartment, the spinal subdural space remains the least common area of localized infection in the central nervous system. Infectious processes of the subdural spinal space include subdural spinal empyema, subdural spinal abscess, infected spinal subdural cyst, and infectious spinal subdural cyst. To date, there has been no systematic review of these entities in children, with the cumulative knowledge of the pathophysiologic, microbiologic, and demographic characteristics of these infections relegated solely to few small series and case reports. Methods: A series of 11 recent cases culled from the collaboration of international authors are presented. In addition, an exhaustive MEDLINE search and manual review of the international literature was performed, identifying a total of 73 cases of spinal subdural infections in patients under the age of 21. Data of interest include the age, sex, signs, and symptoms at presentation, spinal location of infection, presence of spinal dysraphism, and other comorbidities, offending organism, treatment, outcome, and follow-up. Results: Patients ages ranged from 4 weeks to 20 years (mean, 6.5 years). Males outnumbered females by a ratio of 2:1. Over half (53 {\%}) of spinal subdural infections in children were associated with spinal dysraphism or other congenital abnormalities of the spine. The commonest organism to infect the spinal subdural space in children is mycobacterium tuberculosis and the thoracic spinal region was most commonly infected. Conclusions: The disease is usually treated surgically, although a more expectant approach consisting of antibiotics and observation has also been proposed.",
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AU - El Khashab, Mostafa

AU - Nejat, Farideh

AU - Cornips, Erwin

AU - Mohindra, Sandeep

AU - Gupta, Rahul

AU - Yassari, Reza

AU - Daniels, Lawrence B.

AU - Biswas, Arundhati

AU - Abbott, III, Ira Richmond

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N2 - Introduction: Positioned anatomically between the spinal epidural space and the intramedullary compartment, the spinal subdural space remains the least common area of localized infection in the central nervous system. Infectious processes of the subdural spinal space include subdural spinal empyema, subdural spinal abscess, infected spinal subdural cyst, and infectious spinal subdural cyst. To date, there has been no systematic review of these entities in children, with the cumulative knowledge of the pathophysiologic, microbiologic, and demographic characteristics of these infections relegated solely to few small series and case reports. Methods: A series of 11 recent cases culled from the collaboration of international authors are presented. In addition, an exhaustive MEDLINE search and manual review of the international literature was performed, identifying a total of 73 cases of spinal subdural infections in patients under the age of 21. Data of interest include the age, sex, signs, and symptoms at presentation, spinal location of infection, presence of spinal dysraphism, and other comorbidities, offending organism, treatment, outcome, and follow-up. Results: Patients ages ranged from 4 weeks to 20 years (mean, 6.5 years). Males outnumbered females by a ratio of 2:1. Over half (53 %) of spinal subdural infections in children were associated with spinal dysraphism or other congenital abnormalities of the spine. The commonest organism to infect the spinal subdural space in children is mycobacterium tuberculosis and the thoracic spinal region was most commonly infected. Conclusions: The disease is usually treated surgically, although a more expectant approach consisting of antibiotics and observation has also been proposed.

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