European Spine Journal

, Volume 22, Issue 12, pp 2787–2799 | Cite as

Spinal infection: state of the art and management algorithm

  • Rui M. DuarteEmail author
  • Alexander R. Vaccaro
Review Article



Spinal infection is a rare pathology although a concerning rising incidence has been observed in recent years. This increase might reflect a progressively more susceptible population but also the availability of increased diagnostic accuracy. Yet, even with improved diagnosis tools and procedures, the delay in diagnosis remains an important issue. This review aims to highlight the importance of a methodological attitude towards accurate and prompt diagnosis using an algorithm to aid on spinal infection management.


Appropriate literature on spinal infection was selected using databases from the US National Library of Medicine and the National Institutes of Health.


Literature reveals that histopathological analysis of infected tissues is a paramount for diagnosis and must be performed routinely. Antibiotic therapy is transversal to both conservative and surgical approaches and must be initiated after etiological diagnosis. Indications for surgical treatment include neurological deficits or sepsis, spine instability and/or deformity, presence of epidural abscess and upon failure of conservative treatment.


A methodological assessment could lead to diagnosis effectiveness of spinal infection. Towards this, we present a management algorithm based on literature findings.


Spinal infection Spondylodiscitis Spondylitis 



Special acknowledgments to Professor António Oliveira and Dr. Jorge Seabra (Hospital Geral de Santo António, Porto) and Dr. Pedro Varanda (Hospital de Braga, Braga) for their contributions to the manuscript.

Conflict of interest



  1. 1.
    Tayles N, Buckley HR (2004) Leprosy and tuberculosis in iron age southeast Asia? Am J Phys Anthropol 125(3):239–256PubMedGoogle Scholar
  2. 2.
    Camillo FX (2008) Infections of the spine. In: Canale ST, Beaty JH (eds) Campbell’s operative orthopaedics. Mosby Elsevier, PhiladelphiaGoogle Scholar
  3. 3.
    Frangen TM et al (2006) Surgical management of spondylodiscitis. An analysis of 78 cases. Unfallchirurg 109(9):743–753PubMedGoogle Scholar
  4. 4.
    Sobottke R et al (2008) Current diagnosis and treatment of spondylodiscitis. Dtsch Arztebl Int 105(10):181–187PubMedGoogle Scholar
  5. 5.
    Butler JS et al (2006) Nontuberculous pyogenic spinal infection in adults: a 12-year experience from a tertiary referral center. Spine (Phila Pa 1976) 31(23):2695–2700Google Scholar
  6. 6.
    Tsiodras S, Falagas ME (2006) Clinical assessment and medical treatment of spine infections. Clin Orthop Relat Res 444:38–50PubMedGoogle Scholar
  7. 7.
    Tyrrell PN, Cassar-Pullicino VN, McCall IW (1999) Spinal infection. Eur Radiol 9(6):1066–1077PubMedGoogle Scholar
  8. 8.
    Krogsgaard MR, Wagn P, Bengtsson J (1998) Epidemiology of acute vertebral osteomyelitis in Denmark: 137 cases in Denmark 1978–1982, compared to cases reported to the National Patient Register 1991–1993. Acta Orthop Scand 69(5):513–517PubMedGoogle Scholar
  9. 9.
    Mylona E et al (2009) Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum 39(1):10–17PubMedGoogle Scholar
  10. 10.
    Grammatico L et al (2008) Epidemiology of vertebral osteomyelitis (VO) in France: analysis of hospital-discharge data 2002–2003. Epidemiol Infect 136(5):653–660PubMedGoogle Scholar
  11. 11.
    Carragee EJ (1997) Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am 79(6):874–880PubMedGoogle Scholar
  12. 12.
    Fantoni M et al (2012) Epidemiological and clinical features of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):2–7PubMedGoogle Scholar
  13. 13.
    Afshar M, Reilly RF (2011) Spondylodiscitis in a patient on chronic hemodialysis. Nat Rev Nephrol 7(10):599–604PubMedGoogle Scholar
  14. 14.
    Jensen AG et al (1997) Increasing frequency of vertebral osteomyelitis following Staphylococcus aureus bacteraemia in Denmark 1980–1990. J Infect 34(2):113–118PubMedGoogle Scholar
  15. 15.
    Silber JS et al (2002) Management of postprocedural discitis. Spine J 2(4):279–287PubMedGoogle Scholar
  16. 16.
    Jimenez-Mejias ME et al (1999) Postoperative spondylodiskitis: etiology, clinical findings, prognosis, and comparison with non-operative pyogenic spondylodiskitis. Clin Infect Dis 29(2):339–345PubMedGoogle Scholar
  17. 17.
    Euba G et al (2008) Long-term clinical and radiological magnetic resonance imaging outcome of abscess-associated spontaneous pyogenic vertebral osteomyelitis under conservative management. Semin Arthritis Rheum 38(1):28–40PubMedGoogle Scholar
  18. 18.
    Hadjipavlou AG et al (2000) Hematogenous pyogenic spinal infections and their surgical management. Spine (Phila Pa 1976) 25(13):1668–1679Google Scholar
  19. 19.
    Lim MR, Lee JY, Vaccaro AR (2006) Surgical infections in the traumatized spine. Clin Orthop Relat Res 444:114–119PubMedGoogle Scholar
  20. 20.
    Govender S (2005) Spinal infection. J Bone Joint Surg Br 87 (B):1454–1458Google Scholar
  21. 21.
    Sapico FL (1996) Microbiology and antimicrobial therapy of spinal infections. Orthop Clin North Am 27(1):9–13PubMedGoogle Scholar
  22. 22.
    Colmenero JD et al (1997) Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases. Ann Rheum Dis 56(12):709–715PubMedGoogle Scholar
  23. 23.
    Turunc T et al (2007) A comparative analysis of tuberculous, brucellar and pyogenic spontaneous spondylodiscitis patients. J Infect 55(2):158–163PubMedGoogle Scholar
  24. 24.
    Ratcliffe JF (1982) An evaluation of the intra-osseous arterial anastomoses in the human vertebral body at different ages. Microarteriographic Study. J Anat 134(Pt 2):373–382Google Scholar
  25. 25.
    Ratcliffe JF (1985) Anatomic basis for the pathogenesis and radiologic features of vertebral osteomyelitis and its differentiation from childhood discitis. A microarteriographic investigation. Acta Radiol Diagn (Stockh) 26(2):137–143Google Scholar
  26. 26.
    Wiley AM, Trueta J (1959) The vascular anatomy of the spine and its relationship to pyogenic vertebral osteomyelitis. J Bone Joint Surg Br 41-B:796–809PubMedGoogle Scholar
  27. 27.
    Gouliouris T, Aliyu SH, Brown NM (2010) Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother 65 Suppl 3:iii11–iii24PubMedGoogle Scholar
  28. 28.
    Babinchak TJ, Riley DK, Rotheram EB Jr (1997) Pyogenic vertebral osteomyelitis of the posterior elements. Clin Infect Dis 25(2):221–224PubMedGoogle Scholar
  29. 29.
    Kim CJ et al (2010) A comparative study of pyogenic and tuberculous spondylodiscitis. Spine (Phila Pa 197) 35(21):E1096–E1100Google Scholar
  30. 30.
    Schimmer RC et al (2002) Osteomyelitis of the cervical spine: a potentially dramatic disease. J Spinal Disord Tech 15(2):110–117PubMedGoogle Scholar
  31. 31.
    Pigrau C et al (2005) Spontaneous pyogenic vertebral osteomyelitis and endocarditis: incidence, risk factors, and outcome. Am J Med 118(11):1287PubMedGoogle Scholar
  32. 32.
    Turgut M (2001) Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients. Neurosurg Rev 24(1):8–13PubMedGoogle Scholar
  33. 33.
    Chang MC et al (2006) Tuberculous spondylitis and pyogenic spondylitis: comparative magnetic resonance imaging features. Spine (Phila Pa 1976) 31(7):782–788Google Scholar
  34. 34.
    Roblot F et al (2007) Optimal duration of antibiotic therapy in vertebral osteomyelitis. Semin Arthritis Rheum 36(5):269–277PubMedGoogle Scholar
  35. 35.
    Zimmerli W (2010) Clinical practice. Vertebral osteomyelitis. N Engl J Med 362(11):1022–1029PubMedGoogle Scholar
  36. 36.
    Garron E et al (2002) Nontuberculous spondylodiscitis in children. J Pediatr Orthop 22(3):321–328PubMedGoogle Scholar
  37. 37.
    Fernandez M, Carrol CL, Baker CJ (2000) Discitis and vertebral osteomyelitis in children: an 18-year review. Pediatrics 105(6):1299–1304PubMedGoogle Scholar
  38. 38.
    Brown R et al (2001) Discitis in young children. J Bone Joint Surg Br 83(1):106–111PubMedGoogle Scholar
  39. 39.
    Carragee EJ et al (1997) The clinical use of erythrocyte sedimentation rate in pyogenic vertebral osteomyelitis. Spine (Phila Pa 1976) 22(18):2089–2093Google Scholar
  40. 40.
    Beronius M, Bergman B, Andersson R (2001) Vertebral osteomyelitis in Goteborg, Sweden: a retrospective study of patients during 1990–95. Scand J Infect Dis 33(7):527–532PubMedGoogle Scholar
  41. 41.
    Hsieh PC et al (2004) Surgical strategies for vertebral osteomyelitis and epidural abscess. Neurosurg Focus 17(6):E4PubMedGoogle Scholar
  42. 42.
    Kang BU et al (2010) Surgical site infection in spinal surgery: detection and management based on serial C-reactive protein measurements. J Neurosurg Spine 13(2):158–164PubMedGoogle Scholar
  43. 43.
    Lillie P et al (2008) Healthcare associated discitis in the era of antimicrobial resistance. J Clin Rheumatol 14(4):234–237PubMedGoogle Scholar
  44. 44.
    Goldstein EJ (1996) Anaerobic bacteremia. Clin Infect Dis 23 Suppl 1:S97–S101PubMedGoogle Scholar
  45. 45.
    Lassmann B et al (2007) Reemergence of anaerobic bacteremia. Clin Infect Dis 44(7):895–900PubMedGoogle Scholar
  46. 46.
    Karadimas EJ et al (2008) Spondylodiscitis. A retrospective study of 163 patients. Acta Orthop 79(5):650–659PubMedGoogle Scholar
  47. 47.
    Gasbarrini A et al (2012) Biopsy for suspected spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):26–34PubMedGoogle Scholar
  48. 48.
    Fucs PM, Meves R, Yamada HH (2012) Spinal infections in children: a review. Int Orthop 36(2):387–395PubMedGoogle Scholar
  49. 49.
    Cheng VC et al (2004) Clinical evaluation of the polymerase chain reaction for the rapid diagnosis of tuberculosis. J Clin Pathol 57(3):281–285PubMedGoogle Scholar
  50. 50.
    Kumar R, Das RK, Mahapatra AK (2010) Role of interferon gamma release assay in the diagnosis of Pott disease. J Neurosurg Spine 12(5):462–466PubMedGoogle Scholar
  51. 51.
    de Lucas EM et al (2009) CT-guided fine-needle aspiration in vertebral osteomyelitis: true usefulness of a common practice. Clin Rheumatol 28(3):315–320PubMedGoogle Scholar
  52. 52.
    Rankine JJ et al (2004) Therapeutic impact of percutaneous spinal biopsy in spinal infection. Postgrad Med J 80(948):607–609PubMedGoogle Scholar
  53. 53.
    Michel SC et al (2006) CT-guided core biopsy of subchondral bone and intervertebral space in suspected spondylodiskitis. AJR Am J Roentgenol 186(4):977–980PubMedGoogle Scholar
  54. 54.
    Fenollar F, Levy PY, Raoult D (2008) Usefulness of broad-range PCR for the diagnosis of osteoarticular infections. Curr Opin Rheumatol 20(4):463–470PubMedGoogle Scholar
  55. 55.
    Fuursted K et al (2008) Broad-range PCR as a supplement to culture for detection of bacterial pathogens in patients with a clinically diagnosed spinal infection. Scand J Infect Dis 40(10):772–777PubMedGoogle Scholar
  56. 56.
    Delogu G, Zumbo A, Fadda G (2012) Microbiological and immunological diagnosis of tuberculous spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):73–78PubMedGoogle Scholar
  57. 57.
    Jevtic V (2004) Vertebral infection. Eur Radiol 14(Suppl 3):E43–E52PubMedGoogle Scholar
  58. 58.
    Ledermann HP et al (2003) MR imaging findings in spinal infections: rules or myths? Radiology 228(2):506–514PubMedGoogle Scholar
  59. 59.
    Modic MT et al (1985) Vertebral osteomyelitis: assessment using MR. Radiology 157(1):157–166PubMedGoogle Scholar
  60. 60.
    Leone A et al (2012) Imaging of spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):8–19PubMedGoogle Scholar
  61. 61.
    Diehn FE (2012) Imaging of spine infection. Radiol Clin North Am 50(4):777–798PubMedGoogle Scholar
  62. 62.
    Shah LM, Salzman KL (2011) Imaging of spinal metastatic disease. Int J Surg Oncol 2011:769753PubMedGoogle Scholar
  63. 63.
    Anley CM, Brandt AD, Dunn R (2012) Magnetic resonance imaging findings in spinal tuberculosis: comparison of HIV positive and negative patients. Indian J Orthop 46(2):186–190PubMedGoogle Scholar
  64. 64.
    Kowalski TJ et al (2007) Follow-up MR imaging in patients with pyogenic spine infections: lack of correlation with clinical features. AJNR Am J Neuroradiol 28(4):693–699PubMedGoogle Scholar
  65. 65.
    Carragee EJ (1997) The clinical use of magnetic resonance imaging in pyogenic vertebral osteomyelitis. Spine (Phila Pa 1976) 22(7):780–785Google Scholar
  66. 66.
    Gemmel F, Dumarey N, Palestro CJ (2006) Radionuclide imaging of spinal infections. Eur J Nucl Med Mol Imaging 33(10):1226–1237PubMedGoogle Scholar
  67. 67.
    Gemmel F et al (2010) Expanding role of 18F-fluoro-d-deoxyglucose PET and PET/CT in spinal infections. Eur Spine J 19(4):540–551PubMedGoogle Scholar
  68. 68.
    Kwon JW et al (2011) MRI findings of Aspergillus spondylitis. AJR Am J Roentgenol 197(5):W919–W923PubMedGoogle Scholar
  69. 69.
    Currie S et al (2011) MRI characteristics of tuberculous spondylitis. Clin Radiol 66(8):778–787PubMedGoogle Scholar
  70. 70.
    James SL, Davies AM (2006) Imaging of infectious spinal disorders in children and adults. Eur J Radiol 58(1):27–40PubMedGoogle Scholar
  71. 71.
    Zarghooni K et al (2012) Treatment of spondylodiscitis. Int Orthop 36(2):405–411PubMedGoogle Scholar
  72. 72.
    Thwaites G et al (2009) British infection society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect 59(3):167–187PubMedGoogle Scholar
  73. 73.
    van Ooij A et al (2000) Surgical treatment of aspergillus spondylodiscitis. Eur Spine J 9(1):75–79PubMedGoogle Scholar
  74. 74.
    Friedman JA et al (2002) Spontaneous disc space infections in adults. Surg Neurol 57(2):81–86PubMedGoogle Scholar
  75. 75.
    Darley ES, MacGowan AP (2004) Antibiotic treatment of gram-positive bone and joint infections. J Antimicrob Chemother 53(6):928–935PubMedGoogle Scholar
  76. 76.
    McHenry MC, Easley KA, Locker GA (2002) Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis 34(10):1342–1350PubMedGoogle Scholar
  77. 77.
    Nolla JM et al (2002) Spontaneous pyogenic vertebral osteomyelitis in nondrug users. Semin Arthritis Rheum 31(4):271–278PubMedGoogle Scholar
  78. 78.
    Baker AS, RG OJ, Baker RA (1992) To decompress or not to decompress–spinal epidural abscess. Clin Infect Dis 15(1):28–29PubMedGoogle Scholar
  79. 79.
    Chen WH, Jiang LS, Dai LY (2007) Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation. Eur Spine J 16(9):1307–1316PubMedGoogle Scholar
  80. 80.
    Darouiche RO (2006) Spinal epidural abscess. N Engl J Med 355(19):2012–2020PubMedGoogle Scholar
  81. 81.
    Yoshimoto M et al (2011) Pyogenic spondylitis in the elderly: a report from Japan with the most aging society. Eur Spine J 20(4):649–654PubMedGoogle Scholar
  82. 82.
    Pola E et al (2012) Surgical treatment of tuberculous spondylodiscitis. Eur Rev Med Pharmacol Sci 16(Suppl 2):79–85PubMedGoogle Scholar
  83. 83.
    Linhardt O et al (2007) Long-term results of ventro-dorsal versus ventral instrumentation fusion in the treatment of spondylitis. Int Orthop 31(1):113–119PubMedGoogle Scholar
  84. 84.
    Schinkel C, Gottwald M, Andress HJ (2003) Surgical treatment of spondylodiscitis. Surg Infect (Larchmt) 4(4):387–391Google Scholar
  85. 85.
    Muckley T et al (2004) The role of thoracoscopic spinal surgery in the management of pyogenic vertebral osteomyelitis. Spine (Phila Pa 1976) 29(11):E227–E233Google Scholar
  86. 86.
    Lee JS, Suh KT (2006) Posterior lumbar interbody fusion with an autogenous iliac crest bone graft in the treatment of pyogenic spondylodiscitis. J Bone Joint Surg Br 88(6):765–770PubMedGoogle Scholar
  87. 87.
    Zhang HQ et al (2012) Two-stage surgical management using posterior instrumentation, anterior debridement and allografting for tuberculosis of the lower lumbar spine in children of elementary school age: minimum 3-year follow-up of 14 patients. Arch Orthop Trauma Surg 132(9):1273–1279PubMedGoogle Scholar
  88. 88.
    Shousha M, Boehm H (2012) Surgical treatment of cervical spondylodiscitis: a review of 30 consecutive patients. Spine (Phila Pa 1976) 37(1):E30–E36Google Scholar
  89. 89.
    Masuda T et al (2011) Comparative study on the efficacy of two-staged (posterior followed by anterior) surgical treatment using spinal instrumentation on pyogenic and tuberculotic spondylitis. Arch Orthop Trauma Surg 131(6):765–772PubMedGoogle Scholar
  90. 90.
    Koptan W, Elmiligui Y, Elsharkawi M (2011) Single stage anterior reconstruction using titanium mesh cages in neglected kyphotic tuberculous spondylodiscitis of the cervical spine. Eur Spine J 20(2):308–313PubMedGoogle Scholar
  91. 91.
    Erturer E et al (2010) The results of simultaneous posterior-anterior-posterior surgery in multilevel tuberculosis spondylitis associated with severe kyphosis. Eur Spine J 19(12):2209–2215PubMedGoogle Scholar
  92. 92.
    Chen LH et al (2010) Surgical treatment of infectious spondylitis in patients undergoing hemodialysis therapy. Eur Spine J 19(12):2223–2228PubMedGoogle Scholar
  93. 93.
    Hempelmann RG, Mater E, Schon R (2010) Septic hematogenous lumbar spondylodiscitis in elderly patients with multiple risk factors: efficacy of posterior stabilization and interbody fusion with iliac crest bone graft. Eur Spine J 19(10):1720–1727PubMedGoogle Scholar
  94. 94.
    Hirakawa A et al (2010) Surgical outcome of 2-stage (posterior and anterior) surgical treatment using spinal instrumentation for tuberculous spondylitis. J Spinal Disord Tech 23(2):133–138PubMedGoogle Scholar
  95. 95.
    Okada Y et al (2009) Clinical and radiological outcome of surgery for pyogenic and tuberculous spondylitis: comparisons of surgical techniques and disease types. J Neurosurg Spine 11(5):620–627PubMedGoogle Scholar
  96. 96.
    Zaveri GR, Mehta SS (2009) Surgical treatment of lumbar tuberculous spondylodiscitis by transforaminal lumbar interbody fusion (TLIF) and posterior instrumentation. J Spinal Disord Tech 22(4):257–262PubMedGoogle Scholar
  97. 97.
    Lu DC, Wang V, Chou D (2009) The use of allograft or autograft and expandable titanium cages for the treatment of vertebral osteomyelitis. Neurosurgery 64(1):122–129 Discussion 129–30PubMedGoogle Scholar
  98. 98.
    Robinson Y et al (2008) Successful treatment of spondylodiscitis using titanium cages: a 3-year follow-up of 22 consecutive patients. Acta Orthop 79(5):660–664PubMedGoogle Scholar
  99. 99.
    Pee YH et al (2008) Anterior debridement and fusion followed by posterior pedicle screw fixation in pyogenic spondylodiscitis: autologous iliac bone strut versus cage. J Neurosurg Spine 8(5):405–412PubMedGoogle Scholar
  100. 100.
    Korovessis P et al (2008) Beneficial influence of titanium mesh cage on infection healing and spinal reconstruction in hematogenous septic spondylitis: a retrospective analysis of surgical outcome of twenty-five consecutive cases and review of literature. Spine (Phila Pa 1976) 33(21):E759–E767Google Scholar
  101. 101.
    Hee HT et al (2002) Better treatment of vertebral osteomyelitis using posterior stabilization and titanium mesh cages. J Spinal Disord Tech 15(2):149–156 Discussion 156PubMedGoogle Scholar
  102. 102.
    Liljenqvist U et al (2003) Titanium cages in the surgical treatment of severe vertebral osteomyelitis. Eur Spine J 12(6):606–612PubMedGoogle Scholar
  103. 103.
    Korovessis P, Repantis T, Hadjipavlou AG (2012) Hematogenous pyogenic spinal infection: current perceptions. Orthopedics 35(10):885–892PubMedGoogle Scholar
  104. 104.
    Schuster JM et al (2000) Use of structural allografts in spinal osteomyelitis: a review of 47 cases. J Neurosurg 93(1 Suppl):8–14PubMedGoogle Scholar
  105. 105.
    Dimar JR et al (2004) Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion. Spine (Phila Pa 1976) 29(3):326–332 Discussion 332Google Scholar
  106. 106.
    Rihn JA et al (2009) The use of RhBMP-2 in single-level transforaminal lumbar interbody fusion: a clinical and radiographic analysis. Eur Spine J 18(11):1629–1636PubMedGoogle Scholar
  107. 107.
    O’Shaughnessy BA, Kuklo TR, Ondra SL (2008) Surgical treatment of vertebral osteomyelitis with recombinant human bone morphogenetic protein-2. Spine (Phila Pa 1976) 33(5):E132–E139Google Scholar
  108. 108.
    Allen RT et al (2007) Bone morphogenetic protein-2 (BMP-2) in the treatment of pyogenic vertebral osteomyelitis. Spine (Phila Pa 1976) 32(26):2996–3006Google Scholar
  109. 109.
    Jin D et al (2004) One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis. Eur Spine J 13(2):114–121PubMedGoogle Scholar
  110. 110.
    Oga M et al (1993) Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study. Spine (Phila Pa 1976) 18(13):1890–1894Google Scholar
  111. 111.
    Benli IT et al (2003) Anterior radical debridement and anterior instrumentation in tuberculosis spondylitis. Eur Spine J 12(2):224–234PubMedGoogle Scholar
  112. 112.
    Yilmaz C et al (1999) Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg Am 81(9):1261–1267PubMedGoogle Scholar
  113. 113.
    Lu CH et al (2002) Adult spinal epidural abscess: clinical features and prognostic factors. Clin Neurol Neurosurg 104(4):306–310PubMedGoogle Scholar
  114. 114.
    Chen SH et al (2011) The clinical characteristics, therapeutic outcome, and prognostic factors of non-tuberculous bacterial spinal epidural abscess in adults: a hospital-based study. Acta Neurol Taiwan 20(2):107–113PubMedGoogle Scholar
  115. 115.
    Khanna RK et al (1996) Spinal epidural abscess: evaluation of factors influencing outcome. Neurosurgery 39(5):958–964PubMedGoogle Scholar
  116. 116.
    Huang PY et al (2012) Spinal epidural abscess in adults caused by Staphylococcus aureus: clinical characteristics and prognostic factors. Clin Neurol Neurosurg 114(6):572–576PubMedGoogle Scholar
  117. 117.
    Tang HJ et al (2002) Spinal epidural abscess–experience with 46 patients and evaluation of prognostic factors. J Infect 45(2):76–81PubMedGoogle Scholar
  118. 118.
    Gonzalez-Lopez JJ et al (2009) Spontaneous epidural abscess: analysis of 15 cases with emphasis on diagnostic and prognostic factors. Eur J Intern Med 20(5):514–517PubMedGoogle Scholar
  119. 119.
    Soehle M, Wallenfang T (2002) Spinal epidural abscesses: clinical manifestations, prognostic factors, and outcomes. Neurosurgery 51(1):79–85 Discussion 86–7PubMedGoogle Scholar
  120. 120.
    Reihsaus E, Waldbaur H, Seeling W (2000) Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev 23(4):175–204 Discussion 205PubMedGoogle Scholar
  121. 121.
    Bostrom A et al (2008) Treatment strategies and outcome in patients with non-tuberculous spinal epidural abscess–a review of 46 cases. Minim Invasive Neurosurg 51(1):36–42PubMedGoogle Scholar
  122. 122.
    Rigamonti D et al (1999) Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol 52(2):189–196 Discussion 197PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Orthopedic Surgery DepartmentHospital de BragaBragaPortugal
  2. 2.Life and Health Sciences Research Institute (ICVS)School of Health Sciences, University of MinhoBragaPortugal
  3. 3.Rothman InstituteThomas Jefferson UniversityPhiladelphiaUSA

Personalised recommendations