Infections of the spinal subdural space in children: a series of 11 contemporary cases and review of all published reports. A multinational collaborative effort.
BACKGROUND
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.
Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 3316 Rochambeau Avenue, Bronx, NY 10467, USA. adamlsandler@gmail.com
Adam L
AL
Sandler
Dominic
D
Thompson
James T
JT
Goodrich
Jasper
J
van Aalst
Eliezer
E
Kolatch
Mostafa
M
El Khashab
Farideh
F
Nejat
Erwin
E
Cornips
Sandeep
S
Mohindra
Rahul
R
Gupta
Reza
R
Yassari
Lawrence B
LB
Daniels
Arundhati
A
Biswas
Rick
R
Abbott
D000293:Adolescent; D000328:Adult; D000349:Africa; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007391:International Cooperation; D016239:MEDLINE / Q000706:statistics & numerical data; D008297:Male; D008581:Meningitis / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D013116:Spinal Cord / Q000473:pathology; D013118:Spinal Cord Diseases / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D013355:Subdural Space / Q000382:microbiology / Q000473:pathology*; D055815:Young Adult