Clinical Outcome of Spinal Epidural Abscess in Elderly Patients

Abstract

Spinal epidural abscess (SEA) is a rare infection with a high rate of mortality and morbidity, which requires urgent surgery. Although surgery is the mainstay of treatment, some investigators currently report good outcomes after medical treatment. Thus, the optimal treatment option is debatable without established guidelines for standard of care. Moreover, surgery in elderly SEA patients is challenging because of comorbidities and perioperative risks. Methods: We retrospectively reviewed the medical records of 16 elderly patients with SEA, including 6 males and 10 females, ranging in age from 69 to 88 years (mean 75 years). Fourteen patients underwent open surgery, and 2 underwent aspiration biopsy as well as antibiotic treatment. We statistically analyzed variables related to clinical outcomes. The mean follow-up duration was 21.6 months. Results: Twelve patients had comorbidities, and 5 had other systemic infections. Four and 3 patients had a history of spinal intervention and spinal fusion surgery, respectively. Finally, 7 patients completely improved and 2 were moderately disabled. Another 2 patients were severely disabled and 5 died during antibiotic treatment. Most mortalities were due to comorbidities. SEA in elderly patients with comorbidities was associated with high mortality rates. Furthermore, delayed surgery was significantly related to poor neurological outcomes, whereas other variables were not significantly related to the outcomes of SEA in elderly patients. Conclusion: We identified a statistically significant relationship between neurological outcome and comorbidity (p= 0.026), predisposing conditions (p=0.010), and time to surgery (p=0.014), suggesting that early surgery should be considered, even in elderly SEA patients.

Decompression only versus fusion in octogenarians with spinal epidural abscesses: early complications, clinical and radiological outcome with two years follow-up

“…Compared to Kim et al, who found a relatively low morbidity rate and a CCI as high as 4 in only 3 patients, our study cohort in both groups presented severe comorbidities with a mean CCI of 9.0 or greater [15]. Kim and colleagues did not report surgical duration, ICU stay, or hospital stay and observed a higher mortality rate after surgery (31.3%) [15]. In contrast, the in-hospital mortality in our group undergoing surgical decompression only was fundamentally lower (5.6%).…”

“…Conversely, in the present study, we examined 35 patients older than 80 years, of whom 18 underwent surgical decompression only, and 17 underwent surgical decompression with instrumentation. Compared to Kim et al, who found a relatively low morbidity rate and a CCI as high as 4 in only 3 patients, our study cohort in both groups presented severe comorbidities with a mean CCI of 9.0 or greater [15]. Kim and colleagues did not report surgical duration, ICU stay, or hospital stay and observed a higher mortality rate after surgery (31.3%) [15].…”

“…Kim et al retrospectively studied 16 patients aged > 65 years with PVO and SEA. Almost all patients (87.5%) underwent surgical decompression only [15]. Three patients were older than 80 years.…”

“…Since both symptomatic vertebral osteomyelitis and SEA with neurological de cits are considered surgical emergencies, the main goal of treatment is expedient surgical decompression and antibiotic therapy. Importantly, studies clearly show that the time between the occurrence of neurological symptoms and surgical treatment is pivotal and predictive of neurological recovery [7,15].…”

Decompression only versus fusion in octogenarians with spinal epidural abscesses: early complications, clinical and radiological outcome with 2-year follow-up

“…Since both symptomatic vertebral osteomyelitis and SEA with neurological deficits are considered surgical emergencies, the main goal of treatment is expedient surgical decompression and antibiotic therapy. Importantly, studies clearly show that the time between the occurrence of neurological symptoms and surgical treatment is pivotal and predictive of neurological recovery [ 8 , 11 , 17 ].…”