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

Abstract

Despite increased life expectancy due to health care quality improvements globally, pyogenic vertebral osteomyelitis (PVO) treatment with a spinal epidural abscess (SEA) remains challenging in patients older than 80 years. We aimed to assess octogenarians for PVO prevalence with SEA and compare after-surgery clinical outcomes of decompression and decompression and instrumentation. A retrospective review of electronic medical records at a single institution was conducted between September 2005 and December 2020. Patient demographics, surgical characteristics, complications, hospital course, and 90-day mortality were collected. Comorbidities were assessed using the age-adjusted Charlson comorbidity index (CCI). Over 16 years, 35 patients aged ≥80 years with PVO and SEA were identified. Eighteen patients underwent surgical decompression (“decompression group”), and 17 underwent surgical decompression with instrumentation (“instrumentation group”). Both groups had a CCI >6 (mean±SD, 8.9±2.1 vs. 9.6±2.7, respectively; p=0.065). Instrumentation group patients had a significantly longer hospital stay but no ICU stay. In-hospital and 90-days mortality rates were similar in both groups. The mean follow-up was 26.6±12.4 months. No further surgeries were performed. Infection levels and neurological status were improved in both groups at discharge. At the second-stage analysis, significant improvements in the blood infection parameters and the neurological status were detected in the decompression group. Octogenarians with PVO and SEA have a high adverse events risk after surgical procedures. Surgical decompression might contribute to earlier clinical recovery in older patients. Thus, the surgical approach should be discussed with patients and their relatives and be carefully weighed.

Prospective insights into spinal surgery outcomes and adverse events: A comparative study between patients 65–79 years vs. ≥80 years from a German tertiary center

“…Previous studies from our study group focused on octogenarians have shown that heightened comorbidity rates significantly increase the likelihood of complications and, in certain instances, mortality ( Lenga et al, 2022a , 2022b , 2022c , 2022d , 2023b ). This observation is consistent with a retrospective study of 47 octogenarians with diverse spinal pathologies, where comorbidity rates emerged as a critical factor for adverse events (AEs), exhibiting a prevalence of 17.0%.…”

Patients Follow-up for Spinal Epidural Abscess as a Critical Treatment Plan Consideration

“…Most often, follow-up was reported as a mean and a range, with further details omitted. It was also typically not clearly reported how many patients may have been excluded from the study due to inadequate follow-up [2,4,5,[9][10][11][12][13][14][15][16][17][18][19].…”

“…The mean follow-up for Khanna et al was 20.9 months (with a range of 4-45 months) [28]. Lenga et al reported a mean follow-up of 26.6 ± 12.4 months [12].…”

Mortality, complication risks, and clinical outcomes after surgical treatment of spinal epidural abscess: a comparative analysis of patients aged 18–64 years, 65–79 years, and ≥ 80 years, with a 3-year follow-up

“…As already shown in our previous studies on SEA [ 3 , 9 ], patient demographics, comorbidities, American Society of Anesthesiologists (ASA) scores, surgery duration, blood loss, number of treated spinal levels, perioperative and postoperative complications, hospital length of stay (LOS), intensive care unit (ICU) stay, readmission rate, reoperation rate, and mortality rate were retrieved from the patients’ electronic medical records. The age-adjusted Charlson comorbidity index (CCI) was used to assess the comorbidities [ 10 , 11 ].…”

“…Prompt surgical decompression and evacuation with concurrent antibiotic treatment seem to be state-of-the-art therapy for such a condition, especially in the presence of neurological deficits [ 5 , 8 ]. Previous studies suggested that such therapeutic approaches might benefit older patients or even octogenarians by preserving or improving their neurological condition; nevertheless, a multidisciplinary approach and understanding of their unique needs are important aspects given their poor baseline reserve [ 3 , 9 ]. However, there is a lack of comparative studies involving young and older patients with SEA focusing on the outcomes after surgical management.…”