Treatment of Spinal Epidural Abscess and Predisposing Factors of Motor Weakness: Experience with 48 Patients

Abstract

ObjectiveSpinal epidural abscess (SEA) can be fatal if untreated, so early diagnosis and treatment are essential. We conducted a retrospective study to define its clinical features and evaluate the risk factors of motor weakness.MethodsWe retrospectively analyzed the medical records and images of patients with SEA who had been hospitalized in our institute from January 2005 to June 2012. Pyogenic SEA patients were categorized as patients without motor weakness (Group A) and with motor weakness (Group B). Abscess volume was measured using the Gamma-Plan program. Intervertebral foramen height and posterior disc height were measured to evaluate degree of spinal stenosis.ResultsOf 48 patients with pyogenic SEA, 33 (68%) were treated surgically, and 15 (32%) were treated with antibiotics. Eleven patients had weakness and abscess volume was unrelated to motor weakness. Old age, 'spare room' (abscess volume subtracted from spinal volume) and intervertebral foramen height and posterior disc height were statistically significant. Among the 48 patients, 43 (85%) had good outcome and erythrocyte sedimentation rate (ESR) was the only meaningful prognostic factor (p=0.014). The cut-off value of ESR was 112mm/h with 80% sensitivity and 79% specificity and had borderline significance (p=0.062).ConclusionSEA needs emergent diagnosis and treatment. Motor weakness is the most important factor in treatment decision. By careful image reading, early surgical treatment can be an option for selected patients with severe spinal stenosis for prevent motor weakness. Inflammatory markers, especially ESR, are valuable to identify worsening of SEA.

Spinal Epidural Abscess Diagnosed at Lumbar Puncture Tap and Revealed by Paraparesis

“…Haemophilus was isolated in only one patient [7]. In the J. Min-Wook series in Korea, epidural pus culture was negative in 33% and Blood culture positive in only 32% of patients [6]. The analysis of cerebrospinal fluid found an inflammatory fluid in most cases.…”

“…SEA can occur at any age, but this condition is more common in male after 50 years. With an increasing incidence of 2/10000 hospitalizations, the main risk factors are diabetes, intravenous drug abuse, chronic alcoholism, skin infections, spine disorders, chronic kidney disease, chronic inflammatory diseases, pregnancy and post-partum or invasive procedures on the spine [6,7,10].…”

“…Severe back pain can be the only clinical finding and a delayed diagnosis can result [4,5]. The main risk factors identified are diabetes, intravenous drug abuse, invasive procedures, and pre-existing spinal column anomalies [6][7][8]. In some cases, such as ours, risk factors can be multiple.…”

“…. neurological status before surgery (patients in stage 1 or 2 are unlikely to have neurological sequelae, while stage 3 patients may have a total or partial recovery, those in stage 4 have been paralyzed for more than 24-36 hours may show partial recovery)[17] 2. elevation of ESR beyond 111.5 mm is associated with poor functional recovery[6].…”

Extensive Cervical Epidural Abscess: Case Report

“…The clinical significance of patients of epidural abscess is that the increased neurological complications in such patients have an adverse effect on prognosis [4,5]. The most valuable radiological technique in the diagnosis of spinal epidural abscess is MRI due to its high resolution power and ability to characterize the tissues [6].…”