Spinal epidural abscess: an analysis of 24 cases

Despite advances in neuroimaging and neurosurgical care, spinal abscess remains a challenging problem with mortality rates ranging from 4.6% to 31% in recent series.

Between January 1986 and December 2003, 24 patients with spinal epidural abscess were treated. Seventeen were men and 7 were women at the average age of 47.5 years. Concurrent illnesses that result in immunodepression such as diabetes and infections occurred in 62% of the case patients. All patients had back pain, 16 had muscle weakness, 9 had paresthesias, and 8 had sphincteral changes. Twenty-one patients underwent surgical procedures. In 11 case patients, the abscess had a frankly purulent material, and, in 5, the epidural lesion consisted of granulation tissue; the other 5 case patients had a combination of the 2. Three patients were treated conservatively. Staphylococcus aureus was isolated in 57% of the case patients. The lumbar spine was affected in 11 patients; the cervical spine, in 3.

Fifteen patients recovered their normal neurological functions but 4 remained with some neurological disability. No deaths occurred in this series.

Immediate surgical drainage of the abscess, before the development of severe neurological deficit, combined with specific antibiotics remains the treatment of choice.