Spinal epidural abscess: clinical presentation, management, and outcome

Area of Science:

• Neurology
• Infectious Diseases
• Neurosurgery

Background:

• Spinal epidural abscess (SEA) is a serious condition requiring prompt diagnosis and management.
• Clinical characteristics and outcomes of SEA patients are not fully understood.
• Understanding presentation and treatment impact on outcomes is vital for patient care.

Purpose of the Study:

• To describe the clinical features of patients diagnosed with spinal epidural abscess.
• To evaluate the relationship between patient presentation, treatment strategies, and short-term clinical and neurologic outcomes.

Main Methods:

• Retrospective review of medical records and radiographic images.
• Inclusion criteria: patients admitted with spinal epidural abscess between January 1995 and March 2001.
• Data analysis focused on clinical presentation, causative organisms, abscess location, and treatment outcomes.

Main Results:

• 48 patients (30 male, 18 female; median age 61) were analyzed.
• Common risk factors included intravenous drug abuse (13) and non-spinal infections like endocarditis (10).
• Staphylococcus aureus was the most frequent pathogen; abscesses commonly occurred in the lumbosacral spine (22).
• Early surgery (25 patients) resulted in better outcomes compared to antibiotic-only treatment (23 patients), with fewer unfavorable outcomes (P < 0.005).

Conclusions:

• Spinal epidural abscess patients may present without fever or elevated white blood cell counts.
• Neurologic deficits at presentation influenced the decision for urgent surgery.
• Delayed surgical intervention in SEA patients is associated with significantly higher rates of deterioration and poor outcomes.