Management of a spontaneous spinal epidural abscess: a single-center 10-year experience

There is significant debate in the literature regarding the optimal management of patients with the diagnosis of a spinal epidural abscess (SEA). Although some have advocated conservative treatment with intravenous antibiotics alone in select patients, recent studies have shown that patients treated without early surgery are more likely to have poor outcomes.

In this study, we review patients treated at a tertiary medical center with a spontaneous SEA. A total of 104 patients had a diagnosis of an SEA over a 10-year period. More than half of these patients presented with back pain alone and no objective motor weakness. Sixty-four patients (61.5%) were treated conservatively with computed tomography-guided aspiration or antibiotics alone based on blood cultures, whereas 40 patients (38.5%) underwent surgical decompression.

Of the patients managed nonoperatively, 11% improved, 64% remained stable, and 17% died. Conversely, of the patients treated with surgery, 25% improved, 43% remained stable, and 23% died. Review of the imaging studies revealed that 65.4% of patients had a ventral SEA, whereas 34.6% had a dorsal SEA. Although there were no statistically significant differences between these 2 groups in terms of management or outcome, 30.6% of the patients with a dorsal SEA were paraplegic or quadriplegic, and only 7.3% of the patients with a ventral SEA were paraplegic or quadriplegic (P = 0.003).

Our data do not support the hypothesis that patients treated without early surgery are more likely to have a poor outcome. Furthermore, we propose that the anatomy of the SEA (ventral or dorsal) should play an important role in determining the treatment plan.