Related Experiment Video
Updated: Apr 14, 2026
A Retrospective Study on Endoscopic Surgery for the Treatment of Paravertebral Abscess in Spinal Tuberculosis Patients
Published on: October 25, 2024
Surgical management in 40 consecutive patients with cervical spinal epidural abscesses: shifting toward
George M Ghobrial1, Matthew J Viereck, Philip J Margiotta
1*Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA †Department of Neurological Surgery, Tulane University, New Orleans, LA; and ‡Department of Orthopedic Surgery, The Rothman Institute, Philadelphia, PA.
Study Design:
Retrospective database review of a prospectively maintained neurosurgical database.
Objective:
The surgical management of cervical spinal epidural abscesses (CSEA) is reviewed examining the shift from single to staged anteroposterior decompression and stabilization.
Summary Of Background Data:
CSEA management is guided by small case series.
Methods:
A retrospective review from 1997 to 2011 was conducted for patients with the diagnostic headings: cervical epidural abscess, infection, osteomyelitis, osteodiscitis, spondylodiscitis, and abscess. Comorbidities, risk factors, surgical approach, neurologic grade, and outcomes were recorded.
Results:
Forty consecutive patients (mean age 53 years, age range 23-74, SD ±14, 10 female) were identified with CSEA in the operative database from 1997 to 2010. Twenty one patients had a body mass index more than 25 (53%), 6 (15%) had diabetes mellitus, 6 (15%) had a prior malignancy with 2 having prior neck irradiation, and 9 (23%) used tobacco products. The most common risk factor associated with CSEA was intravenous drug abuse, found in 10 patients (25%). The most common level of discitis involvement was C6-C7 in 12 (30%) followed by C5-C6 disc in 11 (28%) and least often at C1-C2 level in 2(5%) and C7-T1 in 2(5%). The most common neurologic grades at presentation were AIS D in 20 (50%) followed by AIS E in 9 (28%). All patients received magnetic resonance imaging identifying 17 (43%) with dorsal, 12 ventral (30%), and 11 circumferential epidural abscesses (28%). The majority of patients underwent anterior followed by posterior decompression and stabilization (n = 26, 65%); 8 (20%) underwent a ventral approach and six underwent a dorsal approach (15%). Fusion was achieved in 39 of 40 (97.5%) and not significantly influenced halo use in 10 patients.
Conclusions:
In this series, patients underwent acute evacuation and spinal cord decompression, and the shift toward staged treatment did not lead to an increased periprocedural complication rate.
Level Of Evidence:
3.
Related Concept Videos
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
01:22Aneurysm IV: Nursing Management
01:26Tonsillitis II: Management
01:11Local Anesthetics: Clinical Application as Spinal Anesthesia