How Best to Manage the Spinal Epidural Abscess? A Current Systematic Review

Area of Science:

• Neurosurgery
• Infectious Diseases
• Neurology

Background:

• Spinal epidural abscess (SEA) is a critical condition with variable neurologic outcomes despite prompt treatment.
• Clinical practice for SEA management is inconsistent, influenced by patient factors and imaging findings.

Purpose of the Study:

• To systematically review the literature on spinal epidural abscess management.
• To evaluate treatment outcomes and identify prognostic factors for neurologic recovery.

Main Methods:

• Systematic literature search (1990-2015) in MEDLINE and similar databases for "spinal epidural abscess" in human studies.
• Included 34 retrospective case series (≥10 patients); graded evidence using GRADE criteria.
• Excluded case series with fewer than 10 patients.

Main Results:

• Analysis of 1843 patients showed no significant difference between surgical and medical management for good outcome or neurologic improvement.
• Medical management alone had failure rates of 10-50% requiring surgery.
• Early surgery demonstrated significant positive impact on neurologic outcomes (P < 0.01).

Conclusions:

• Surgery combined with antibiotics is the preferred treatment for neurologically symptomatic SEA patients.
• Neurologically intact patients considered for antibiotic therapy require interdisciplinary consultation and vigilant monitoring for potential failure.