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Lumbar Epidural Abscesses: A Systematic Review.

Charles N de Leeuw1,2, Patrick R Fann1,2, Joseph E Tanenbaum1,2

  • 1Cleveland Clinic, Cleveland, OH, USA.

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|December 22, 2018
PubMed
Summary

Early surgical treatment for lumbar spinal epidural abscesses (SEAs) appears to improve motor recovery compared to medical management. Prompt diagnosis and intervention are critical for minimizing complications and mortality from SEAs.

Keywords:
EDASEAepidural abscesslumbarlumbar epidural abscessmedical managementoutcomesspine abscesssurgical managementsystematic review

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Area of Science:

  • Neurosurgery
  • Infectious Diseases
  • Spine Surgery

Background:

  • Spinal epidural abscesses (SEAs) are uncommon but can cause severe neurological deficits or death if diagnosis or treatment is delayed.
  • Optimal management strategies for lumbar SEAs remain unclear, necessitating a review of current evidence.

Purpose of the Study:

  • To synthesize existing literature on the clinical features, diagnosis, management, and outcomes of lumbar SEAs.
  • To provide guidance for spine surgeons on the best treatment modalities for lumbar SEAs.

Main Methods:

  • A systematic review of published literature was conducted.
  • Searches were performed across four major databases: EMBASE, MEDLINE, Scopus, and Web of Science.
  • Ten articles, encompassing 600 cases of lumbar SEA from 2000-2017, were included.

Main Results:

  • Negative prognostic factors for lumbar SEA include diabetes, advanced age, methicillin-resistant Staphylococcus aureus (MRSA) infection, immune compromise, and severe initial presentation.
  • Patients treated surgically as a first-line intervention demonstrated better motor recovery than those managed medically or those who failed medical treatment.
  • Predictors of medical management failure included elevated C-reactive protein, leukocytosis, and positive blood cultures.

Conclusions:

  • Surgical intervention may offer superior outcomes, particularly for patients with motor deficits, compared to medical management alone.
  • The current evidence base is limited by a scarcity of high-quality studies, hindering definitive evidence-based recommendations.
  • Early recognition and prompt treatment are paramount for reducing morbidity and mortality associated with SEAs.