Risk Factors for Neurologic Deficits in Patients With Spinal Epidural Abscess: An Analysis of One-Hundred-Forty Cases

Area of Science:

• Neurosurgery
• Infectious Diseases
• Orthopedic Surgery

Background:

• Spinal epidural abscess (SEA) treatment can be surgical or conservative for patients without acute neurological deficits.
• Risk factors for neurological impairment in SEA patients are not well-defined.
• Identifying these factors is crucial for optimizing treatment strategies.

Purpose of the Study:

• To identify factors that predispose patients with spinal epidural abscesses to neurological impairment.
• To inform clinical decision-making regarding early surgical intervention.

Main Methods:

• Retrospective analysis of 140 patients with SEA treated between 2008 and 2021.
• Data collected included demographics, comorbidities, pathogens, osseous destruction, SEA location, and preoperative neurological status.
• Univariate and logistic regression analyses compared patients with and without pretreatment neurological deficits.

Main Results:

• 31% of patients presented with neurological deficits.
• Univariate analysis showed significant differences in diabetes mellitus, leg pain, ASA Score, and BMI between groups.
• Multivariable analysis identified diabetes mellitus (OR=2.7), female sex (OR=2.5), and ASA Score (OR=2.4) as significant predictors of neurological deficits.

Conclusions:

• Diabetes mellitus, female sex, and higher ASA scores are significant risk factors for neurological deficits in SEA patients.
• These factors should be considered, particularly in female patients, to assess the risk of neurological deterioration.
• Early surgical treatment may be beneficial for SEA patients identified as high-risk for neurological impairment.