Clinical Characteristics of Patients With Spinal Epidural Abscess: A Systematic Review and Meta-Analysis

The diagnosis of spinal epidural abscess (SEA) is often delayed, as initial symptoms may be undifferentiated or mimic musculoskeletal disorders. The aim of this systematic review was to elucidate the demographics, symptoms and signs of patients with SEA. A systematic review of relevant manuscripts published from 1990 to September 2023 was performed. Quality appraisal of the studies was performed using the Newcastle-Ottawa Scale (NOS). The prevalence of each risk factor, symptoms and signs were extracted and pooled using a random effects model. There were 79 manuscripts included in this review. Most patients with SEA were male (61.3%), with an average age of 55.7 years. Most patients underwent surgical treatment (n = 4950; 69%). Overall mortality was reported in 759 (11%) patients from 44 studies. There were 17 variables identified as risk factors for SEA, with bacteraemia, smoking, and diabetes most commonly reported. The most common symptoms were back pain and fever. The most frequently observed signs were motor and sensory deficit, though 40% presented without neurological deficit. A wide range of risk factors and clinical presentation have been attributed to SEA. While heterogeneity in the literature precludes confidence in accurately classifying the variables, the range of variables corresponded to the anatomy and pathophysiology of the disease. Knowledge of the more commonly reported variables is essential for earlier diagnosis of this critical condition.