Introduction: Spinal epidural abscess (SEA) is relatively rare disease but is frequently needed emergent surgery. Their incidence is on the rise, which is attributing to various factors such as the elderly, intravenous drug use, epidural steroid injection for pain control, epidural anesthesia and development of imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI).
The aim of this study is to elucidate the clinical characteristics of patients with spinal epidural abscess (SEA) and related presentation, risk factors, treatment and neurologic outcome.
Methods: We retrospectively reviewed the medical records and radiologic images of 35 patients admitted to our department with SEA between March 1987 and April 2011. We performed decompressive laminectomy, abscess drainage on nineteen patients (54.3%), and 16 patients (45.7%) initially received conservative therapy with antibiotics alone. Medical Research Council scale (MRC) was applied to estimate results objectively.
Results: The neurological outcome data showed improved MRC score for 14 (40%) patients. 13 (37.1%) patients were unchanged MRC score and 8 (22.9%) patients were revealed with worsened MRC score at the time of discharge. The patients who underwent surgical treatment showed more improved MRC score than the patients who received conservative treatment and this was statistically significant (p=0.001) on univariate analysis. Initially, patients with decreased MRC score and rapidly progressing neurological deficit underwent emergency surgery within 24 hours. Patients with intact MRC score and minor neurological deficit underwent delayed surgery or conservative manage with antibiotics. Among 19 patients those who underwent emergent operation within 24 hours showed better prognoses than those who underwent delayed operation after 24 hours.
Conclusions: Surgical treatment is the modality of choice in patients with SEA and urgent surgery especially indicated in patients with a neurological deficit. And early surgery is more effective in neurological improvement than delay surgery and conservative manage.
Patient Care: The improvement of neurological symptoms can be expected through emergency surgery particularly in the patients with neurological deficit
Learning Objectives: Good outcomes can be expected if decompression and surgical drainage are conducted immediately after diagnosing SEA.