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  • Spinal Epidural Abscess

    Final Number:
    1121

    Authors:
    Vismay Thakkar MBBS; Cory Donovan Bovenzi; Saurabh Singhal; Kim A Williams MD; Jack Jallo MD, PhD, FACS

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Spinal epidural abscess (SEA) is an uncommon clinico-pathological entity associated with high morbidity. We intend to share our experience regarding clinical outcome of SEA cases treated with a combined treatment paradigm comprised of medical therapy and surgical decompression.

    Methods: Prospectively maintained department database was searched for cases of SEA during year 2007 to 2011, which resulted in a total of 20 patients.

    Results: 10 (50%) patients who presented with only back pain +/- fever, 7 (70%) had excellent outcomes (complete/near complete recovery), 2 (20%) had fair outcomes (partial recovery) and 1 (10%) had poor outcome (no recovery/worsened) at discharge. From 10 (50%) patients who presented with a neurological deficit, 3 (30%) had excellent outcomes, 6 (60%) had fair outcomes and 1 (10%) had poor outcome. Among the 10 patients who presented with neuro-deficit, 8 (80%) patients had this deficit present for >24 hours of duration before treatment, from which, only 2 (25%) patients had excellent outcomes, whereas 5(62.5%) had fair and 1 (12.5%) had poor outcomes. 2 (20%)patients with neuro-deficit present <24 hours before treatment, 1 (50%) had excellent outcome and 1 (50%) had poor outcomes. 9 (45%) patients made a follow-up visit with mean follow up time 6.6 months (range:1-30 months). 5 (55.6%)of these 9 patients were without neurological deficit and showed favorable score on mRS (mRS 1/2/3), whereas 4 (44.5%) patients had neuro-deficit, 3 (33.4%) showed favorable mRS score and 1 (11.1%) showed unfavorable mRS (mRS4/5) score.

    Conclusions: It is evident that irreversible neurological damage was strongly associated with presence of neuro-deficit at initial presentation and with diagnostic delay of more than 24 hours in SEA patients presenting with neurological deficit. Outcomes for patients presenting with only back pain and/or fever were relatively better.

    Patient Care: This study provides an important data that supports the need of emergent treatment in terms of combined medical and surgical interventions in spinal epidural abscess patients to minimize morbidity and mortality and attain best neurological outcomes.

    Learning Objectives: By the conclusion of this session, participants will be able to discuss:- 1) clinical outcomes of patients with spinal epidural abscess 2) importance of early diagnosis and prompt intervention of such patients 3) discuss the dilemma of whether to consider emergent decompression or to wait for clinical improvement and then consider delayed decompression while the patient with only back pain +/- fever (without a neuro-deficit) is on medical therapy.

    References:

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