Introduction: Non-iatrogenic spine infections (epidural abscess, diskitis, osteomyelitis) comprise a spectrum of clinical disorders that affect the spinal column, the paravertebral soft tissues, and the spinal cord itself. Although rare, these infections can cause significant morbidity and mortality. We reviewed 241 cases to further elucidate the factors that lead to positive neurological outcomes in patients with non-iatrogenic spine infections.
Methods: Following IRB approval, a retrospective chart review was performed of inpatients over a 6-year period with a discharge diagnosis of `spinal abscess`. Various factors including patient demographics, Charlson Comorbidity Index, hospital course, and type of treatment were assessed. Exclusion criteria included patients in the database with undocumented final neurological exams, patients with baseline limb amputations, or patients with baseline paraplegia.
Results: Of the 241 patients initially reviewed, 69 were excluded based on criteria. The factors associated with an improved neurological outcome were male sex (OR 2.27 p = 0.045 95% CI = 1.00 – 5.11), increased number of operations on logistical regression (Unit OR 1.43 p< 0.005 95% CI 1.13 – 1.85) and spinal fusion (OR 2.74 p <0.003 95% CI 1.4 – 5.35).
Conclusions: Multiple factors play a role in neurological outcomes in patients with spinal infection. From our data, male sex, greater number of operations, and spinal fusion were associated with better outcomes. Spinal fusion and a greater number of operations are somewhat predictably associated with better outcomes, as abscesses in other locations are best treated with thorough evacuation. There are many parameters that will be tested as we continue to analyze the patient database to help develop treatment guidelines and provide optimal management for patients.
Patient Care: Spine infections are relatively rare but can lead to significant morbidity and mortality. By identifying important factors that are associated with improved outcomes such as spinal fusion surgery, we can help develop improved treatment regimens for these particular patients.
Learning Objectives: By the conclusion of this session, participants should be able to 1) Identify the factors that contribute to improved neurological outcome in patients with spine infection. 2) Recognize the positive association of spinal fusion surgery with improved neurological outcome in these patients