Introduction: Spinal epidural abscesses (SEA) remain a potentially life-threatening ailment that can lead to paralysis by the accumulation of purulent material in the epidural space. Some studies document that patients diagnosed with SEA account for 0.2 to 1.2 cases per 10,000 hospital admissions. We analyzed the factors that contributed more significantly in Los Angeles, one of the most populous cities in the world; whether subtle findings prompted a more fastidious inquiry as the years progressed; and whether LA was distinct in its predisposing factors that led to SEA.
Methods: Retrospective analysis of 169 patients diagnosed with a SEA from 1999 to 2011. We reviewed clinical exams; lab findings such as ESR, CRP, WBC, blood cultures, and wound cultures; neuroimaging studies performed; and predisposing illnesses (i.e. HIV/AIDS, diabetes mellitus).
Results: Of the 169 patients, more than 30% are IVDA and 10-15% had liver disease (i.e. Hepatitis B/C or cirrhosis). Having had previous spinal surgery combined with diabetes resulted in a higher incidence of SEA. Length of time it took from arrival to diagnosis decreased from an average of 4-24 hours to 5 hours. More than 50% of our population demonstrated elevated WBC or CRP. S. aureus was the predominant causative organism identified from the abscesses. MRI was the modality of choice during these years, with its usage increasing substantially in those patients scanned after 2011.
Conclusions: Neuroimaging advances and recognizing subtle findings have improved the ability to diagnose SEAs at LAC+USC. IVDA, hepatitis, and DM were main predisposing factors. Liver disease may be secondary to IVDA and alcoholism. In large-scale institutions, socioeconomic factors are significant contributors to the incidence of SEAs. Treatment of spinal epidural abscesses goes far beyond antibiotic or surgical management. It must include a more comprehensive paradigm that monitors intravenous drug users and alcoholics closely.
Patient Care: Create a paradigm that goes beyond simply treating SEA. Addresses the socioeconomic factors that are prevalent in large cities that result in this ailment.
Learning Objectives: Report the incidence of spinal abscesses, its predisposing factors, and changes in accuracy and length of time of diagnosis in a large institution such as Los Angeles County + University of Southern California Medical. The goal is to establish a paradigm for diagnosis and treatment in large-scale institutions.