Introduction: Cervical Spinal Epidural Abscess(CSEA) management is guided by small case series. The authors perform a retrospective review of a prospectively maintained neurosurgical database to evaluate the outcomes of surgical management for this disease.

Methods: : A retrospective review from 1997 - 2011 was conducted for patients with the diagnostic headings: cervical epidural abscess, infection, osteomyelitis, osteodiscitis, spondylodiscitis, and abscess. Comorbidities, risk factors, surgical approach, neurologic grade and outcomes were recorded.

Results: 40 consecutive patients (mean age 53 years, age range 23-74, SD ±14, 10 female) were identified with CSEA in the operative database from 1997-2010. 21 patients had a body mass index >25 (53%), 6 (15%) had diabetes mellitus, 6 (15%) had a prior malignancy, with 2 having prior neck irradiation and 9 (23%) used tobacco products. The most common risk factor associated with CSEA was intravenous drug abuse, found in 10 patients (25%). The most common level of discitis involvement was C6/C7 in 12 (30%) followed by C5/C6 disc in 11 (28%) and least often at C1/C2 level in 2(5%) and C7/T1 in 2(5%). The most common neurologic grades at presentation were AIS D in 20 (50%) followed by AIS E in 9 (28%). All patients received magnetic resonance imaging identifying 17 (43%) with dorsal, 12 ventral (30%), and 11 circumferential epidural abscesses (28%). The majority of patients underwent anterior followed by posterior decompression and stabilization (n=26, 65%); 8 (20%) underwent a ventral approach and six underwent a dorsal approach (15%). Fusion was achieved in 39 of 40 (97.5%) and was not significantly influenced by halo use in 10 patients.

Conclusions: : In this series, patients underwent acute evacuation and spinal cord decompression, and the shift towards staged treatment did not lead to an increased periprocedural complication rate.

Patient Care: This research is essential to the spinal community as it presents the largest patient population of a rare disease, providing guidance on the treatment options and outcomes of surgical management.

Learning Objectives: By the conclusion of this session, participants should be able to: 1:) Identify the treatment options for Cervical Spondylodiscitis with Epidural Abscesses 2:) Understand relative postoperative outcomes between surgical treatment plans. 3:) Understand the influence of Halo Orthosis on fusion rate in the postoperative spondylodiscitis patient.

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