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  • A Retrospective Study of Operative Outcomes for Patients with Spinal Epidural Abscess

    Final Number:

    Leonard Keller BS; Thomas Mroz; Edward C. Benzel MD; Amy S. Nowacki PhD; Bryan S Lee MD; Michael P. Steinmetz MD; Joseph E Tanenbaum BA; Vincent J Alentado MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: The objectives of this study were to assess the clinical outcomes of spinal epidural abscess (SEA) after surgical management and to identify patient-level factors that are associated with outcomes following surgical decompression of SEA.

    Methods: A retrospective analysis of 152 consecutive patients that presented to the Cleveland Clinic with SEA and that were treated with surgery between 2010 and 2015 was performed.

    Results: 152 patients (mean age, 58 years) were treated using surgical decompression and antibiotics during the study period. A comparison of the pre-operative ASIA and post-operative pre-discharge ASIA scores showed that 49% of patients maintained an ASIA score of E or improved while 45% remained at their pre-operative status and 6% worsened. Among a subset of patients (n=36) for whom a 6 ± 2 month follow-up encounter occurred, 75% maintained an ASIA score of E or improved, 19% remained at their pre-operative status, and 6% worsened. Both the presence and longer duration of pre-operative paresis was associated with an increased risk of remaining at the same ASIA score or worsening at the post-operative pre-discharge encounter (both p < 0.001). Age, race, sex, BMI, smoking status, bladder or bowel dysfunction, C-reactive protein level, white blood cell count, diabetes status, erythrocyte sedimentation rate, location of abscess in a specific spinal region, and degree of thecal sac compression were not associated with an increased risk of remaining at the same or worsening ASIA score at the post-operative pre-discharge encounter.

    Conclusions: Surgical decompression as part of the management of SEA can contribute to improving or maintaining ASIA scores in most patients. The presence and duration of pre-operative paresis are prognostic for poorer outcomes and suggest that rapid surgical intervention before it develops may lead to improved post-operative outcomes.

    Patient Care: This research can enable enhanced understanding of the pre-operative patient-level factors associated with outcomes of SEA managed with surgery which allows better clinical and patient decision making.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the clinical outcomes of SEA after surgical management, 2) Identify patient-level factors that are associated with outcomes following surgical decompression of SEA, 3) Appreciate the prognostic value of pre-operative paresis on outcomes of surgical management of SEA


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