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  • Epidural Abscess: A Propensity Analysis of Surgical Treatment Strategies

    Final Number:

    Anisse N Chaker BA; Abhiraj D. Bhimani; Darian R. Esfahani MD; Clayton L Rosinski BS; Brett Geever BS; Akash_ S. Patel BS; Jonathan Hobbs MD, MS; Taylor G Burch MS; Saavan Patel BS; Ankit Indravadan Mehta MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Spinal epidural abscess (SEA) is a highly morbid condition typically presenting with back pain, fever, and neurologic deficits. Posterior fusion has been used to supplement traditional laminectomy of SEA to improve spinal stability. At present, the ideal surgical strategy – laminectomy with or without fusion – remains elusive. In this study we compare the surgical profile of risk factors and perioperative complications for laminectomy and laminectomy with fusion procedures in the treatment of SEA.

    Methods: 30-day outcomes such as reoperation and readmission following laminectomy and laminectomy with fusion in patients with SEA were investigated utilizing the American College of Surgeons National Quality Improvement Program database. Demographics and clinical risk factors were collected, and propensity matching was performed to account for differences in risk profiles between the groups.

    Results: 738 patients were studied (608 laminectomy alone, 130 fusion). The fusion population was in worse health. The fusion population experienced significantly greater rate of return to the operating room (odds ratio (OR) 1.892), with the difference primarily accounted for by cervical spine operations. Additionally, fusion patients had significantly greater rates of blood transfusion. Infection was the most common reason for reoperation in both populations.

    Conclusions: Both laminectomy and laminectomy with fusion effectively treat SEA, but addition of fusion is associated with significantly higher rates of transfusion and perioperative return to the operating room. In operative situations where either procedure is reasonable, surgeons should consider that fusion nearly doubles the odds of reoperation in the short-term, and weigh this risk against the benefit of added stability.

    Patient Care: Spinal epidural abscesses are common and disabling in neurosurgery, and the optimal surgical strategy to address them remains unclear. This research improves patient care by providing a contemporary, propensity-matched risk profile for laminectomy and laminectomy with fusion in SEA, and identifies risk factors predictive of poor outcomes for each. This research further aids the decision making of the surgeon trying to decide between these two procedures in this challenging population.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify and compare outcomes for patients undergoing laminectomy and laminectomy for fusion for spinal epidural abscesses (SEA). 2) Characterize risk factors for reoperation in patients with SEA and identify the most common reasons for reoperation. 3) Recognize the added short-term risk from fusion for SEA, and weigh this hazard against the benefit of added stability.


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