title: A retrospective study of surgical and conservative treatment for spinal extradural abscess.
abstract: The management of spinal extradural abscess (SEA), particularly the choice between surgical and conservative treatment, is controversial. We therefore undertook a retrospective study of patients admitted with this diagnosis: Details of presentation, treatment and outcome were obtained by review of inpatient notes and radiology. Twenty-five individuals with SEA aged 10-79 years were admitted between 1989 and 1995. Nine were treated non-operatively with antibiotics, of which three also underwent diagnostic CT-guided biopsy, and 16 underwent surgical drainage. There was no significant difference in the neurological features at presentation between the two groups. Two patients (8%) died; 11 (44%) patients remained the same and 12 (48%) improved following treatment. Four patients treated conservatively (44%) and seven treated surgically (43%) were capable of return to work or school, whilst a further seven patients (three treated conservatively and four treated surgically) were able to lead independent lives. No significant difference in outcome was demonstrated between patients treated non-operatively and those treated surgically. We conclude that certain carefully selected patients can be treated conservatively, but that surgery should remain the mainstay of management.
authors.affiliation: Department of Neurosurgery, Atkinson Morley's Hospital, Wimbledon, UK.
authors.forename: J P
authors.initials: JP
authors.lastname: Grieve
authors.forename: N
authors.initials: N
authors.lastname: Ashwood
authors.forename: K S
authors.initials: KS
authors.lastname: O'Neill
authors.forename: A J
authors.initials: AJ
authors.lastname: Moore
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D001706:Biopsy; D002648:Child; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013396:Suction; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents