Long-term outcome after neurosurgically treated spinal epidural abscess following epidural analgesia.
BACKGROUND
A recent investigation demonstrated a high incidence of epidural abscess secondary to epidural catheterization and a 50% frequency of neurologic deficits. We studied short- and long-term neurologic outcome in patients operated for spinal epidural abscess after epidural analgesia.


METHODS
Nineteen patients who had undergone neurosurgical decompression and drainage of a spinal epidural abscess during a 5-year period at three neurosurgical departments in East Denmark were identified by manual review of operating lists.


RESULTS
Median epidural catheterization time was 8 days (range 3-44). Preoperatively 12 patients suffered from inferior paraparesis, one had irradiating pain from the back, and 6 patients had no neurologic deficits. Postoperatively 2 patients had recovered, but 3 other patients had deteriorated; therefore, 13 patients were discharged with paresis/plegia. Seven patients died during a median follow-up time for all patients of 41.6 months. One patient recovered completely, and one suffered from minor deficits. The remaining patients suffered from paraparesis/plegia or bladder/bowel dysfunction.


CONCLUSIONS
Overall recovery rate for patients with paresis/plegia after epidural abscess was 20%. No patients with paresis/plegia following a thoracic abscess recovered in contrast to a 50% recovery rate for patients with lumbar epidural abscess. The majority of long-term survivors had severe neurologic deficits. Abscess formation contributed to one death.
Wang
L P
LP
Department of Neuroanesthesiology, National University Hospital, Rigshospitalet, Copenhagen, Denmark. lp.wang@dadlnet.dk
Hauerberg
J
J
Schmidt
J F
JF
D000038:Abscess / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D004824:Epidural Space / Q000382:microbiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000209:etiology; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D013203:Staphylococcal Infections / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome