title: Spinal epidural abscesses: a retrospective analysis of clinical manifestations, sources of infection, and outcomes.
abstract: BACKGROUND
  Spinal epidural abscess (SEA) is uncommon but has a potentially disastrous outcome. Its early recognition and management may lead to satisfactory results. We analyzed the clinical manifestations, sources of infection, and outcomes of patients with SEA.
  
  
  METHODS
  Between 1997 and 2003, 17 patients in the Department of Neurosurgery at Keelung Chang Gung Memorial Hospital had SEA. We retrospectively reviewed their records to analyze their clinical presentations, image findings, laboratory data, and clinical outcomes.
  
  
  RESULTS
  All 17 patients (mean age, 63 years) underwent surgery and received antibiotics. Back and/or neck pain (82%), motor deficits (70%), and elevated C-reactive protein levels or erythrocyte sedimentation rates (64%) were the most common symptoms and signs. The most common etiological organism was oxacillin-resistant Staphylococcus aureus. The SEA was most commonly located in the lumbar spine, anterior to the spinal canal. Outcomes were poor in 29% of the patients, fair in 18%, and good in 53%.
  
  
  CONCLUSIONS
  Abdominal complications in patients with spinal disease are not uncommon, especially when the thoracic level is involved. The abdominal symptoms may initially mask neurological deficits due to spinal cord involvement, however, spinal pain and motor deficits present in most cases under more thorough investigation. In a suspected SEA patient with a history of gouty arthritis, tissue biopsy should include additional crystal analysis. Although the increasing availability of MRI makes diagnosis easier and quicker, repeated neurological examination and full evaluation are essential in any patient with an unknown focus of infection and spinal pain or tenderness.
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung; Chang Gung University, Taoyuan, Taiwan 204, R.O.C. samchen@cgmh.org.tw
authors.forename: Hsien-Chih
authors.initials: HC
authors.lastname: Chen
authors.forename: Wen-Ching
authors.initials: WC
authors.lastname: Tzaan
authors.forename: Tai-Ngar
authors.initials: TN
authors.lastname: Lui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D048909:Diabetes Complications; D020802:Epidural Abscess / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000175:diagnosis; D019547:Neck Pain / Q000175:diagnosis; D011009:Pneumoconiosis / Q000150:complications; D011379:Prognosis; D011843:Radiculopathy / Q000175:diagnosis; D011859:Radiography; D012189:Retrospective Studies; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology; D013203:Staphylococcal Infections / Q000150:complications*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D016896:Treatment Outcome