Medical vs surgical management of spinal epidural abscess.
BACKGROUND
We compared the clinical features and outcomes of patients with spinal epidural abscess treated with prolonged parenteral antibiotics alone or combined with computed tomography-guided percutaneous needle aspiration drainage with those of patients undergoing surgical decompression.


METHODS
A retrospective analysis of 57 cases of spinal epidural abscess treated at an academic teaching hospital during a 14-year period.


RESULTS
The lumbar region was most frequently involved, and 46% of patients were immunocompromised. Staphylococcus aureus was the most frequently encountered pathogen. For 60 treatment courses, management included medical only (25 patients), medical plus computed tomography-guided percutaneous needle aspiration (7 patients), or surgical drainage approaches (28 patients). Prolonged use of parenteral antibiotics alone or combined with percutaneous needle drainage yielded clinical outcomes at least comparable with antibiotics plus surgical intervention, irrespective of patient age, presence of comorbid illness, disease onset, neurologic abnormality at time of presentation, or abscess size.


CONCLUSIONS
Patients with spinal epidural abscess can be safely and effectively treated with conservative medical treatment without the need for surgery.
Siddiq
Farhan
F
Department of Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, USA.
Chowfin
Ashish
A
Tight
Robert
R
Sahmoun
Abe E
AE
Smego
Raymond A
RA
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D020802:Epidural Abscess / Q000628:therapy*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007263:Infusions, Parenteral; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013211:Staphylococcus aureus; D013396:Suction / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents