Spinal epidural abscess.
BACKGROUND
The incidence of spinal epidural abscesses (SEAs) is rising. Although increased awareness has led to decreased mortality, morbidity remains unacceptably high, with rapid deterioration of neurological status when there is a delay in initiation of treatment. Therefore, we need to build a better understanding of prognostic factors and management strategies. The goal of this article is to identify various prognostic factors, the role of inflammatory markers, optimal management strategies, and the relationship between timing of intervention and outcome.


METHODS
A computer search of health records in our institution revealed 20 cases of spinal epidural abscess over the past 5 years. A retrospective analysis of clinical, radiological, laboratory, and surgical findings was performed. A scoring system ranging from 1 (complete neurological recovery) to 5 (dead) was used to assess outcomes. We also analyzed the prognostic value of several factors, including demographics, clinical presentation, comorbidities, inflammatory markers, imaging findings, and timing of intervention.


RESULTS
Fifteen of 20 patients had a good outcome (score of 1 or 2) in this series. Erythrocyte sedimentation rate, muscle strength at time of admission, and timing of intervention were found to have a statistically significant relationship with outcome. C-reactive protein, comorbidities, age, sex, and degree of thecal sac compression were found to have no prognostic value.


CONCLUSIONS
Although many prognostic factors have been suggested and analyzed, the most important contributor to outcome in SEA remains a high clinical suspicion, prompt investigation, and immediate intervention.
Kumar
Krishna
K
Division of Neurosurgery, Regina General Hospital, University of Saskatchewan, Regina SK, Canada. krishna.kumar@rqhealth.ca
Hunter
Gary
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D020802:Epidural Abscess / Q000097:blood / Q000150:complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000097:blood / Q000150:complications / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein