Cervical spine epidural abscess: experience with microsurgical treatment in eight cases.
OBJECTIVE
The authors report a series of eight consecutive cases in which epidural abscesses in the cervical spine were treated by microsurgery without arthrodesis, including two cases of concomitant pyogenic and tubercular infection.


METHODS
The authors used a minimally invasive surgical approach consisting of single-level anterior microsurgical discectomy and drainage of the epidural abscess via a silicone catheter, and then initiated antibiotic therapy. At follow-up examination (mean duration 39 months), six patients exhibited complete recovery and two suffered from minor residual deficits. In all cases, spontaneous vertebral fusion occurred. Sagittal alignment was maintained in seven patients, and in one there was slight asymptomatic kyphosis. In two patients, tubercular and pyogenic infections were found. Prior intervention for dental infection was recorded in four cases.


CONCLUSIONS
In the absence of preoperative spinal instability, microsurgical drainage of the abscess followed by specific antibiotic therapy resulted in spinal cord decompression and neurological recovery, thereby facilitating spontaneous fusion and vertebral stability. The presence of combined tubercular and pyogenic infections of the cervical spine should be considered, especially in patients whose immune systems are depressed.
Muzii
Vitaliano Francesco
VF
Neurosurgical Clinic, University of Siena, Policlinico Santa Maria alle Scotte, Italy. muzii@unisi.it
Mariottini
Aldo
A
Zalaffi
Alessandro
A
Carangelo
Biagio Roberto
BR
Palma
Lucio
L
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D015299:Discitis / Q000382:microbiology / Q000601:surgery*; D017586:Diskectomy / Q000379:methods*; D004322:Drainage / Q000379:methods*; D020802:Epidural Abscess / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000601:surgery; D013290:Streptococcal Infections / Q000601:surgery; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000601:surgery