Spinal epidural abscess: a 5-year case-controlled review of neurologic outcomes after rehabilitation.
OBJECTIVE
To describe the neurologic outcomes of 29 spinal epidural abscess (SEA) patients after rehabilitation compared with a case-controlled traumatic spinal cord injury (TSCI) cohort.


METHODS
Five-year retrospective chart review.


METHODS
University-affiliated surgical spine unit and inpatient rehabilitation program.


METHODS
Patients (n=29; 19 men, 10 women) requiring inpatient rehabilitation after SEA and TSCI case controls (n=29) matched by level of injury, American Spinal Injury Association (ASIA) Impairment Scale (AIS), ASIA motor score (AMS), sex, and age.


METHODS
The primary outcome was a change in AMS from acute admission to discharge from inpatient rehabilitation.


RESULTS
Despite having lower admission motor scores, there was a significant trend toward greater neurologic recovery in the SEA group (P=.047). In contrast to what is known regarding recovery from complete TSCI, this study shows potential for dramatic recovery in SEA subjects presenting with AIS grade A deficit with a 73% conversion rate to incomplete status; out of 11 SEA subjects with initial AIS grade A, 2 improved to AIS grade B, 1 to AIS grade C, and 5 to AIS grade D.


CONCLUSIONS
This study shows the potential for a significant improvement in neurologic deficits related to SEA. Based on the results of our study, it is clearly inappropriate to generalize recovery patterns seen in the TSCI patient population to SEA-associated myelopathy because the latter appears to have more favorable outcomes.
Koo
David W
DW
Department of Medicine, Division of Physical Medicine and Rehabilitation, Spinal Cord Injury Program, G.F. Strong Rehabiliation Centre, University of British Columbia, Vancouver, BC, Canada. david.koo@vch.ca
Townson
Andrea F
AF
Dvorak
Marcel F
MF
Fisher
Charles G
CG
D000328:Adult; D000367:Age Factors; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology; D016022:Case-Control Studies; D015897:Comorbidity; D003872:Dermatitis / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D020802:Epidural Abscess / Q000534:rehabilitation*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006525:Hepatitis, Viral, Human / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000534:rehabilitation; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D016896:Treatment Outcome