title: Ten-year review of extradural spinal abscesses in a New Zealand tertiary referral centre.
abstract: Despite being a well-understood pathology, patients with an extradural spinal abscess (ESA) still experience delays in diagnosis, with associated morbidity and mortality. This 10-year retrospective audit aimed to define the presentation, findings and prognosis of ESA in a New Zealand tertiary referral centre. Forty-two patients were diagnosed and treated between 1 May 1997 and 30 June 2007. The mean age was 55 years, with a male predominance of 1.6:1. Staphylococcus aureus was identified in 67% of patients. On presentation, 27/38 patients with back pain were afebrile and 2/37 patients had a normal C-reactive protein (CRP) level in the first 24 hours. Ten patients were discharged with neurological dysfunction and one died. One reason for the delays in diagnosis and appropriate referral could be the lack of "red flag" symptoms at the time of presentation. Attention needs to be paid to the history and nature of a patient's back pain. We recommend routine CRP and full blood count to help raise clinical suspicion.
authors.affiliation: Department of Neurosurgery, Christchurch Hospital, Christchurch, New Zealand. jkempthorne@ihug.co.nz
authors.forename: Joshua Timothy
authors.initials: JT
authors.lastname: Kempthorne
authors.forename: Chris
authors.initials: C
authors.lastname: Pratt
authors.forename: Emma Louise
authors.initials: EL
authors.lastname: Smale
authors.forename: Martin Richard
authors.initials: MR
authors.lastname: MacFarlane
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D020802:Epidural Abscess / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein