Spontaneous epidural abscess: analysis of 15 cases with emphasis on diagnostic and prognostic factors.
OBJECTIVE
To describe the incidence and characterize the clinical manifestations, diagnosis and outcome of spontaneous epidural abscess (SEA) not associated with neurosurgical procedures or instrumentation of the spine.


METHODS
Review of cases of SEA over 10 years. Diagnosis was made by imaging-techniques and surgical examination.


RESULTS
Fifteen patients were studied. The incidence of SEA was 0.4 cases per 100,000 person-years. Infection gained access to the epidural space haematogenously in 9 patients (60%). SEA was located at the lumbar (7 cases), cervical (4), cranial (2) and thoracic (1) areas. Local pain was the most common manifestation (93.3%); fever was absent in 40%. One third did not show neurologic abnormalities. Staphylococcus aureus was the most commonly isolated agent (87% of cases). All the patients received antimicrobial therapy for a mean period of 6.1+/-3.9 weeks. In addition, open surgical drainage or CT-guided needle aspiration was successfully performed in 10 and 3 patients respectively. Two patients were managed with antibiotics alone. Poor outcome occurred more frequently in patients with abscess at higher levels (67% in cranial or cervical abscesses versus 0% in thoracic or lumbosacral abscesses). An association was found between delayed diagnosis and poor outcome (p<0.05). Overall, 54% of our patients recovered without sequelae.


CONCLUSIONS
SEA resulted from the extension of nearby or distant infections into the epidural space. Diagnosis was frequently delayed and the patient's neurologic status at presentation was the most important predictor of the outcome. The onset of spinal pain in patients with focal infections should prompt MRI of the spine, even in the absence of neurologic abnormalities or fever.
González-López
Julio J
JJ
Division of Infectious Diseases (Department of Medicine), Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain.
Górgolas
Miguel
M
Muñiz
Jesús
J
López-Medrano
Francisco
F
Barnés
Pedro Ruiz
PR
Fernández Guerrero
Manuel L
ML
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D004322:Drainage; D020802:Epidural Abscess / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D004927:Escherichia coli Infections / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D034364:Streptococcus milleri Group
D000900:Anti-Bacterial Agents