Motor function improvement in patients undergoing surgery for spinal epidural abscess.
BACKGROUND
Spinal epidural abscess (SEA) is a rare and devastating clinical entity. Definitive diagnosis is usually delayed because most patients present initially with minor or variable symptoms resulting in poor outcome. The clinical outcome of SEA has been associated with various prognostic factors; however, reports on factors relating to motor function improvement after surgical treatment are limited.


OBJECTIVE
The aim of this study is to elucidate which clinical factors may affect motor function recovery after surgical treatment of SEA.


METHODS
The clinical features of patients with SEA undergoing surgical drainage and antibiotics treatment were reviewed, and their outcomes were identified and analyzed.


RESULTS
The most common presenting symptoms were neck or back pain, motor deficits, and urinary incontinence. The most common underlying medical condition was diabetes mellitus. Leukocytosis (P = .036; odds ratio [OR] = 0.754; confidence interval [CI] = 0.579-0.982), elevated C-reactive protein level (P = .017; OR 0.96; CI = 0.965-0.994), poor glycemic control (P = .012; OR = 23.33; CI = 1.992-273.29), and duration of motor deficit at the time of operation (P = .005; OR = 40.50; CI = 3.093-530.293) were found to have a strong influence on motor function improvement after surgical treatment.


CONCLUSIONS
Infection control and the prevention of further neurological deterioration in time are paramount in the treatment of SEA for optimal recovery. Patients with rapid neurological deterioration or higher white blood cell count or C-reactive protein level on presentation warrant aggressive surgical intervention; even in those who are completely paralyzed, an improvement in muscle power may still be possible.
Wang
Ting-Chung
TC
Division of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi Center, Chang Gung University, Putz City, Chia-Yi, Taiwan.
Lu
Ming-Shian
MS
Yang
Jen-Tsung
JT
Weng
Hsu-Huei
HH
Cheng
Yu-Kai
YK
Lin
Martin Hsiu-Chu
MH
Su
Chen-Hsing
CH
Lee
Ming-Hsueh
MH
D000328:Adult; D000368:Aged; D004322:Drainage; D020802:Epidural Abscess / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D020127:Recovery of Function; D016896:Treatment Outcome