title: Aggressive surgical intervention in end-stage renal disease patients with spinal epidural abscess.
abstract: BACKGROUND
  Despite advances in imaging, as well as antibiotic and surgical treatment, spinal epidural abscess (SEA) remains a challenging problem in end-stage renal disease (ESRD) patients. This investigation assesses the influence of ESRD on clinical manifestations, complications, and outcomes in patients with SEA.
  
  
  METHODS
  This study retrospectively reviewed medical records of 41 patients with SEA treated during 2003-2006. The patients comprised two groups: group I (patients with ESRD) and group II (patients without ESRD). Patient characteristics, including age, gender, comorbidities, clinical presentations, laboratory data, locations of epidural abscess, and outcome, were recorded and compared.
  
  
  RESULTS
  The final sample comprised 41 patients. The mean age of the subjects was 62 + 12 years. The sample included 12 patients with ESRD and 29 without ESRD. The development of symptoms was similar for both groups. Group I patients displayed higher serum erythrocyte sedimentation rate (ESR) (108 + 26 vs. 81 + 31 mm/h, p = 0.014) and lower serum hematocrit (27.1 + 4.3 vs. 33.7 + 5.1%, p < 0.001) than group II patients. Overall survival at 3 months was 88.9% and 93.1% for patients in groups I and II, respectively (p = 0.876). Meanwhile, patients that underwent surgical decompression of epidural abscess received more surgeries than group I patients (1.08 vs. 0.55, p = 0.086), although the difference was not significant.
  
  
  CONCLUSIONS
  ESRD is a risk factor for repeat surgery in patients with SEA. This investigation suggests that ESRD patients with SEA may require aggressive surgical intervention despite ESRD not affecting their long-term prognosis.
authors.affiliation: Department of Nephrology, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan.
authors.forename: Mei-Yi
authors.initials: MY
authors.lastname: Wu
authors.forename: Tsai-Sheng
authors.initials: TS
authors.lastname: Fu
authors.forename: Chih-Hsiang
authors.initials: CH
authors.lastname: Chang
authors.forename: Hsiang-Hao
authors.initials: HH
authors.lastname: Hsu
authors.forename: Ming-Yang
authors.initials: MY
authors.lastname: Chang
authors.forename: Ya-Chung
authors.initials: YC
authors.lastname: Tian
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Hung
authors.forename: Ji-Tseng
authors.initials: JT
authors.lastname: Fang
authors.forename: Lih-Huei
authors.initials: LH
authors.lastname: Chen
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Chen
mesh_terms: D019299:Decompression, Surgical / Q000379:methods; D020802:Epidural Abscess / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D006435:Renal Dialysis; D012189:Retrospective Studies; D012447:Sacrum; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013904:Thoracic Vertebrae; D016896:Treatment Outcome