title: Surgical treatment of patients with spondylodiscitis and neurological deficits caused by spinal epidural abscess (SEA) is a predictor of clinical outcome.
abstract: METHODS
  Retrospective study.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the question whether surgical treatment of patients with spondylodiscitis and neurological deficits caused by a spinal epidural abscess (SEA) is a predictor of clinical outcome.
  
  
  BACKGROUND
  Spondylodiscitis with an accompanying SEA is a serious medical condition that is associated with potentially high risk for long-term neurological morbidity. In the literature, up to 75% of patients suffer from neurological deficits related to SEA in spondylodiscitis. Independent of treatment, residual neurology persists at a high rate.
  
  
  METHODS
  A retrospective analysis of 135 patients admitted to our department due to a diagnosis of spondylodiscitis was performed. Presence of SEA was evaluated based on computed tomography and magnetic resonance imaging. Neurological status was documented on admission and at discharge according to the Frankel Score. In addition, our patient population was separated into group I without neurological deficits (Frankel E) and group II with abnormal Frankel A-D. Surgical and nonsurgical therapy was retrospectively evaluated. Data were statistically analyzed using the 2-sided Fisher exact test.
  
  
  RESULTS
  On admission, 102 patients were graded as Frankel E in group I. In group II, 15 were Frankel D, 8 Frankel C, 8 Frankel B, and 2 Frankel A. After treatment, 105 patients were Frankel E, 19 Frankel D, 4 Frankel C, 3 Frankel B, and none Frankel A. Four patients died because of severe comorbidities. In group II, 13 of 33 patients had a SEA. Twelve patients showed improvement in Frankel grade, 1 remained unchanged. Of the 20 patients in group II without a SEA, 11 improved and 9 remained unchanged. Twenty-eight of the 33 patients in group II were treated surgically. Patients in both groups with improved neurology showed an upgrade by 1 or 2 Frankel scores. There was no deterioration of neurology. The correlation between surgically treated patients with SEA in comparison with patients without SEA is considered to be statistically significant.
  
  
  CONCLUSIONS
  Surgical treatment of patients with spondylodiscitis and neurological deficits caused by SEA is a predictor of clinical outcome.
authors.affiliation: Department of Orthopaedic Surgery, University Hospital of Munich (LMU), Munich, Germany.
authors.forename: Björn P
authors.initials: BP
authors.lastname: Roßbach
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Niethammer
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Paulus
authors.forename: Carolin
authors.initials: C
authors.lastname: Melcher
authors.forename: Christof
authors.initials: C
authors.lastname: Birkenmaier
authors.forename: Volkmar
authors.initials: V
authors.lastname: Jansson
authors.forename: Bernd
authors.initials: B
authors.lastname: Wegener
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015299:Discitis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D020802:Epidural Abscess / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult