title: Surgical management in 40 consecutive patients with cervical spinal epidural abscesses: shifting toward circumferential treatment.
abstract: METHODS
  Retrospective database review of a prospectively maintained neurosurgical database.
  
  
  OBJECTIVE
  The surgical management of cervical spinal epidural abscesses (CSEA) is reviewed examining the shift from single to staged anteroposterior decompression and stabilization.
  
  
  BACKGROUND
  CSEA management is guided by small case series.
  
  
  METHODS
  A retrospective review from 1997 to 2011 was conducted for patients with the diagnostic headings: cervical epidural abscess, infection, osteomyelitis, osteodiscitis, spondylodiscitis, and abscess. Comorbidities, risk factors, surgical approach, neurologic grade, and outcomes were recorded.
  
  
  RESULTS
  Forty consecutive patients (mean age 53 years, age range 23-74, SD ±14, 10 female) were identified with CSEA in the operative database from 1997 to 2010. Twenty one patients had a body mass index more than 25 (53%), 6 (15%) had diabetes mellitus, 6 (15%) had a prior malignancy with 2 having prior neck irradiation, and 9 (23%) used tobacco products. The most common risk factor associated with CSEA was intravenous drug abuse, found in 10 patients (25%). The most common level of discitis involvement was C6-C7 in 12 (30%) followed by C5-C6 disc in 11 (28%) and least often at C1-C2 level in 2(5%) and C7-T1 in 2(5%). The most common neurologic grades at presentation were AIS D in 20 (50%) followed by AIS E in 9 (28%). All patients received magnetic resonance imaging identifying 17 (43%) with dorsal, 12 ventral (30%), and 11 circumferential epidural abscesses (28%). The majority of patients underwent anterior followed by posterior decompression and stabilization (n = 26, 65%); 8 (20%) underwent a ventral approach and six underwent a dorsal approach (15%). Fusion was achieved in 39 of 40 (97.5%) and not significantly influenced halo use in 10 patients.
  
  
  CONCLUSIONS
  In this series, patients underwent acute evacuation and spinal cord decompression, and the shift toward staged treatment did not lead to an increased periprocedural complication rate.
  
  
  METHODS
  3.
authors.affiliation: *Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA †Department of Neurological Surgery, Tulane University, New Orleans, LA; and ‡Department of Orthopedic Surgery, The Rothman Institute, Philadelphia, PA.
authors.forename: George M
authors.initials: GM
authors.lastname: Ghobrial
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Viereck
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Margiotta
authors.forename: Sara
authors.initials: S
authors.lastname: Beygi
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Maulucci
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Heller
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D020802:Epidural Abscess / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult