title: Treatment of Spinal Epidural Abscess and Predisposing Factors of Motor Weakness: Experience with 48 Patients.
abstract: OBJECTIVE
  Spinal epidural abscess (SEA) can be fatal if untreated, so early diagnosis and treatment are essential. We conducted a retrospective study to define its clinical features and evaluate the risk factors of motor weakness.
  
  
  METHODS
  We retrospectively analyzed the medical records and images of patients with SEA who had been hospitalized in our institute from January 2005 to June 2012. Pyogenic SEA patients were categorized as patients without motor weakness (Group A) and with motor weakness (Group B). Abscess volume was measured using the Gamma-Plan program. Intervertebral foramen height and posterior disc height were measured to evaluate degree of spinal stenosis.
  
  
  RESULTS
  Of 48 patients with pyogenic SEA, 33 (68%) were treated surgically, and 15 (32%) were treated with antibiotics. Eleven patients had weakness and abscess volume was unrelated to motor weakness. Old age, 'spare room' (abscess volume subtracted from spinal volume) and intervertebral foramen height and posterior disc height were statistically significant. Among the 48 patients, 43 (85%) had good outcome and erythrocyte sedimentation rate (ESR) was the only meaningful prognostic factor (p=0.014). The cut-off value of ESR was 112mm/h with 80% sensitivity and 79% specificity and had borderline significance (p=0.062).
  
  
  CONCLUSIONS
  SEA needs emergent diagnosis and treatment. Motor weakness is the most important factor in treatment decision. By careful image reading, early surgical treatment can be an option for selected patients with severe spinal stenosis for prevent motor weakness. Inflammatory markers, especially ESR, are valuable to identify worsening of SEA.
authors.affiliation: Department of Neurosurgery, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Min-Wook
authors.initials: MW
authors.lastname: Ju
authors.affiliation: Department of Neurosurgery, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Seung-Won
authors.initials: SW
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Hyon-Jo
authors.initials: HJ
authors.lastname: Kwon
authors.affiliation: Department of Neurosurgery, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Seon-Hwan
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Hyeon-Song
authors.initials: HS
authors.lastname: Koh
authors.affiliation: Department of Neurosurgery, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Youm
authors.affiliation: Department of Neurosurgery, Chungnam National University School of Medicine, Daejeon, Korea.
authors.forename: Shi-Hun
authors.initials: SH
authors.lastname: Song
keywords: Abscess volume measurement; Gamma-Plan program; Motor weakness; Spinal epidural abscess