SpineSpinal epidural abscess: contemporary trends in etiology, evaluation, and management
Section snippets
Clinical material and methods
From January 1, 1983 to December 31, 1992, a total of 74,477 patients were admitted to the University of Maryland Medical Systems. Seventy-five patients with SEA were identified by a computerized search of discharge diagnoses. The medical records, laboratory data, hospital notes, radiological studies, and operative reports of all patients with SEA were carefully reviewed.
Patients with manifestations for less than 2 weeks before admission were considered to have an acute presentation. Those
Patient demographics
We identified 75 cases (48 male (64%); 27 female (36%); age range 3 months to 83 years; mean age, 50.7 years) of spinal epidural abscess (0.1% of all hospital admissions during the study period). Yearly frequency of SEA revealed a significant increase (least squares regression method, p = 0.0195) in incidence after December 1988 (Figure 1).
Microbiology
Staphylococcus aureus was the predominant pathogen isolated in 50 (67%) patients; 11 (15%) cases showed methicillin-resistant Staphylococcal species. Five
Discussion
Spinal epidural abscess poses a formidable problem to the practicing physician in both diagnosis and treatment. The morbidity and mortality associated with this condition remain significant. In the present series, 8 of 75 patients died and 17 had fair to poor outcome, highlighting the need for prompt diagnosis and initiation of appropriate therapy. With rapid intervention, excellent outcome (50 of 75 patients in the present study) can be achieved and morbidity avoided.
Conclusions
Given our extensive experience with SEA, we propose the following recommendations to all physicians who encounter patients who may harbor this potentially devastating disease:
1. For all high risk patients the following clinical presentations should prompt an urgent MRI (or CT myelogram when MRI is not available): neurologic deficit and focal back pain; neurologic deficit with unexplained fever; neurologic deficit with elevated ESR; severe focal back pain with fever; severe focal back pain with
Acknowledgements
This work was presented at the European Congress of Neurological Surgeons, Berlin, Germany, May 11–15, 1995, and also at the International Congress of Neurological Surgeons. Amsterdam, Netherlands, July 4–9, 1997. We thank Dr. Pamela Talalay and Ritu Goel for assistance in preparing this article.
References (34)
- et al.
Spinal epidural abscess
Ann Emerg Med
(1987) - et al.
Spinal epidural abscessa report of 40 cases and review
Surg Neurol
(1992) - et al.
Acute epidural abscess
Am J Emerg Med
(1987) - et al.
Surgical aspects of nonspecific inflammatory and suppurative disease of the vertebral column
Am J Surg
(1966) - National Institute for Drug Abuse. University of Michigan Institute for Social Research,...
- et al.
MR imaging of spinal epidural abscess
Am J Radiol
(1987) - et al.
Spinal epidural abscess
N Eng J Med
(1975) - et al.
Epidural abscess and vertebral osteomyelitis following serial lumbar punctures
Pediatrics
(1983) - et al.
Acute spinal epidural abscess
J Neurol
(1985) - et al.
Contrast enhancement in spinal MR imaging
AJNR
(1989)
Changing concepts in spinal epidural abscessa report of 29 cases
Neurosurgery
Update of spinal epidural abscess35 cases and review of the literature
Rev Infect Dis
Spinal epidural abscess in adultsreview and report of 29 cases
Neurosurgery
Spinal epidural abscess in adultsreview and report of iatrogenic cases
Scand J Infect Dis
Acute spinal epidural abscess
Paraplegia
A study of 49 patients with acute spinal epidural abscess
Paraplegia
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