Elsevier

Surgical Neurology

Volume 63, Supplement 1, January 2005, Pages S26-S29
Surgical Neurology

Spinal epidural abscess: an analysis of 24 cases

https://doi.org/10.1016/j.surneu.2004.09.021Get rights and content

Abstract

Background

Despite advances in neuroimaging and neurosurgical care, spinal abscess remains a challenging problem with mortality rates ranging from 4.6% to 31% in recent series.

Methods

Between January 1986 and December 2003, 24 patients with spinal epidural abscess were treated. Seventeen were men and 7 were women at the average age of 47.5 years. Concurrent illnesses that result in immunodepression such as diabetes and infections occurred in 62% of the case patients. All patients had back pain, 16 had muscle weakness, 9 had paresthesias, and 8 had sphincteral changes. Twenty-one patients underwent surgical procedures. In 11 case patients, the abscess had a frankly purulent material, and, in 5, the epidural lesion consisted of granulation tissue; the other 5 case patients had a combination of the 2. Three patients were treated conservatively. Staphylococcus aureus was isolated in 57% of the case patients. The lumbar spine was affected in 11 patients; the cervical spine, in 3.

Results

Fifteen patients recovered their normal neurological functions but 4 remained with some neurological disability. No deaths occurred in this series.

Conclusions

Immediate surgical drainage of the abscess, before the development of severe neurological deficit, combined with specific antibiotics remains the treatment of choice.

Abstract

Resumo

Vinte e quatro pacientes com abscesso epidural raquiano foram tratados entre janeiro de 1986 e dezembro de 2003. Dezessete eram homens e 7 mulheres, com idade mediana de 47,5 anos. A associação de patologias que levam a imunodepressão como diabetes e infecções ocorreram em 62% dos casos. Todos os pacientes tinham dor na coluna vertebral, dezesseis se apresentavam com fraqueza muscular, 9 tinham parestesias e 8, alterações esfincterianas.

Vinte e um procedimentos cirúrgicos foram realizados. Em 11 casos o abscesso continha material francamente purulento; em 5 a lesão epidural se apresentava como tecido de granulação e, em outros 5 casos, ambos estavam presentes. Três pacientes foram tratados de forma conservadora. O Staphylococcus aureus foi isolado em 57% dos casos. A coluna lombar foi comprometida em 11 casos e a cervical em 3.

O tratamento de escolha consistiu em uma imediata drenagem cirúrgica do abscesso antes do desenvolvimento de déficit neurológico, combinado com antibioticoterapia específica.

Quinze pacientes recuperaram suas funções neurológicas normais e 9 permaneceram com alguma seqüela. Não ocorreu nenhum óbito nesta série.

Introduction

Spinal epidural abscess (SEA) is an unusual illness [1], [4], [5], [7], [16], [18], [21], [26]. In the review carried out by Darouiche et al [4], the prevalence rate varied from 0.18 to 1.96 per 10.000 admissions in general hospitals. Despite the recent improvements in the diagnosis and treatment of SEA, the mortality rate is still high, varying from 4.6% to 31%. The purpose of this paper is to call attention to the importance of early diagnosis and treatment because there is a close relationship between good results and early diagnosis [11], [20], [22], [25], [26], [28].

Section snippets

Materials and methods

Between January 1986 and December 2003, 24 patients with SEA underwent treatment at the Servidores do Estado Hospital. We carried out a retrospective analysis of medical records, radiological examinations, and surgical reports. Seventeen patients were men and 7 were women. Their ages varied from 17 to 73 years, and the average age was 47.5 years. Patients who had discitis and/or osteomyelitis would only be included in this sample if an epidural abscess concomitantly occurred with the

Clinical findings

All patients had back pain and/or sciatica, 16 patients (66.5%) had fever. Seventeen (71%) had motor deficit. The time between the appearance of the clinical symptoms and the surgical treatment was an average of 15 days. The median time from the admission to the surgery was 72 hours.

The leukometry varied from 6.5000/mm3 to 24.800/mm3. The erythrocyte sedimentation rate (ESR) was high, varying from 28 to 124 mm. Hemocultures were positive in 6 of 11 cases.

Predisposing factors and origin of the infection

We identified predisposing factors to

Discussion

The SEA is an uncommon suppurative pathology that may occur in association with spinal osteomyelitis [1], [2], [4], [5], [7], [12], [13], [15], [16], [18], [21], [22], [24], [25], [26]. The prevalence rate established in the comparative study carried out by Darouiche et al [4] varied from 0.18 to 1.96 per 10,000 admissions a year. In our series, this rate was 0.65 per 10,000 admissions. The male patients were more frequently compromised (70.8%) than the female patients (29.2%), in a proportion

Conclusion

Febrile back pain, radicular pain, and occasional paralysis are very frequent among SEA patients. The knowledge of a variable and insidious clinical presentation of this disease is crucial so that a fast and accurate diagnosis can be established. Magnetic resonance imaging has been the examination of choice because it shows the whole extension of the lesion and because it allows a better and distinct diagnosis. The emergency surgical treatment followed by specific antibiotic therapy has proved

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