Spinal epidural abscess: an analysis of 24 cases
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].
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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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