Korean J Spine.  2015 Sep;12(3):124-129. 10.14245/kjs.2015.12.3.124.

Treatment of Spinal Epidural Abscess and Predisposing Factors of Motor Weakness: Experience with 48 Patients

Affiliations
  • 1Department of Neurosurgery, Chungnam National University School of Medicine, Daejeon, Korea. swchoi@cnu.ac.kr

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).
CONCLUSION
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.

Keyword

Spinal epidural abscess; Abscess volume measurement; Gamma-Plan program; Motor weakness

MeSH Terms

Abscess
Anti-Bacterial Agents
Blood Sedimentation
Causality*
Diagnosis
Early Diagnosis
Epidural Abscess*
Humans
Medical Records
Retrospective Studies
Risk Factors
Sensitivity and Specificity
Spinal Stenosis
Anti-Bacterial Agents
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