Krishna Kumar1, Gary Hunter. 1. Division of Neurosurgery, Regina General Hospital, University of Saskatchewan, Regina SK, Canada. krishna.kumar@rqhealth.ca
Abstract
INTRODUCTION: The incidence of spinal epidural abscesses (SEAs) is rising. Although increased awareness has led to decreased mortality, morbidity remains unacceptably high, with rapid deterioration of neurological status when there is a delay in initiation of treatment. Therefore, we need to build a better understanding of prognostic factors and management strategies. The goal of this article is to identify various prognostic factors, the role of inflammatory markers, optimal management strategies, and the relationship between timing of intervention and outcome. METHODS: A computer search of health records in our institution revealed 20 cases of spinal epidural abscess over the past 5 years. A retrospective analysis of clinical, radiological, laboratory, and surgical findings was performed. A scoring system ranging from 1 (complete neurological recovery) to 5 (dead) was used to assess outcomes. We also analyzed the prognostic value of several factors, including demographics, clinical presentation, comorbidities, inflammatory markers, imaging findings, and timing of intervention. RESULTS: Fifteen of 20 patients had a good outcome (score of 1 or 2) in this series. Erythrocyte sedimentation rate, muscle strength at time of admission, and timing of intervention were found to have a statistically significant relationship with outcome. C-reactive protein, comorbidities, age, sex, and degree of thecal sac compression were found to have no prognostic value. CONCLUSION: Although many prognostic factors have been suggested and analyzed, the most important contributor to outcome in SEA remains a high clinical suspicion, prompt investigation, and immediate intervention.
INTRODUCTION: The incidence of spinal epidural abscesses (SEAs) is rising. Although increased awareness has led to decreased mortality, morbidity remains unacceptably high, with rapid deterioration of neurological status when there is a delay in initiation of treatment. Therefore, we need to build a better understanding of prognostic factors and management strategies. The goal of this article is to identify various prognostic factors, the role of inflammatory markers, optimal management strategies, and the relationship between timing of intervention and outcome. METHODS: A computer search of health records in our institution revealed 20 cases of spinal epidural abscess over the past 5 years. A retrospective analysis of clinical, radiological, laboratory, and surgical findings was performed. A scoring system ranging from 1 (complete neurological recovery) to 5 (dead) was used to assess outcomes. We also analyzed the prognostic value of several factors, including demographics, clinical presentation, comorbidities, inflammatory markers, imaging findings, and timing of intervention. RESULTS: Fifteen of 20 patients had a good outcome (score of 1 or 2) in this series. Erythrocyte sedimentation rate, muscle strength at time of admission, and timing of intervention were found to have a statistically significant relationship with outcome. C-reactive protein, comorbidities, age, sex, and degree of thecal sac compression were found to have no prognostic value. CONCLUSION: Although many prognostic factors have been suggested and analyzed, the most important contributor to outcome in SEA remains a high clinical suspicion, prompt investigation, and immediate intervention.