Spinal epidural abscesses: clinical manifestations, prognostic factors, and outcomes

Abstract

Objective: This study was performed to evaluate the clinical manifestations and prognostic factors for outcomes among patients with nontuberculous spinal epidural abscesses.

Methods: The records and magnetic resonance imaging/computed tomographic results for patients treated between 1994 and 2000 were retrospectively evaluated. Outcomes were assessed after 11 months, using scores ranging from 0 (dead) to 4 (no neurological deficits).

Results: All 25 patients (mean age, 62 yr) underwent surgery and subsequently received antibiotics. Back/neck pain (72% of patients), leukocytosis (64%), fever (60%), and motor deficits (56%) were the most common symptoms at admission. Outcomes were assessed as poor for 40% of the patients and as good (no deficit or independently ambulatory) for 60%. Low leg muscle strength grades (r = 0.68, P < 0.001) and high white blood cell (WBC) counts (r = -0.56, P = 0.006) at admission were significantly correlated with low outcome scores. From the time of admission until 14 days after surgery, the poor-outcome group exhibited significantly (P < 0.005) higher WBC counts, compared with the good-outcome group. The same was true for C-reactive protein levels, with the exception that no differences between groups were observed until 8 days after surgery. Factors such as cervicothoracic abscess locations (P = 0.041), lower limb motor deficits (P = 0.005), complete paralysis (P = 0.005), and WBC counts of more than 14,000 cells/microl (P = 0.049) at admission were observed to be prognostic for poor outcomes.

Conclusion: Surgical decompression combined with antimicrobial therapy remains the recommended treatment. In addition to abscess locations and motor deficits, inflammatory markers such as WBC counts and C-reactive protein levels are prognostic for outcomes.