[Spinal epidural abscess-an interdisciplinary emergency]

Abstract

Introduction Spinal epidural abscess is a rare cause of neurological disability, which is frequently, preceded by local spinal pain. There are only a few case series in the literature and the prognosis for this disease has not improved significantly over the past 50 years. Patients and methods Seven patients were treated neurosurgically with laminectomy and abscess drainage for spinal epidural abscesses from 1991 to 1994. Results All but one patient had several weeks of local spinal pain (mainly after minor trauma), immunosuppression, and all exhibited excessively high blood sedimentation rates. On admission they presented either with hemiparesis or with signs of complete spinal cord transection. Since preoperative neuronal damage persisted too long, only 3 patients showed slight improvement of their neurological functions postoperatively. Conclusion A spinal epidural abscess is a rare, but devastating interdisciplinary emergency, which poses no operative technical problem to the neurosurgeon. Poor results can be avoided by carefully taken individual histories, which are dominated by long-standing and significant local spinal pain in most cases. The pre-operative neurological status is crucial for the long-term outcome. Elevated blood sedimentation rates in conjunction with local pain of the vertebral column should direct attention to the possibility of an epidural abscess. Magnetic resonance imaging is the radiological technique of choice for establishment of the diagnosis. Conventional X-rays are of no value for early diagnosis because neurological signs and symptoms precede bony changes of the vertebrae.