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Diagnosis and Management of Spinal Epidural Abscess

Published online by Cambridge University Press:  18 September 2015

Gary J. Redekop  and
Rolando F. Del Maestro
Gary J. Redekop*
Affiliation:
Brain Research Laboratories, Clinical Investigational Unit, Division of Neurosurgery, Department of Clinical Neurological Sciences, University of Western Ontario, London
Rolando F. Del Maestro
Affiliation:
Brain Research Laboratories, Clinical Investigational Unit, Division of Neurosurgery, Department of Clinical Neurological Sciences, University of Western Ontario, London
*
Division of Neurosurgery, Department of Clinical Neurological Sciences, The University of Western Ontario, London, Ontario, Canada N6A 5A5
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Abstract:

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Twenty-five patients with spinal epidural abscess were treated at the University of Western Ontario hospitals between July 1980 and July 1990. There were eighteen males (72%) and seven females (28%), with a median age of 60 years. Concurrent illness resulting in immunocompromise was present in 60%. Eleven presented with complete myelopathy, thirteen had limb weakness, and one had no neurological deficit. In twenty cases the abscess consisted of frankly purulent material, while in five the epidural collection consisted of chronic granulation tissue. Staphylococcus aureus was isolated in 64% of the abscesses. Twenty-seven surgical procedures were performed on 21 patients. Ten cases occurred in the cervical spine (40%), seven in the thoracic spine (28%), three in both the cervical and thoracic spine (12%) and five in the lumbosacral spine (20%). Fourteen patients (56%) retained or recovered ambulation and there were five deaths (20%). The progression from back and radicular pain to weakness and eventual paralysis continues to be characteristic of spinal epidural infection. Morbidity and mortality remain unacceptably high because of delay in diagnosis and treatment. Magnetic resonance imaging is the radiological investigation of choice for the diagnosis of spinal epidural abscess. Prompt intervention, before the development of severe neurological deficits, can improve outcome. Immediate surgical drainage combined with antibiotics remains the treatment of choice.

Type
Articles
Information
Canadian Journal of Neurological Sciences , Volume 19 , Issue 2 , May 1992 , pp. 180 - 187
Copyright
Copyright © Canadian Neurological Sciences Federation 1992

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