Is there a difference in neurologic outcome in medical versus early operative management of cervical epidural abscesses?

• Published in: The spine journal 2015-01, Vol.15 (1), p.10-17
• Main Authors: Alton, Timothy B., MD, Patel, Amit R., MD, Bransford, Richard J., MD, Bellabarba, Carlo, MD, Lee, Michael J., MD, Chapman, Jens R., MD
• Format: Article
• Language: English
• Subjects: Adult; Cervical; Cervical Vertebrae - pathology; Cervical Vertebrae - surgery; Electronic Health Records; Epidural Abscess - surgery; Epidural infection; Epidural Space - pathology; Epidural Space - surgery; Female; Humans; Male; Medical; Middle Aged; Orthopedics; Outcome; Postoperative Complications - surgery; Retrospective Studies; Risk Factors; Surgical; Treatment Outcome
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2014.06.010

Abstract Background context The ideal management of cervical spine epidural abscess (CSEA), medical versus surgical, is controversial. The medical failure rate and neurologic consequences of delayed surgery are not known. Purpose The purpose of this study is to assess the neurologic outcome of patients with CSEA managed medically or with early surgical intervention and to identify the risk factors for medical failure and the consequences of delayed surgery. Study design/setting Retrospective electronic medical record (EMR) review. Patient sample Sixty-two patients with spontaneous CSEA, confirmed with advanced imaging, from a single tertiary medical center from January 5 to September 11. Outcome measures Patient data were collected from the EMR with motor scores (MS) (American Spinal Injury Association 0–100) recorded pre/posttreatment. Three treatment groups emerged: medical without surgery, early surgery, and those initially managed medically but failed requiring delayed surgery. Methods Inclusion criteria: spontaneous CSEA based on imaging and intraoperative findings when available, age >18 years, and adequate EMR documentation of the medical decision-making process. Exclusion criteria: postoperative infections, Pott disease, isolated discitis/osteomyelitis, and patients with imaging findings suggestive of CSEA but negative intraoperative findings and cultures. Results Of the 62 patients included, 6 were successfully managed medically (Group 1) with MS increase of 2.3 points (standard deviation [SD] 4.4). Thirty-eight patients were treated with early surgery (Group 2) (average time to operating room 24.4 hours [SD 19.2] with average MS increase 11.89 points [SD 19.5]). Eighteen failed medical management (Group 3) requiring delayed surgery (time to OR 7.02 days [SD 5.33]) with a net MS drop of 15.89 (SD 24.9). The medical failure rate was 75%. MS change between early and delayed surgery was significant (p