Spinal epidural abscess: an analysis of 24 cases

• Published in: Surgical neurology 2005, Vol.63, p.S26-S29
• Main Authors: Pereira, Celestino Esteves, Lynch, José Carlos
• Format: Article
• Language: English
• Subjects: Abscesso epidural raquiano; Adolescent; Adult; Aged; Anti-Bacterial Agents - therapeutic use; Back Pain - microbiology; Causality; Epidural Abscess - microbiology; Epidural Abscess - physiopathology; Epidural Abscess - therapy; Epidural Space - microbiology; Epidural Space - pathology; Epidural Space - surgery; Female; Humans; Immunocompromised Host - immunology; Laminectomy - statistics & numerical data; Male; Middle Aged; Muscle Weakness - microbiology; Osteomielite vertebral; Paresthesia - microbiology; Retrospective Studies; Spinal Cord - physiopathology; Spinal epidural abscess; Spinal osteomyelitis; Staphylococcal Infections - pathology; Staphylococcal Infections - physiopathology; Staphylococcal Infections - therapy; Treatment Outcome; Urinary Incontinence - microbiology
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/j.surneu.2004.09.021

Despite advances in neuroimaging and neurosurgical care, spinal abscess remains a challenging problem with mortality rates ranging from 4.6% to 31% in recent series. Between January 1986 and December 2003, 24 patients with spinal epidural abscess were treated. Seventeen were men and 7 were women at the average age of 47.5 years. Concurrent illnesses that result in immunodepression such as diabetes and infections occurred in 62% of the case patients. All patients had back pain, 16 had muscle weakness, 9 had paresthesias, and 8 had sphincteral changes. Twenty-one patients underwent surgical procedures. In 11 case patients, the abscess had a frankly purulent material, and, in 5, the epidural lesion consisted of granulation tissue; the other 5 case patients had a combination of the 2. Three patients were treated conservatively. Staphylococcus aureus was isolated in 57% of the case patients. The lumbar spine was affected in 11 patients; the cervical spine, in 3. Fifteen patients recovered their normal neurological functions but 4 remained with some neurological disability. No deaths occurred in this series. Immediate surgical drainage of the abscess, before the development of severe neurological deficit, combined with specific antibiotics remains the treatment of choice. Vinte e quatro pacientes com abscesso epidural raquiano foram tratados entre janeiro de 1986 e dezembro de 2003. Dezessete eram homens e 7 mulheres, com idade mediana de 47,5 anos. A associação de patologias que levam a imunodepressão como diabetes e infecções ocorreram em 62% dos casos. Todos os pacientes tinham dor na coluna vertebral, dezesseis se apresentavam com fraqueza muscular, 9 tinham parestesias e 8, alterações esfincterianas. Vinte e um procedimentos cirúrgicos foram realizados. Em 11 casos o abscesso continha material francamente purulento; em 5 a lesão epidural se apresentava como tecido de granulação e, em outros 5 casos, ambos estavam presentes. Três pacientes foram tratados de forma conservadora. O Staphylococcus aureus foi isolado em 57% dos casos. A coluna lombar foi comprometida em 11 casos e a cervical em 3. O tratamento de escolha consistiu em uma imediata drenagem cirúrgica do abscesso antes do desenvolvimento de déficit neurológico, combinado com antibioticoterapia específica. Quinze pacientes recuperaram suas funções neurológicas normais e 9 permaneceram com alguma seqüela. Não ocorreu nenhum óbito nesta série.