Spinal epidural abscess: report of 16 patients

Abstract

Although spinal epidural abscess is a rare disease causing back pain, it often results in severe and irreversible neurological deficits. We retrospectively studied 16 in-patients with spinal epidural abscess who were treated during eight years since 2001 at Iizuka Hospital. We reviewed the medical records of the patients with spinal epidural abscess, focusing on the underlying diseases, symptoms and signs, laboratory results, treatments, and outcomes. The frequency of spinal epidural abscess in our hospital was one patient in 7,000 in-patients. The mean age was 66 years. Most patients had one or more predisposing disorders including diabetes mellitus, chronic alcohol consumption, and injections. All patients suffered from back pain and had signs and laboratory results suggesting the presence of inflammation. Magnetic resonance imaging studies confirmed the presence of spinal epidural abscess in all patients. Staphylococcus aureus was the most frequent pathogen. All patients received antibiotics, and eight underwent surgical decompression. The patients who showed minimal neurological abnormalities received only antibiotics and neurologic outcomes were good. The outcomes of the patients who had severe neurological abnormalities were bad, whether surgical decompression was or was not done. Physicians should have spinal epidural abscess in mind when patients have back pain with laboratory evidence of inflammation. Early magnetic resonance imaging study confirms the presence of spinal epidural abscess. Immediate surgical decompression of the spinal cord should be performed as early as possible for patients with severe neurological abnormalities.