SPINAL EPIDURAL ABSCESS - EVALUATION OF FACTORS INFLUENCING OUTCOME

OBJECTIVE: The goal of this study was to critically evaluate the predi ctive efficacy of various clinical factors in spinal epidural abscess influencing outcome after surgical and/or medical treatment. METHODS: A retrospective analysis of 41 cases of spinal epidural abscess treate d at Henry Ford Hospital between 1984 and 1992 was performed. RESULTS: Thirty patients underwent open surgery and received antibiotic therap y, and 11 patients received medical treatment alone. After a mean foll ow-up period of 20.9 months (range, 4 - 45 mo), 24 patients (58.5%) ha d no or minimal deficits, 9 patients (22%) had severe paresis or plegi a and/or bowel/bladder dysfunction, and 8 patients (19.5%) died. Univa riate analysis revealed patient age, degree of thecal sac compression, spinal location, surgical findings, and septic presentation to be sig nificantly associated with outcome. In multiple logistic regression an alysis, increasing age and degree of thecal sac compression were the o nly factors with significant independent association with poor outcome (P = 0.01 for both). A simple grading system (Grades 0 - III) was dev eloped, with patient age, degree of thecal sac compression, and durati on of symptoms as the determining criteria. The incidence of poor outc ome for patients with Grade 0 was 0%, compared to 85.7% for patients w ith Grade III. CONCLUSION: We conclude that long-term outcome after tr eatment of spinal epidural abscess can be predicted with the use of th e proposed grading scheme. Surgical drainage plus parenterally adminis tered antibiotics remains the recommended treatment, although medical treatment alone can also be used for certain patients.