EPIDURAL ABSCESS IN THE CERVICAL-SPINE

A ten-year retrospective review of 23 cases of documented spinal epidu ral abscess in the cervical spine was undertaken to define the clinica l features and establish current diagnostic and therapeutic criteria. Diagnosis was made by magnetic resonance imaging or myelography. Risk factors included intravenous drug abuse, diabetes mellitus, previous t rauma, and a positive serologic test for the human immunodeficiency vi rus. A bacterial agent was isolated in 21 cases (91%). Neurologic defi cits were present in 20 of the cases (87%) at the time of diagnosis. E rythrocyte sedimentation rate was elevated in all patients in whom it was measured. All patients were treated with appropriate antibiotics, usually for 6 to 8 weeks. Twenty-one patients underwent operative proc edures using percutaneous aspiration (1 patient), the anterior approac h (14 patients) or the posterior approach (4 patients), or a combinati on of the two approaches (2 patients). Four of ten patients who initia lly had less than antigravity strength were eventually ambulatory and continent; in each case, operative decompression was performed within 36 hours of initial consultation. Three patients who had no initial ne urologic deficits remained intact.