Extradural infections of the spine

Objectives: We have observed a recent increase in the incidence of spinal e xtradural infections. To determine postoperative outcome and prognosis we h ave undertaken a retrospective study on patients with spinal extradural abs cesses between 1978 and 1996 treated in the Department of Neurosurgery at t he Nordstadt Hospital in Hannover, Germany. Methods: Case records, outpatient files, operation notes, neuroradiological examinations and pathological reports were analysed, Neurological function was documented using a score system for each symptom. Results: Twenty-two patients underwent 24 operations during the study perio d. Staphylococcus aureus was the organism most commonly isolated. Patients presented after a mean history of 1.8 +/- 2.6 months with acute development of severe para- or tetraparesis and were followed up for an average period of 6 +/- 7 months. Two groups were distinguished, One group was characteri zed by epidural collections of pus (14 patients). Two patients in this grou p were not operated due to their moribund state and died from uncontrollabl e septicemia. Two of the remaining 12 operated patients died within 30 days after surgery due to generalized septicemia or other medical problems unre lated to the spinal involvement. Of the ten surviving patients, five sustai ned major neurological deficits, whereas the remaining five patients made a n incomplete recovery, The second group consisted of eight patients in a si gnificantly better pre-operative health condition in whom granulomatous mat erial was obtained during the operation and the outcome was considerably be tter. No patient in this group died. Six patients recovered with no or mild neurological deficits. Conclusion: Spinal extradural infections require immediate surgical interve ntion. Neurological outcome depends on the pre-operative neurological statu s. Survival is determined by the general health condition of the patient.