Long-term outcome after neurosurgically treated spinal epidural abscess following epidural analgesia

Background: A recent investigation demonstrated a high incidence of epidura l abscess secondary to epidural catheterization and a 50% frequency of neur ologic deficits. We studied short- and long-term neurologic outcome in pati ents operated for spinal epidural abscess after epidural analgesia. Methods: Nineteen patients who had undergone neurosurgical decompression an d drainage of a spinal epidural abscess during a 5-year period at three neu rosurgical departments in East Denmark were identified by manual review of operating lists. Results: Median epidural catheterization time was 8 days (range 3-44). Preo peratively 12 patients suffered from inferior paraparesis, one had irradiat ing pain from the back, and 6 patients had no neurologic deficits. Postoper atively 2 patients had recovered, but 3 other patients had deteriorated; th erefore, 13 patients were discharged with paresis/plegia. Seven patients di ed during a median follow-up time for all patients of 41.6 months. One pati ent recovered completely, and one suffered from minor deficits. The remaini ng patients suffered from paraparesis/plegia or bladder/bowel dysfunction. Conclusion: Overall recovery rate for patients with paresis/plegia after ep idural abscess was 20%. No patients with paresis/plegia following a thoraci c abscess recovered in contrast to a 50% recovery rate for patients with lu mbar epidural abscess. The majority of long-term survivors had severe neuro logic deficits. Abscess formation contributed to one death.