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Factors for failure of conservative treatment of spinal epidural abscesses found
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SCOTTSDALE, Ariz. — In a retrospective study of patients with spinal epidural abscesses treated in a single hospital health care system during a nearly 20-year period, investigators identified independent risk factors for failure of medical management and created a risk stratification model for failure.
“[Spinal epidural abscess] SEA is a potentially fatal disease that requires early diagnosis and treatment,” Sang Kim, MD, said during his presentation here at the International Society for the Study of the Lumbar Spine Meeting. “We present four independent risk factors: age greater than 65 years, [Methicillin-resistant Staphylococcus aureus] MRSA infection, diabetes and neurologic compromise.”
Sang Kim
The investigators studied 355 adult patients with SEA documented by MRI or CT myelogram. The researchers defined successful nonsurgical management as having cleared an infection without progression on exam. Failure was defined as death from sepsis or the need for additional surgery after undergoing 1 week of antibiotic treatment due to progression on exam, sepsis or radiographic findings.
Kim and colleagues found that 142 patients were indicated to have medical management with antibiotics alone. Of these, 42 patients failed and required surgical treatment. Of the 100 patients who underwent nonoperative management, 73 patients were successfully treated. Twelve patients died from being treated with antibiotics alone. The investigators found an overall mortality of 9% for death in hospital and 11% for death within 90 days of admission.
“Looking at the microbiology data, 75% of infections were due to Staph species,” Kim said.
A univariate analysis revealed age greater than 65 years, neurologic status of an incomplete or complete spinal cord deficient, diabetes, MRSA, and a circumferential SEA or SEA above the conus medullaris as risk factors for failure. Multivariate analysis removed circumferential SEA or SEA above the conus medullaris as risk factors.
“If you had none of these four independent risk factors, you have a 17% probability of failure alone,” Kim said. A 99% failure rate was predicted if all risk factors were present.
Reference:
Kim S. Paper #51. Presented at: The International Society for the Study of the Lumbar Spine Meeting. May 13-17, 2013; Scottsdale, Ariz.
Disclosure: Kim has no relevant financial disclosures.