Surgical management in 40 consecutive patients with cervical spinal epidural abscesses: shifting toward circumferential treatment.
Publication/Presentation Date
9-1-2015
Abstract
STUDY DESIGN: Retrospective database review of a prospectively maintained neurosurgical database.
OBJECTIVE: The surgical management of cervical spinal epidural abscesses (CSEA) is reviewed examining the shift from single to staged anteroposterior decompression and stabilization.
SUMMARY OF BACKGROUND DATA: CSEA management is guided by small case series.
METHODS: A retrospective review from 1997 to 2011 was conducted for patients with the diagnostic headings: cervical epidural abscess, infection, osteomyelitis, osteodiscitis, spondylodiscitis, and abscess. Comorbidities, risk factors, surgical approach, neurologic grade, and outcomes were recorded.
RESULTS: Forty consecutive patients (mean age 53 years, age range 23-74, SD ±14, 10 female) were identified with CSEA in the operative database from 1997 to 2010. Twenty one patients had a body mass index more than 25 (53%), 6 (15%) had diabetes mellitus, 6 (15%) had a prior malignancy with 2 having prior neck irradiation, and 9 (23%) used tobacco products. The most common risk factor associated with CSEA was intravenous drug abuse, found in 10 patients (25%). The most common level of discitis involvement was C6-C7 in 12 (30%) followed by C5-C6 disc in 11 (28%) and least often at C1-C2 level in 2(5%) and C7-T1 in 2(5%). The most common neurologic grades at presentation were AIS D in 20 (50%) followed by AIS E in 9 (28%). All patients received magnetic resonance imaging identifying 17 (43%) with dorsal, 12 ventral (30%), and 11 circumferential epidural abscesses (28%). The majority of patients underwent anterior followed by posterior decompression and stabilization (n = 26, 65%); 8 (20%) underwent a ventral approach and six underwent a dorsal approach (15%). Fusion was achieved in 39 of 40 (97.5%) and not significantly influenced halo use in 10 patients.
CONCLUSIONS: In this series, patients underwent acute evacuation and spinal cord decompression, and the shift toward staged treatment did not lead to an increased periprocedural complication rate.
LEVEL OF EVIDENCE: 3.
Volume
40
Issue
17
First Page
949
Last Page
953
ISSN
1528-1159
Published In/Presented At
Ghobrial, G. M., Viereck, M. J., Margiotta, P. J., Beygi, S., Maulucci, C. M., Heller, J. E., Vaccaro, A. R., & Harrop, J. S. (2015). Surgical management in 40 consecutive patients with cervical spinal epidural abscesses: shifting toward circumferential treatment. Spine, 40(17), E949–E953. https://doi.org/10.1097/BRS.0000000000000942
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
25893350
Department(s)
Administration and Leadership
Document Type
Article