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Surgical management in 40 consecutive patients with cervical spinal epidural abscesses: shifting toward circumferential treatment.

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.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Ghobrial GM,Viereck MJ,Margiotta PJ,Beygi S,Maulucci CM,Heller JE,Vaccaro AR,Harrop JS

doi

10.1097/BRS.0000000000000942

subject

Has Abstract

pub_date

2015-09-01 00:00:00

pages

E949-53

issue

eissn

0362-2436

issn

1528-1159

journal_volume

pub_type

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Surgical management in 40 consecutive patients with cervical spinal epidural abscesses: shifting toward circumferential treatment.