Spinal Epidural Abscess: A comprehensive Review and an Update Focusing on Outcome and Management

Background: Spinal epidural abscess (SEA) is a rare but severe infection requiring prompt diagnosis and therapy. Its incidence yet doubled in the past decade probably due to aging population with risk factors and increasing number of spinal interventions. Objective: The optimal risk stratified management of the SEA patient remains a matter of debate. We present a comprehensive review of literature of the past 15 years and focus o management and outcome. Methods: A broad MeSH search for the terms “spinal” “epidural” “abscess” was performed, and papers were evaluated for demographic data, comorbidities, treatment, surgical technique and outcome. Results: The pooled results from studies showed a total of 1928 patients with SEA. The most common comorbidity was diabetes mellitus (27.02%) followed by i.v. substance abuse (19.55%), whereas 12.02% (n 129/1073) had a previous spinal surgery. Staphylococcus aureus (74.74%) is still the most common pathogen, including Methicillin-resistant staphylococcus aureus (MRSA) in 18.78% of the cases, reflecting a shift toward more virulent species. The surgical evacuation yielded a better outcome than medical treatment only (p<0.001). Parameters such as age, duration of (neurological) symptoms, spinal level of SEA, comorbidities like diabetes mellitus, level of inflammatory parameters and immunological status were proposed as predictors of success/failure of a given therapy. Conclusion: The main difficulty in management of SEA is the choice of an appropriate therapy. Surgical evacuation plays a substantial role in preventing further neurological damage. Where feasible and indicated, a surgical evacuation should be offered as soon as possible.