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Hindi Review Article, J Spine Neurosurg Vol: 5 Issue: 6
Spinal Epidural Abscess: A comprehensive Review and an Update Focusing on Outcome and Management
| Sitoci-Ficici KH*, Zolal A, Schackert G and Juratli TA | |
| Department of Neurosurgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany | |
| Corresponding author : Dr. Kerim Hakan Sitoci-Ficici Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany Tel: +49 351 458 18160 Fax: +49 351 458 5775 E-mail: hakan.sitoci@icloud.com; sitoci@uniklinikum-dresden.de |
|
| Received: June 26, 2016 Accepted: August 25, 2016 Published: September 03, 2016 | |
| Citation: Sitoci-Ficici KH, Zolal A, Schackert G, Juratli TA (2016) Spinal Epidural Abscess: A comprehensive Review and an Update Focusing on Outcome and Management. J Spine Neurosurg 5:6. doi: 10.4172/2325-9701.1000244 |
Abstract
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.
