Surgical Management in 40 Consecutive Patients With Cervical Spinal Epidural Abscesses: Shifting Toward Circumferential Treatment. Issue 17 (1st September 2015) - Ghobrial, George M.
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 Abstract : Forty consecutive patients with cervical epidural abscesses were identified retrospectively. Fusion was achieved in 39 of 40 (97.5%) and not influenced by approach, staging, or halo use (N = 10, 25%). In this series, urgent evacuation halted neurologic deterioration, and the shift toward staged treatment did not lead to an increased complication rate.