P44. Surgical management of spinal epidural abscess: risk factors and outcomes

Abstract

<h3>BACKGROUND CONTEXT</h3> A spinal epidural abscess (SEA), a pyogenic infection, can often lead to permanent neurological deficits and mortality. Over the past three decades, the incidence of SEAs, while uncommon, has risen from 0.2-1.0 cases per 10,000 hospital admissions to 2.5-5.1 per 10,000 admissions. Given this rising incidence and potential of SEAs to become a surgical emergency, it is imperative that we develop new methods of prospectively identifying at-risk patients. <h3>PURPOSE</h3> To analyze patient demographics and clinical outcomes of patients undergoing operative management for SEAs in order to decrease diagnostic delay and elucidate factors associated with a better or worse prognosis. <h3>STUDY DESIGN/SETTING</h3> Retrospective study at an academic medical center. <h3>PATIENT SAMPLE</h3> Adult patients (18 and above) treated surgically for SEA. <h3>OUTCOME MEASURES</h3> Patient demographics, LOS, procedures performed, pre-and postoperative American Spinal Injury Association (ASIA) score, comorbidities, lab values. <h3>METHODS</h3> Electronic medical records of patients diagnosed with spinal epidural abscesses and surgically managed from September 2003-December 2021, were reviewed. <h3>RESULTS</h3> A total of 76 patients met our inclusion criteria. A majority were men (46; 60.5%) and Caucasian (62; 81.6%). The mean age on admission was 58.5 years (range: 29-84) and the average LOS was 22 days (SD 20.3 days). The most common location of SEA was in the thoracic spine (26, 34.2%) followed by lumbar (22, 28.9%), cervical (19, 25 %), and multilevel (9, 11.8%) regions. Patient comorbidities included DM (23, 30.3%), IVDU (13, 17.1%) and coexisting infections (53, 69.7%), which included vertebral osteomyelitis (24, 31.6%), bacteremia (25, 32.9%), other abscesses (6, 7.9%) and meningitis (2, 2.6%). Surgical intervention consisted of: transpedicular decompression (n=9 patients, average 1.0 levels), corpectomies (n=17 patients, average 1.2 levels), laminectomies (n =56 patients, average 3.7 levels), discectomies (n=16 patients, average 1.4 levels) and fusions (n=26 patients, average 4.7 levels). Intraoperative complications occurred in 1 (1.3%) patient and involved a dural tear, which was successfully repaired. Average lab values at presentation were WBC (13.8), ESR (80.6) and CRP (171.4). On admission, 13 (17.1%) patients were febrile and 40 (52.6%) had a positive blood culture. The most cultured organisms were MSSA (31; 46.3%) and MRSA (11; 16.4%). Preoperative ASIA scores were ASIA A (4.4%), ASIA B (0.0%), ASIA C (4.4%), ASIA D (26.7%), and ASIA E (64.4%). Postoperative ASIA scores were ASIA A (4.4%), ASIA B (2.2%), ASIA C (2.2%), ASIA D (11.1%) and ASIA E (80.0%). <h3>CONCLUSIONS</h3> Most SEAs occurred in the thoracic and lumbar regions of the spine. Patients typically have a history DM and IVDU and more likely present with coexisting infection, such as bacteremia, vertebral osteomyelitis and other abscesses. S. aureus is the most cultured organism. Most patients present with ASIA D and E scores and are subsequently treated predominantly with laminectomies and fusions. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.