Quantitative Guidance for Treating Patients with Spinal Epidural Abscess

Any patient presenting with a spinal epidural abscess is in a high-risk situation, but decisions about operative versus nonoperative management in such cases are influenced largely by the presence, absence, or imminent risk of a motor deficit. This is why the identification by Shah et al. of 8 independent predictors of pre-treatment motor deficit and 7 independent predictors of 90-day mortality among patients with spinal epidural abscess is so important. The findings appear in the June 20, 2018 issue of JBJS.

The authors retrospectively analyzed data from 1,053 patients admitted with spinal epidural abscess at 2 tertiary medical centers and 3 regional community hospitals. Using multivariable logistic regression, they identified the following 8 significant risk factors for pre-treatment motor deficits in these patients:

• Diabetes
• Sensory changes
• Urinary incontinence/retention
• Fecal incontinence/retention
• Abscess location proximal to conus medullaris
• Abscess location dorsal to the thecal sac
• Abscess in multiple locations
• White blood cell (WBC) count >12 X 10⁹ cells/L

Similarly, the authors identified the following 7 significant risk factors for 90-day mortality:

• Diabetes
• Age >65 years
• Active malignancy
• Renal disease requiring hemodialysis
• Pre-treatment motor deficit
• Endocarditis
• WBC count >15 X 10⁹ cells/L

By themselves, these predictors are not prognostic, but the authors provide an algorithm that clinicians can use to generate an individualized probability of pre-treatment motor deficit or 90-day mortality for a given patient. The authors express hope that the resulting quantitative information will help guide management decisions for patients with spinal epidural abscess.