Independent predictors of spinal epidural abscess recurrence

Publication date: Available online 9 April 2018
Source:The Spine Journal
Author(s): Akash A. Shah, Huiliang Yang, Paul T. Ogink, Joseph H. Schwab
Background contextRecurrence of spinal epidural abscess (SEA) after treatment is an important cause of continued morbidity for patients.PurposeThe purpose of this study is to identify independent predictors of recurrence of SEA.Study design/settingThis was a retrospective, case-control study.Patient samplePatients 18 years or older with a diagnosis of SEA admitted to our hospital system during the study period were included in the study sample.Outcome measuresThe outcome measure was recurrence of SEA, defined as a re-accumulation of pus or infected granulation tissue in the epidural space after initial treatment.MethodsAll patients older than 18 years admitted to our hospital system with a diagnosis of SEA from 1993 to 2016 were identified, and explanatory variables and outcomes were collected retrospectively. Patients 18 years or older diagnosed with SEA were included. We excluded patients whose treatment was initiated at an outside institution. Bivariate and multivariate analyses were performed to identify independent predictors of recurrence.ResultsWe identified 1,053 patients with SEA. We only considered patients to be recurrence-free if they had no documented recurrence with greater than 20 weeks of follow-up. Five hundred and thirty-four patients were recurrence-free and 38 had documented recurrence, yielding 572 patients who were included in this analysis. Bivariate and multivariate analyses identified three independent predictors of recurrence: history of intravenous drug use, fecal incontinence/retention, and local spinal wound infection.ConclusionsPatients with SEA who have a history of intravenous drug use, bowel dysfunction at presentation, and/or concurrent local spinal wound infection are at increased risk of disease recurrence. These patients ought to be closely followed after discharge, with frequent serial imaging and aggressive antibiotic treatment.



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