Spinal Epidural Abscess-Experience with 46 patients and evaluation of prognostic factors

H. J. Tang, H. J. Lin, Y. C. Liu, C. M. Li

Research output: Contribution to journalArticle

158 Citations (Scopus)

Abstract

Objective: Spinal epidural abscess is a rare infectious disorder, often with a delayed diagnosis, and associated with significant morbidity and mortality rates. We conducted a retrospective study to define its clinical characteristics and to evaluate its prognostic factors. Methods: The medical charts of 46 patients (36 men and 10 women) with spinal epidural abscess over a 10-year period (from July 1991 to May 2000) were reviewed and analyzed. Results: A high proportion of patients had underlying diseases of diabetes (46%), frequent venous puncture (35%), spinal trauma (24%), and history of spinal surgery (22%). The initial accurate diagnostic rate was 11%. Localized spinal pain (89%), paralysis (80%), fever/chills (67%), and radicular pain (57%) were the common manifestations. The erythrocyte sedimentation rate (ESR) was elevated uniformly (mean, 86.6 mm/h) when measured. Staphylococcus aureus was the most common cause of spinal epidural abscess isolated from blood (39%) and pus (50%). Low platelet counts (9/L) (odds ratio (OR): 8.8, 95% confidence interval (CI): 1.0-77.8), extremely high ESR (≥110 mm/h) (OR: 4.8, 95% CI: 0.9-25.4), and cervical spine epidural abscess (OR: 5.2, 95% CI: 0.8-32.0) predicted a poor outcome. Conclusions: Localized back pain in a febrile patient with significant risk for epidural abscess warrants an immediate magnetic resonance imaging examination. The presence of thrombocytopenia, extremely elevated ESR, or evidence of spinal cord compression should prompt aggressive treatment.

Original languageEnglish
Pages (from-to)76-81
Number of pages6
JournalJournal of Infection
Volume45
Issue number2
DOIs
Publication statusPublished - Aug 2002
Externally publishedYes

Fingerprint

Epidural Abscess
Blood Sedimentation
Odds Ratio
Confidence Intervals
Fever
Pain
Chills
Spinal Cord Compression
Spinal Puncture
Suppuration
Delayed Diagnosis
Back Pain
Platelet Count
Paralysis
Thrombocytopenia
Staphylococcus aureus
Spine
Retrospective Studies
Magnetic Resonance Imaging
Morbidity

ASJC Scopus subject areas

  • Applied Microbiology and Biotechnology
  • Microbiology
  • Parasitology
  • Virology
  • Immunology and Allergy
  • Infectious Diseases

Cite this

Spinal Epidural Abscess-Experience with 46 patients and evaluation of prognostic factors. / Tang, H. J.; Lin, H. J.; Liu, Y. C.; Li, C. M.

In: Journal of Infection, Vol. 45, No. 2, 08.2002, p. 76-81.

Research output: Contribution to journalArticle

@article{f2cddfe793434daaafe16797774620f2,
title = "Spinal Epidural Abscess-Experience with 46 patients and evaluation of prognostic factors",
abstract = "Objective: Spinal epidural abscess is a rare infectious disorder, often with a delayed diagnosis, and associated with significant morbidity and mortality rates. We conducted a retrospective study to define its clinical characteristics and to evaluate its prognostic factors. Methods: The medical charts of 46 patients (36 men and 10 women) with spinal epidural abscess over a 10-year period (from July 1991 to May 2000) were reviewed and analyzed. Results: A high proportion of patients had underlying diseases of diabetes (46{\%}), frequent venous puncture (35{\%}), spinal trauma (24{\%}), and history of spinal surgery (22{\%}). The initial accurate diagnostic rate was 11{\%}. Localized spinal pain (89{\%}), paralysis (80{\%}), fever/chills (67{\%}), and radicular pain (57{\%}) were the common manifestations. The erythrocyte sedimentation rate (ESR) was elevated uniformly (mean, 86.6 mm/h) when measured. Staphylococcus aureus was the most common cause of spinal epidural abscess isolated from blood (39{\%}) and pus (50{\%}). Low platelet counts (9/L) (odds ratio (OR): 8.8, 95{\%} confidence interval (CI): 1.0-77.8), extremely high ESR (≥110 mm/h) (OR: 4.8, 95{\%} CI: 0.9-25.4), and cervical spine epidural abscess (OR: 5.2, 95{\%} CI: 0.8-32.0) predicted a poor outcome. Conclusions: Localized back pain in a febrile patient with significant risk for epidural abscess warrants an immediate magnetic resonance imaging examination. The presence of thrombocytopenia, extremely elevated ESR, or evidence of spinal cord compression should prompt aggressive treatment.",
author = "Tang, {H. J.} and Lin, {H. J.} and Liu, {Y. C.} and Li, {C. M.}",
year = "2002",
month = "8",
doi = "10.1053/jinf.2002.1013",
language = "English",
volume = "45",
pages = "76--81",
journal = "Journal of Infection",
issn = "0163-4453",
publisher = "W.B. Saunders Ltd",
number = "2",

}

TY - JOUR

T1 - Spinal Epidural Abscess-Experience with 46 patients and evaluation of prognostic factors

AU - Tang, H. J.

AU - Lin, H. J.

AU - Liu, Y. C.

AU - Li, C. M.

PY - 2002/8

Y1 - 2002/8

N2 - Objective: Spinal epidural abscess is a rare infectious disorder, often with a delayed diagnosis, and associated with significant morbidity and mortality rates. We conducted a retrospective study to define its clinical characteristics and to evaluate its prognostic factors. Methods: The medical charts of 46 patients (36 men and 10 women) with spinal epidural abscess over a 10-year period (from July 1991 to May 2000) were reviewed and analyzed. Results: A high proportion of patients had underlying diseases of diabetes (46%), frequent venous puncture (35%), spinal trauma (24%), and history of spinal surgery (22%). The initial accurate diagnostic rate was 11%. Localized spinal pain (89%), paralysis (80%), fever/chills (67%), and radicular pain (57%) were the common manifestations. The erythrocyte sedimentation rate (ESR) was elevated uniformly (mean, 86.6 mm/h) when measured. Staphylococcus aureus was the most common cause of spinal epidural abscess isolated from blood (39%) and pus (50%). Low platelet counts (9/L) (odds ratio (OR): 8.8, 95% confidence interval (CI): 1.0-77.8), extremely high ESR (≥110 mm/h) (OR: 4.8, 95% CI: 0.9-25.4), and cervical spine epidural abscess (OR: 5.2, 95% CI: 0.8-32.0) predicted a poor outcome. Conclusions: Localized back pain in a febrile patient with significant risk for epidural abscess warrants an immediate magnetic resonance imaging examination. The presence of thrombocytopenia, extremely elevated ESR, or evidence of spinal cord compression should prompt aggressive treatment.

AB - Objective: Spinal epidural abscess is a rare infectious disorder, often with a delayed diagnosis, and associated with significant morbidity and mortality rates. We conducted a retrospective study to define its clinical characteristics and to evaluate its prognostic factors. Methods: The medical charts of 46 patients (36 men and 10 women) with spinal epidural abscess over a 10-year period (from July 1991 to May 2000) were reviewed and analyzed. Results: A high proportion of patients had underlying diseases of diabetes (46%), frequent venous puncture (35%), spinal trauma (24%), and history of spinal surgery (22%). The initial accurate diagnostic rate was 11%. Localized spinal pain (89%), paralysis (80%), fever/chills (67%), and radicular pain (57%) were the common manifestations. The erythrocyte sedimentation rate (ESR) was elevated uniformly (mean, 86.6 mm/h) when measured. Staphylococcus aureus was the most common cause of spinal epidural abscess isolated from blood (39%) and pus (50%). Low platelet counts (9/L) (odds ratio (OR): 8.8, 95% confidence interval (CI): 1.0-77.8), extremely high ESR (≥110 mm/h) (OR: 4.8, 95% CI: 0.9-25.4), and cervical spine epidural abscess (OR: 5.2, 95% CI: 0.8-32.0) predicted a poor outcome. Conclusions: Localized back pain in a febrile patient with significant risk for epidural abscess warrants an immediate magnetic resonance imaging examination. The presence of thrombocytopenia, extremely elevated ESR, or evidence of spinal cord compression should prompt aggressive treatment.

UR - http://www.scopus.com/inward/record.url?scp=0036705783&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036705783&partnerID=8YFLogxK

U2 - 10.1053/jinf.2002.1013

DO - 10.1053/jinf.2002.1013

M3 - Article

VL - 45

SP - 76

EP - 81

JO - Journal of Infection

JF - Journal of Infection

SN - 0163-4453

IS - 2

ER -