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Clinical Observation
December 13, 2004

Medical vs Surgical Management of Spinal Epidural Abscess

Author Affiliations

Author Affiliations: Department of Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo. Dr Smego is currently with the Tuberculosis Research Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Md.

Arch Intern Med. 2004;164(22):2409-2412. doi:10.1001/archinte.164.22.2409

Background  We compared the clinical features and outcomes of patients with spinal epidural abscess treated with prolonged parenteral antibiotics alone or combined with computed tomography–guided percutaneous needle aspiration drainage with those of patients undergoing surgical decompression.

Methods  A retrospective analysis of 57 cases of spinal epidural abscess treated at an academic teaching hospital during a 14-year period.

Results  The lumbar region was most frequently involved, and 46% of patients were immunocompromised. Staphylococcus aureus was the most frequently encountered pathogen. For 60 treatment courses, management included medical only (25 patients), medical plus computed tomography–guided percutaneous needle aspiration (7 patients), or surgical drainage approaches (28 patients). Prolonged use of parenteral antibiotics alone or combined with percutaneous needle drainage yielded clinical outcomes at least comparable with antibiotics plus surgical intervention, irrespective of patient age, presence of comorbid illness, disease onset, neurologic abnormality at time of presentation, or abscess size.

Conclusion  Patients with spinal epidural abscess can be safely and effectively treated with conservative medical treatment without the need for surgery.

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