2004 Abstract : CS 9

Authors: Kathleen Savage, MD1; Paul Holtom, MD2, Charalampos Zalavros, MD2

Title: Medical Management of Spinal Epidural Abscess

Addresses: 1 830 Bonita Drive South Pasadena, CA 91030; 2 1200 N.State Street, Los Angeles, CA 90033- Rm 3900

Purpose: Spinal epidural abscess (SEA) is a rare but potentially lethal disorder. Although treatment is based on surgical debridement, medical management with antibiotics has been proposed as an alternative, but data on its efficacy are limited. We review the outcome of medically managed SEA patients to evaluate the efficacy of this therapeutic approach.

Methods: Spinal epidural abscess (SEA) is a rare but potentially lethal disorder. Although treatment is based on surgical debridement, medical management with antibiotics has been proposed as an alternative, but data on its efficacy are limited. We review the outcome of medically managed SEA patients to evaluate the efficacy of this therapeutic approach.

Results: Twenty-nine patients underwent medical management and 23 were treated surgically. Medical management resulted in good or excellent outcome in 24 of 29 patients (83 percent). One patient was not able to ambulate independently, three patients (10 percent) failed medical management and required surgery and one patient (3.5 percent) with severe comorbidities expired.

Discussion: Medical management is a viable alternative to surgery for SAE patients with back pain or stable radiculopathy and no signs of sepsis. It leads to satisfactory outcome in the majority of selected cases and simplifies patient care, however close follow-up is essential. Emergency surgery should be performed upon neurologic deterioration or development of sepsis.

Significance: