Oral Posters: Values and Outcomes in Spine Surgery

Presented by: N. Jain - View Audio/Video Presentation (Members Only)

Author(s):

A. Bucca(1), Z. Denham(1), J. Darnley(1), N. Jain(2), K. Stammen(1), R. Rauck(3), S. Virk(2), S. Khan(2)

(1) Ohio State University, Columbus, OH, United States
(2) Ohio State University, Orthopaedics, Columbus, OH, United States
(3) Hospital for Special Surgery, Orthopaedics, New York, NY, United States

Abstract

Background: Spinal epidural abscesses (SEA) are significant and potentially life-threatening infections with increasing incidence over the past two decades. There is debate over the presenting symptoms and ideal treatment. The purpose of this study was to determine the etiology and epidemiology of bacterial SEA, their location and treatment trends.

Methods: A retrospective chart review at an academic, tertiary hospital system was done from the medical center's data warehouse. Patients were included by the ICD-9 diagnosis code for intraspinal abscess (324.1) over a 10-year period from September, 2001 to September, 2011. Patients with cytopathologic or radiographic evidence of bacterial SEA and patients 18 years and older were included. Patient demographics, vertebral levels, signs and symptoms, risk factors, microorganisms, clinical status at admission and discharge, and treatment (medical vs. surgical) were recorded. Clinical status was recorded according to the following stages:
stage 1 = pain at affected spinal level;
stage 2 = back and nerve root pain radiating from involved spinal area;
stage 3 = motor weakness, sensory deficit or bladder/bowel dysfunction; and
stage 4 = paralysis.

Results: A total of 175 patients were diagnosed with SEA and included in this study. Male patients made up 58% (n=102) of the sample, and the average age was 54.9 ± 13.0 years (range 18-82). Race of the patients included Caucasian (70%), African-American (26%), non-identified (3%), and other (1%). The average body mass index was 30.1 ± 7.8 (range 15.0-55.4). Locations of the SEA included 43 cervical/cervicothoracic (23%), 53 thoracic/thoracolumbar (30%), 79 lumbar/lumbosacral (45%). The average vertebral levels involved were 3.3 ± 2.1 (range 1-15). Clinical presentation was as follows:
Stage 1 (31%),
Stage 2 (13%),
Stage 3 (44%) and
Stage 4 (12%).
Clinically relevant parameters included elevated erythrocyte sedimentation rate (69%), elevated white blood cell count (66%), and fever (38%). Risk factors included concurrent non-spinal infection (47%), tobacco use (43%), and diabetes mellitus (37%). The most common grown organisms were methicillin-resistant Staphylococcus aureus (39%) and methicillin-susceptible Staphylococcus aureus (MRSA) (30%). 65 patients were treated with antibiotics alone (37%), and 110 were treated with both surgery and antibiotics (63%). Patients successfully treated non-operatively were more likely to have Stage 1 or Stage 2 status on presentation (p < 0.001).

Conclusion: SEA can present anywhere in the spine with a variety of stages and symptoms. There was a significant portion of patients that were obese or morbidly obese. Non-operative treatment may be a viable option for a subset of patients with SEA who present with Stage 1 or Stage 2 disease.