Studies on 11 Cases of Spinal Epidural Abscess and Literature Review

Figures & data

Table 1 Clinical Characteristics of 11 Cases of Epidural Abscess in This Study

Cases	Age	Sex	Symptom	Species	Level	WBC (×10^9/L)	CRP (mg/L)	ESR (mm/h)
1	58	Female	Back pain, limb numbness, weakness, fever	S. constellatus	L4–5	9.12	65.17	84
2	78	Female	Back pain, limbs numbness, weakness, fever	Negative	L4–5	5.98	46.59	99
3	52	Female	Back pain, abdominal radiation pain	Negative	T8–9	6.97	82.6	80.1
4	72	Female	Back pain, fever	Negative	L1-S1	7.81	47.46	104
5	74	Male	Back pain, fever	MSSA	L2–3	8.48	54.11	49
6	65	Male	Back pain, limb numbness, weakness, fever	K. pneumoniae	L5/S1	12.86	60.76	58
7	53	Male	Back pain, limb numbness, weakness, fever	Negative	L4–5	4.42	8.38	20.6
8	63	Female	Back pain, right limb numbness, weakness, fever	Negative	L5-S1	4.43	2.51	32
9	62	Male	Back pain, limb numbness, weakness	TB	L4–5	6.06	7.05	24.1
10	67	Female	Back pain, limb numbness, weakness	TB	L5-S1	7.1	22.79	56
11	56	Male	Neck pain, limb pain, numbness, weakness	MSSA	C4–6	8.7	56	76

Abbreviations: MSSA, methicillin sensitive S. aureus; TB, tuberculosis.

Table 2 Imaging Findings and Diagnosis of 11 Patients in This Study

Case	Osteomyelitis	Spondylodiscitis	Location	Blood Culture	Tissue Culture	Pathology
1	Yes	Yes	Ventral	Positive	Negative	Pyogenic
2	Yes	Yes	Ventral	Negative	Negative	Pyogenic
3	Yes	Yes	Ventral	Negative	Negative	Pyogenic
4	Yes	Yes	Ventral	Negative	Negative	Pyogenic
5	Yes	Yes	Ventral	Positive	Positive	Pyogenic
6	Yes	Yes	Dorsal	Positive	Positive	Pyogenic
7	Yes	Yes	Ventral	Negative	Negative	Pyogenic
8	Yes	Yes	Dorsal	Negative	Negative	Pyogenic
9	Yes	No	Ventral, dorsal	Negative	Negative	Tuberculosis
10	Yes	No	Ventral	Negative	Negative	Tuberculosis
11	Yes	Yes	Ventral	Positive	Positive	Pyogenic

Table 3 Treatment and Prognosis of 11 Patients in This Study

Cases	Course of Disease (Day)	Underlying Disease	Surgery	Antibacterial Treatment	Outcome	Follow-up (Month)
1	20	Hypertension	Laminectomy, debridement, decompression, instrumentation,(posterior)	Penicillin six weeks (intravenous infusion), cefotaxime eight weeks (oral)	Improved	18
2	30	Hypertension, after excision of ovarian cyst	Laminectomy, debridement, decompression,instrumentation,(posterior)	Vancomycin+levofloxacin for six weeks (intravenous infusion), ceftinil for eight weeks (oral)	Left with lower limb motor dysfunction	15
3	10	No	Needle biopsy	Vancomycin+levofloxacin for six weeks (intravenous infusion), ceftinil for eight weeks (oral)	Improved	24
4	40	No	Needle biopsy	Vancomycin+levofloxacin for six weeks (intravenous infusion), ceftinil for eight weeks (oral)	Relapse	24
5	10	Right knee arthroplasty, right knee periprosthetic infection, hypertension, coronary heart disease, history of depression,	Laminectomy, debridement, decompression, instrumentation,(posterior)	Vancomycin+levofloxacin for 10 weeks (intravenous infusion), moxifloxacin for eight weeks (oral)	Relapse	15
6	20	After intestinal polypectomy	Laminectomy, debridement, decompression, instrumentation,(posterior)	Imipenem+levofloxacin for six weeks (intravenous infusion), ciprofloxacin for six weeks (oral)	Residual numbness of lower limbs	24
7	35	No	Laminectomy, debridement, decompression, instrumentation,(posterior)	Vancomycin+levofloxacin for six weeks (intravenous infusion), ceftinil for eight weeks (oral)	Improved	20
8	30	No	Laminectomy, debridement, decompression, instrumentation,(posterior)	Vancomycin+moxifloxacin hydrochloride five weeks (intravenous infusion), ceftinil six weeks (oral)	Improved	18
9	30	Hypertension	Laminectomy, debridement, decompression, instrumentation, (posterior)	Isoniazid, rifampicin, pyrazinamide tablets, ethambutol, four anti-tuberculosis six months	Improved	20
10	30	After tubal ligation	Needle biopsy	Isoniazid, rifampicin, pyrazinamide tablets, ethambutol, four anti-tuberculosis for eight months	Improved	18
11	10	No	Debridement, decompression, vertebrectomy, instrumentation (anterior)	Vancomycin+levofloxacin for six weeks (intravenous infusion), ceftinil for four weeks	Left limb motor function incompleted	24

Table 4 Classification of 642 Cases in the Literature and 11 Cases in This Study

Species	642 Cases in the Literature	11 Cases in this Group
MRSA	145 (23%)	0
MSSA	279 (43%)	2
None (negative)	52 (8%)	5
Other species	166 (26%)	4

Abbreviations: MRSA, methicillin-resistant S. aureus; MSSA, methicillin sensitive S. aureus; Other species included other bacteria species, fungus species, brucellosis species, tuberculosis species.

Table 5 Comparison of Negative and Positive Cultures

	Culture-positive (n=6)	Culture-negative (n=5)	P
Age	63.67±6.53	63.60±11.46	0.991
Sex			0.242
Male	4	1
Female	2	4
Spine pain	6	5	–
Fever	3	2	1.000
Neurological symptoms	5	3	0.545
ESR (>20 mm/h)	6	5	–
CRP (>5 mg/L)	6	4	–
ESR (mm/h), ±s	57.85±21.14	67.14±38.54	0.623
CRP (mg/dL), ±s	44.31±23.62	37.51±32.74	0.698
Spine level			–
Cervical vertebra	1	0
Thoracic vertebra	0	1
Lumbosacral vertebrae	5	4
Immunocompromised	1	0	–
Course (day) ±s	20±8.94	29±11.40	0.176
Treatment			0.545
Surgery	5	3
Conservative treatment	1	2
Prognosis			1.000
Improved	3	3
No improvement/aggravation/death	3	2

Figure 1 X-ray, Anterior and lateral position of lumbar spine before surgery, L3–5 Vertebral bone destruction.

Figure 2 T1WI, epidural abscess in the spinal canal of L3–5.

Figure 3 T2WI, epidural abscess in the spinal canal of L3–5.

Figure 4 Postoperative X-ray, L3–5 Instrumentation, (posterior).

Table 6 Clinical Characteristics of 11 Cases in This Study and 642 Cases in the Literature

	642 Cases in the Literature	11 Cases in this Group
Age	17–94	52–78
Male	387 of 642 (60%)	5 of 10 (45%)
Female	255 of 642 (40%)	6 of 11 (55%)
Symptom
Local spine pain	404 of 642 (63%)	11 of 11 (100%)
Motor/sensory deficit	352 of 642 (55%)	8 of 10 (73%)
Fever	107 of 210 (51%)	6 of 11 (55%)
Radicular pain	185 of 432 (43%)	8 of 11 (73%)
Level
Cervical	74 of 287 (26%)	1
Thoracic	120 of 287 (42%)	1
Lumbar and sacral	131 of 287 (46%)	9
Diabetes	170 of 642 (26%)	0
Immunosuppressed	142 of 514 (28%)	1
Intravenous drug	122 of 565 (22%)	0
Surgery	419 of 642 (65%)	8
Conservative	223 of 642 (35%)	3
Improved	69 of 159 (43%)	6
No improvement/aggravation/death	81 of 159 (51%)	5
Death during hospitalization or within 90 days	41 of 355 (12%)	0