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Early versus Delayed Surgery for Spinal Epidural Abscess : Clinical Outcome and Health-Related Quality of Life

Journal of Korean Neurosurgical Society 2020년 63권 6호 p.757 ~ 766
Behmanesh Bedjan, Gessler Florian, Quick-Weller Johanna, Dubinski Daniel, Konczalla Juergen, Seifert Volker, Setzer Matthias, Weise Lutz,
소속 상세정보
 ( Behmanesh Bedjan ) - Goethe University Department of Neurosurgery
 ( Gessler Florian ) - Goethe University Department of Neurosurgery
 ( Quick-Weller Johanna ) - Goethe University Department of Neurosurgery
 ( Dubinski Daniel ) - Goethe University Department of Neurosurgery
 ( Konczalla Juergen ) - Goethe University Department of Neurosurgery
 ( Seifert Volker ) - Goethe University Department of Neurosurgery
 ( Setzer Matthias ) - Goethe University Department of Neurosurgery
 ( Weise Lutz ) - Goethe University Department of Neurosurgery

Abstract


Objective: Spinal epidural abscess (SEA) is a severe and life-threatening disease. Although commonly performed, the effect of timing in surgical treatment on patient outcome is still unclear. With this study, we aim to provide evidence for early surgical treatment in patients with SEA.

Methods: Patients treated for SEA in the authors’ department between 2007 and 2016 were included for analysis and retrospectively analyzed for basic clinical parameters and outcome. Pre- and postoperative neurological status were assessed using the American Spinal Injury Association Impairment Scale (AIS). The self-reported quality of life (QOL) based on the Short-Form Health Survey 36 (SF-36) was assessed prospectively. Surgery was defined as “early”, when performed within 12 hours after admission and “late” when performed thereafter. Conservative therapy was preferred and recommend in patients without neurological deficits and in patients denying surgical intervention.

Results: One hundred and twenty-three patients were included in this study. Forty-nine patients (39.8%) underwent early, 47 patients (38.2%) delayed surgery and 27 (21.9%) conservative therapy. No significant differences were observed regarding mean age, sex, diabetes, prior history of spinal infection, and bony destruction. Patients undergoing early surgery revealed a significant better clinical outcome before discharge than patients undergoing late surgery (p=0.001) and conservative therapy. QOL based on SF-36 were significantly better in the early surgery cohort in two of four physical items (physical functioning and bodily pain) and in one of four psychological items (role limitation) after a mean follow-up period of 58 months. Readmission to the hospital and failure of conservative therapy were observed more often in patients undergoing conservative therapy.

Conclusion: Our data on both clinical outcome and QOL provide evidence for early surgery within 12 hours after admission in patients with SEA.

키워드

Epidural abscess; Quality of life; Surgery; Conservative treatment

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