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Motor Function Improvement in Patients Undergoing Surgery for Spinal Epidural Abscess

Wang, Ting-Chung MD; Lu, Ming-Shian MD; Yang, Jen-Tsung MD, PhD; Weng, Hsu-Huei MD; Cheng, Yu-Kai MD; Lin, Martin Hsiu-Chu MD; Su, Chen-Hsing MD; Lee, Ming-Hsueh MD

doi: 10.1227/01.NEU.0000368441.10356.28
Clinical Studies

BACKGROUND: Spinal epidural abscess (SEA) is a rare and devastating clinical entity. Definitive diagnosis is usually delayed because most patients present initially with minor or variable symptoms resulting in poor outcome. The clinical outcome of SEA has been associated with various prognostic factors; however, reports on factors relating to motor function improvement after surgical treatment are limited.

OBJECTIVE: The aim of this study is to elucidate which clinical factors may affect motor function recovery after surgical treatment of SEA.

PATIENT AND METHODS: The clinical features of patients with SEA undergoing surgical drainage and antibiotics treatment were reviewed, and their outcomes were identified and analyzed.

RESULTS: The most common presenting symptoms were neck or back pain, motor deficits, and urinary incontinence. The most common underlying medical condition was diabetes mellitus. Leukocytosis (P = .036; odds ratio [OR] = 0.754; confidence interval [CI] = 0.579–0.982), elevated C-reactive protein level (P = .017; OR 0.96; CI = 0.965–0.994), poor glycemic control (P = .012; OR = 23.33; CI = 1.992–273.29), and duration of motor deficit at the time of operation (P = .005; OR = 40.50; CI = 3.093–530.293) were found to have a strong influence on motor function improvement after surgical treatment.

CONCLUSION: Infection control and the prevention of further neurological deterioration in time are paramount in the treatment of SEA for optimal recovery. Patients with rapid neurological deterioration or higher white blood cell count or C-reactive protein level on presentation warrant aggressive surgical intervention; even in those who are completely paralyzed, an improvement in muscle power may still be possible.

Division of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi Center, Chang Gung University, Putz City, Chia-Yi, Taiwan (Wang) (Yang) (Cheng) (Lin) (Su)

Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chia-Yi Center, Chang Gung University, Putz City, Chia-Yi, Taiwan (Lu) (Lee)

Department of Surgery, Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chia-Yi Center, Chang Gung University, Putz City, Chia-Yi, Taiwan (Weng)

Reprint requests: Dr Ming-Hsueh Lee, MD, Division of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi Center, 6, West Section, Chia-Pu Rd, Putz City, Chia-Yi, Taiwan 613. E-mail: westernblotting@hotmail.com

Received, February 25, 2009.

Accepted, September 7, 2009.

Copyright © by the Congress of Neurological Surgeons