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Epidural Abscess

A Propensity Analysis of Surgical Treatment Strategies

Chaker, Anisse N. BA; Bhimani, Abhiraj D. BS; Esfahani, Darian R. MD; Rosinski, Clayton L. BS; Geever, Brett W. BS; Patel, Akash S. BS; Hobbs, Jonathan G. MD; Burch, Taylor G. MS; Patel, Saavan BS; Mehta, Ankit I. MD

doi: 10.1097/BRS.0000000000002747

Study Design. Observational analysis of retrospectively collected data.

Objective. A retrospective study was performed in order to compare the surgical profile of risk factors and perioperative complications for laminectomy and laminectomy with fusion procedures in the treatment of spinal epidural abscess (SEA).

Summary of Background Data. SEA is a highly morbid condition typically presenting with back pain, fever, and neurologic deficits. Posterior fusion has been used to supplement traditional laminectomy of SEA to improve spinal stability. At present, the ideal surgical strategy—laminectomy with or without fusion—remains elusive.

Methods. Thirty-day outcomes such as reoperation and readmission following laminectomy and laminectomy with fusion in patients with SEA were investigated utilizing the American College of Surgeons National Quality Improvement Program database. Demographics and clinical risk factors were collected, and propensity matching was performed to account for differences in risk profiles between the groups.

Results. Seven hundred thirty-eight patients were studied (608 laminectomy alone, 130 fusion). The fusion population was in worse health. The fusion population experienced significantly greater rate of return to the operating room (odds ratio [OR] 1.892), with the difference primarily accounted for by cervical spine operations. Additionally, fusion patients had significantly greater rates of blood transfusion. Infection was the most common reason for reoperation in both populations.

Conclusion. Both laminectomy and laminectomy with fusion effectively treat SEA, but addition of fusion is associated with significantly higher rates of transfusion and perioperative return to the operating room. In operative situations where either procedure is reasonable, surgeons should consider that fusion nearly doubles the odds of reoperation in the short-term, and weigh this risk against the benefit of added stability.

Level of Evidence: 3

Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois

Section of Neurosurgery, The University of Chicago, Chicago, Illinois.

Address correspondence and reprint requests to Ankit I. Mehta, MD, Department of Neurosurgery, University of Illinois at Chicago, 912 S. Wood Street, 4N NPI, Chicago, IL 60612; E-mail:

Received 26 March, 2018

Revised 9 May, 2018

Accepted 18 May, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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