Independent predictors of spinal epidural abscess recurrence

Background Context

Recurrence of spinal epidural abscess (SEA) after treatment is an important cause of continued morbidity for patients.

Purpose

The purpose of this study was to identify independent predictors of recurrence of SEA.

Study Design/Setting

This was a retrospective, case-control study.

Patient Sample

Patients 18 years or older with a diagnosis of SEA admitted to our hospital system during the study period were included in the study sample.

Outcome Measures

The outcome measure was recurrence of SEA, defined as a reaccumulation of pus or infected granulation tissue in the epidural space after initial treatment.

Methods

All patients older than 18 years admitted to our hospital system with a diagnosis of SEA from 1993 to 2016 were identified, and explanatory variables and outcomes were collected retrospectively. Patients 18 years or older diagnosed with SEA were included. We excluded patients whose treatment was initiated at an outside institution. Bivariate and multivariate analyses were performed to identify independent predictors of recurrence.

Results

We identified 1,053 patients with SEA. We only considered patients to be recurrence-free if they had no documented recurrence with greater than 20 weeks of follow-up. Five hundred thirty-four patients were recurrence-free and 38 had documented recurrence, yielding 572 patients who were included in this analysis. Bivariate and multivariate analyses identified three independent predictors of recurrence: history of intravenous drug use, fecal incontinence or retention, and local spinal wound infection.

Conclusions

Patients with SEA who have a history of intravenous drug use, bowel dysfunction at presentation, or concurrent local spinal wound infection are at increased risk of disease recurrence. These patients ought to be closely followed up after discharge, with frequent serial imaging and aggressive antibiotic treatment.