Clinical Outcome of Spinal Epidural Abscess in Elderly Patients

초록

Objective Spinal epidural abscess (SEA) is a rare infection with a high rate of mortality and morbidity, which requires urgent surgery. Although surgery is the mainstay of treatment, some investigators currently report good outcomes after medical treatment. Thus, the optimal treatment option is debatable without established guidelines for standard of care. Moreover, surgery in elderly SEA patients is challenging because of comorbidities and perioperative risks. Methods We retrospectively reviewed the medical records of 16 elderly patients with SEA, including 6 males and 10 females, ranging in age from 69 to 88 years (mean 75 years). Fourteen patients underwent open surgery, and 2 underwent aspiration biopsy as well as antibiotic treatment. We statistically analyzed variables related to clinical outcomes. The mean follow-up duration was 21.6 months. Results Twelve patients had comorbidities, and 5 had other systemic infections. Four and 3 patients had a history of spinal intervention and spinal fusion surgery, respectively. Finally, 7 patients completely improved and 2 were moderately disabled. Another 2 patients were severely disabled and 5 died during antibiotic treatment. Most mortalities were due to comorbidities. SEA in elderly patients with comorbidities was associated with high mortality rates. Furthermore, delayed surgery was significantly related to poor neurological outcomes, whereas other variables were not significantly related to the outcomes of SEA in elderly patients. Conclusion We identified a statistically significant relationship between neurological outcome and comorbidity (p= 0.026), predisposing conditions (p=0.010), and time to surgery (p=0.014), suggesting that early surgery should be considered, even in elderly SEA patients.

키워드