Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH 44106, USA.
Department of Neurological Surgery, Indiana University School of Medicine, 355W. 16th Stt, Goodman Hall Suite 5100, Indianapolis, IN 46202, USA.
Spine J. 2019 May;19(5):888-895. doi: 10.1016/j.spinee.2018.12.006. Epub 2018 Dec 8.
A spinal epidural abscess (SEA) is a serious condition that may be managed with antibiotics alone or with decompressive surgery combined with antibiotics.
The objectives of this study were to assess the clinical outcomes of SEA after surgical management and to identify the patient-level factors that are associated with outcomes following surgical decompression and removal of SEA.
STUDY DESIGN/SETTING: Retrospective chart review analysis.
An analysis of 154 consecutive patients who initially presented to a tertiary-care, academic medical center with SEA, and were subsequently treated with surgery between 2010 and 2015 was performed.
Postoperative predischarge American Spinal Injury Association Impairment Scale (AIS) scores, 6-month follow-up encounter AIS scores, need for revision surgery, and mortality during SEA surgery were the primary outcomes.Physiological Measures: AIS scores.
Fisher's exact and Wilcoxon rank-sum tests were used to assess the associations between patient-level factors and surgical outcomes. Moreover, an interactive, predictive model for postoperative predischarge AIS score was developed using a proportional odds regression model. There was no funding secured for this study and there is no conflict of interest-associated biases.
One hundred fifty-four patients (mean age of 58 years) were treated using surgical decompression in addition to antibiotics. The majority of patients were Caucasian (81%) and male (61%). No intraoperative mortality was reported. A second SEA surgery was performed in 8% of patients. A comparison of the preoperative and postoperative predischarge AIS scores showed that 49% of patients maintained a score of E or improved, while 45% remained at their preoperative status and 6% worsened. Among a subset of patients (n=36; 23%) for whom a 6-month follow-up encounter occurred, 75% maintained an AIS score of E or improved, 19% remained at their preoperative status, and 6% worsened. Both the presence and longer duration of preoperative paresis was associated with an increased risk of remaining at the same AIS score or worsening at the predischarge encounter (both p< .001). A predictive model for predischarge AIS scores was developed based on several patient characteristics.
Surgical decompression can contribute to improving or maintaining AIS scores in a high percentage of SEA patients. The presence and duration of preoperative paresis are prognostic for poorer outcomes and suggest that rapid surgical intervention before paresis develops may lead to improved postoperative outcomes. Our modeling tool enables an estimation of probabilities of patients' predischarge condition.
脊髓硬膜外脓肿（SEA）是一种严重的疾病，可单独使用抗生素治疗，也可使用减压手术联合抗生素治疗。
本研究旨在评估 SEA 手术后的临床结果，并确定与手术减压和 SEA 切除后结局相关的患者水平因素。
研究设计/设置：回顾性图表审查分析。
对 2010 年至 2015 年间在一家三级保健学术医疗中心初次就诊的 154 例 SEA 患者进行了分析，随后接受了手术治疗。
术后出院前美国脊髓损伤协会损伤评分（AIS）、6 个月随访时 AIS 评分、需要再次手术以及 SEA 手术期间的死亡率。生理测量：AIS 评分。
Fisher 确切检验和 Wilcoxon 秩和检验用于评估患者水平因素与手术结果之间的关联。此外，使用比例优势回归模型开发了术后出院前 AIS 评分的预测模型。本研究没有获得资金支持，也没有与利益冲突相关的偏倚。
154 例患者（平均年龄 58 岁）接受了手术减压加抗生素治疗。大多数患者为白种人（81%）和男性（61%）。术中无死亡报告。8%的患者行第二次 SEA 手术。术前和术后出院前 AIS 评分比较显示，49%的患者保持 E 级或改善，45%保持术前状态，6%恶化。在 36 例（23%）接受 6 个月随访的患者亚组中，75%的患者保持 E 级或改善，19%保持术前状态，6%恶化。术前瘫痪的存在和持续时间较长与出院前 AIS 评分相同或恶化的风险增加相关（均 p<0.001）。根据患者的一些特征，开发了一个预测出院前 AIS 评分的模型。
手术减压可使大部分 SEA 患者的 AIS 评分提高或保持不变。术前瘫痪的存在和持续时间是预后不良的预测因素，表明在瘫痪发生前迅速进行手术干预可能会导致术后结局改善。我们的建模工具可以估计患者出院时的情况概率。
