Spinal epidural abscess.

Eighteen patients with spinal epidural abscess were seen at the Tientsin Medical College Hospital 1957-1977. Presentation was uniform, with back pain and local tenderness, fever and leucocytosis, then the appearance of neurologicaspol deficit, tending to paraplegia with 48 hours. There had been an infection elsewhere in 14 cases, one followed vertebral osteomyelitis and in three the origin was unknown. Diagnosis was made by lumbar puncture, either by aspiration of pus or myelography. The infective organism was Staphylococcus aureus in all cases. Treatment was by laminectomy and removal of pus and granulation. Of 12 patients with leg weakness for less than 48 hours before surgery, five made good recovery, four improved but remained with a disability, two were unchanged and one died. None of the cases paraplegic for over 48 hours showed any improvement and 2 died. The importance is urged of early diagnosis and swift and vigorous treatment.