Spinal epidural abscess due to Staphylococcus aureus: Clinical manifestations and outcomes

Background and Purpose: Despite advances in diagnosis and treatment, spinal epidural abscess due to Staphylococcus aureus remains a challenge to clinicians. In this study, we describe the clinical features and outcomes of patients with spinal epidural abscess due to S. aureus. Methods: Thirty one cases of spinal epidural abscess due to S. aureus treated at the National Taiwan University Hospital from January 2001 to December 2006 were retrospectively reviewed, using a standardized case collection form. Spinal epidural abscess was diagnosed by computed tomography or magnetic resonance imaging of the spine. Results: The median age of subjects was 55 years (range, 20 to 90 years) and the male-to-female ratio was 4.2. All patients had spine pain and 18 (58.1%) had fever. Lumbar or lumbosacral region was the most frequently involved site of spinal epidural abscess (61.3%), and 83.9% of the patients also had vertebral osteomyelitis. Sixteen patients (51.6%) were treated successfully with antibiotics alone for a median duration of 70 days (range, 23 to 274 days), whereas the median duration of antibiotic therapy in patients undergoing surgical intervention was 102 days (range, 40 to 227 days). Renal failure, malignancy or underlying comorbid illness estimated by Charlson score was predictive of a poor prognosis with treatment failure or mortality. Conclusion: Although medical treatment alone might benefit selected patients with spinal epidural abscess due to S. aureus and minimal neurologic sequelae, close monitoring of the evolution of neurologic deficits with radiographic imaging follow-up is necessary, since the rate of progression of neurologic impairment is difficult to predict.