Spinal epidural empyemas.

Abstract

We report ten patients harbouring spinal epidural abscess, aiming to evaluate the factors that may lead to an early diagnosis and that can eventually influence the prognosis. There were seven males and 3 females, with ages comprised between 17 and 66 years. Abscesses were localised mainly in the dorsal region. The most important predisposing factors were infections or other disorders know to be related with compromise of the immunological system. Back pain with or without signs of spinal cord involvement was the most frequent clinical presentation. The pretreatment average time was 16,3 days. Staphylococcus aureus was the most commun organism isolated. Erythrocyte sedimentation rate (ERS) was uniformly elevated, being the most important laboratory data for the diagnosis of this situation. Diagnosis was frequently made on clinical grounds but it was always confirmed by myelography with computed tomography or magnetic resonance. All patients were submitted to surgical drainage. Two patients recovered totally, 5 partially, 2 did not recover at all and 1 died. We conclude that the prognosis is related to the surgical delay and that it depends on the identification of the predisposing factors and the recognition of a clinical picture of spinal cord involvement associated to an elevated ESR. Magnetic resonance is the most reliable imaging technique.