Independent predictors of spinal epidural abscess recurrence.

BACKGROUND CONTEXT: Recurrence of spinal epidural abscess (SEA) after treatment is an important cause of continued morbidity for patients.

PURPOSE: The purpose of this study is to identify independent predictors of recurrence of SEA.

STUDY DESIGN/SETTING: This was a retrospective, case-control study.

PATIENT SAMPLE: Patients 18 years or older with a diagnosis of SEA admitted to our hospital system during the study period were included in the study sample.

OUTCOME MEASURES: The outcome measure was recurrence of SEA, defined as a re-accumulation of pus or infected granulation tissue in the epidural space after initial treatment.

METHODS: All patients older than 18 years admitted to our hospital system with a diagnosis of SEA from 1993 to 2016 were identified, and explanatory variables and outcomes were collected retrospectively. Patients 18 years or older diagnosed with SEA were included. We excluded patients whose treatment was initiated at an outside institution. Bivariate and multivariate analyses were performed to identify independent predictors of recurrence.

RESULTS: We identified 1,053 patients with SEA. We only considered patients to be recurrence-free if they had no documented recurrence with greater than 20 weeks of follow-up. Five hundred and thirty-four patients were recurrence-free and 38 had documented recurrence, yielding 572 patients who were included in this analysis. Bivariate and multivariate analyses identified three independent predictors of recurrence: history of intravenous drug use, fecal incontinence/retention, and local spinal wound infection.

CONCLUSIONS: Patients with SEA who have a history of intravenous drug use, bowel dysfunction at presentation, and/or concurrent local spinal wound infection are at increased risk of disease recurrence. These patients ought to be closely followed after discharge, with frequent serial imaging and aggressive antibiotic treatment.