Early surgery improves neurologic outcomes when compared with surgical treatment delayed by trial of medical management. Over 41% of patients treated medically failed management and required surgical decompression. Diabetes, C-reactive protein greater than 115, white blood count greater than 12.5, and bacteremia predict failure of medical management. If a spinal epidural abscess is to be treated medically it should be with great caution and vigilance. Otherwise, early surgical decompression, irrigation, and debridement should be the mainstay of treatment.
Patel, Amit R, et al. “Spinal epidural abscesses: risk factors, medical versus surgical management, a retrospective review of 128 cases.” The spine journal 14.2 (2014):326-30.
Spinal epidural abscess is a rare condition with potentially devastating consequences. Rates range from 0.2 to 1.2 cases per 10,000 hospital admissions. Rates are expectedly higher at referral centers with 12.5 cases per 10,000, and increasing, doubling in the past 20 years. Approximately 50% of patients are initially misdiagnosed at time of presentation . Spinal epidural abscess results from purulent material collecting between the spinal dural covering and osseousligamentous structures of the spine. Bacteria gain entrance to the epidural space via hematogenous spread, contiguous spread, and no identifiable source in the rest. The primary reason for spinal cord injury is unknown. Leading theories include ischemia from direct compression or disruption of vascular supply from septic thrombophlebitis.