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Methods
Study Selection Criteria
A retrospective review of a prospectively maintained neurosurgical database from 2009 to 2011 was conducted for all consecutive adult patients undergoing surgical treatment of an epidural abscess. The ICD-9-CM code 324.1 was queried in an attempt to encounter prior cases involving abscesses of the spinal canal. To obtain all consecutive patients in this database, all additional patients with the following diagnostic headings and/or descriptions were included: epidural abscess, infection, osteomyelitis, osteodiscitis, spondylodiscitis, and abscess. All patients without admission and discharge neurological examination records, admission MRI, and positive bacterial cultures confirming infection were excluded.
Diagnosis
Early diagnosis in all cases of SEA was made first by clinical suspicion followed by rapid acquisition of a contrasted MRI scan. Radiographic confirmation by contrastadministered T1-weighted MRI of epidural abscess was noted for all patients. Supporting clinical evidence such as C-reactive protein, erythrocyte sedimentation rate, and white blood cell counts are routinely obtained throughout the course of admission. The duration to surgery was measured from the point of MRI confirmation of SEA to incision by hospital records, when available.
Neurological Presentation
The American Spinal Injury Association Impairment Scale (AIS) grade was calculated from hospital inpatient records at the immediate time of preoperative neurosurgical consultation and discharge. Numerical scores of 1 through 5 were assigned to grades A through E, respectively. Patients were then divided into 2 cohorts using a 24-hour cutoff into early (< 24 hours) and delayed (> 24 hours) surgical cohorts. Baseline characteristics, risk factors for infection, and admission neurological function were recorded.
Statistical Analysis
Nonparametric data were comparatively assessed using a Wilcoxon signed-rank test. Fisher's exact test, and ANOVA were carried out using a statistical software package (version 8.00, JMP software, SAS Institute).
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