# Spinal Epidural Abscess: A Single-Center Retrospective Review of Incidence, Risk Factors, and Management at a Community Hospital

## TL;DR

This study examines spinal epidural abscess cases at a community hospital to identify risk factors and improve diagnosis and treatment.

## Contribution

The study provides insights into the incidence, risk factors, and management of spinal epidural abscesses in a community hospital setting.

## Key findings

- Most patients did not present with the classic triad of symptoms for spinal epidural abscess.
- Common risk factors included recent infection, smoking, alcohol use, and diabetes mellitus.
- Bacteremia was present in 81% of patients, and most had positive biopsy cultures.

## Abstract

Introduction: While relatively rare, spinal epidural abscess (SEA) is a neurosurgical pathology that can result in life-altering spinal cord injury if not properly managed or if diagnosis is delayed. The textbook presentation of SEA includes the triad of back pain, fever, and neurologic deficits; however, this classic triad is infrequently seen. Due to the nonspecific nature of each individual symptom, the condition is often misdiagnosed, resulting in delayed management and potentially significant consequences for the patient. This study aims to characterize the incidence, risk factors, and management of patients presenting with SEA at Desert Regional Medical Center (DRMC) to optimize the timely identification and treatment of affected individuals at our California community hospital.

Materials and methods: We conducted a single-center retrospective review at DRMC of patients diagnosed with SEA. The data collection period spanned from July 1, 2016, to April 29, 2021, and included a total of 88 patients. For each patient, we extracted data on demographics, risk factors, comorbidities, clinical presentation, diagnostics, management, and discharge disposition. We generated frequency tables for qualitative data and conducted exploratory data analysis for quantitative variables, accompanied by a series of visualizations to illustrate our findings. To assess the suitability of parametric testing for future studies, we created Q-Q plots and performed Shapiro-Wilk and Kolmogorov-Smirnov tests.

Results: Our study population demonstrated a male predominance, with a mean age of 57 years. Among the risk factors and comorbidities evaluated, recent infection, smoking, alcohol use, and diabetes mellitus were the most prevalent. Only 6% (5) of patients presented with the classic triad of back pain, fever, and neurologic deficits. The most common locations of epidural abscesses included the lumbar spine, lumbar plus sacral spine, and thoracic spine. Bacteremia was present in 81% (71) of patients, and biopsy cultures were positive in 77% (68) of those who underwent the procedure. The most common treatment approach was a combination of surgical intervention and antibiotic therapy tailored to culture results.

Conclusions: This study enabled us to characterize the SEA patient population at our institution and compare it to the broader literature, facilitating timely diagnosis and management. Given the condition's tendency to present with nonspecific symptoms and elevated but unremarkable inflammatory markers, this additional data may help reduce diagnostic delays and improve patient outcomes. Beyond its implications for SEA management within the DRMC neurosurgical department, this study contributes to the existing body of literature, supporting improved diagnostic and therapeutic strategies at other institutions as well.