Spinal Epidural Abscess: A comprehensive Review and an Update Focusing on Outcomeand Management

Background: Spinal epidural abscess (SEA) is a rare but severe infection requiring prompt diagnosis and therapy. Its incidence yet doubled in the past decade probably due to aging population with risk factors and increasing number of spinal interventions. Objective: The optimal risk stratified management of the SEA patient remains a matter of debate. We present a comprehensive review of literature of the past 15 years and focus o management and outcome. Methods: A broad MeSH search for the terms “spinal” “epidural” “abscess” was performed, and papers were evaluated for demographic data, comorbidities, treatment, surgical technique and outcome. Results: The pooled results from studies showed a total of 1928 patients with SEA. The most common comorbidity was diabetes mellitus (27.02%) followed by i.v. substance abuse (19.55%), whereas 12.02% (n 129/1073) had a previous spinal surgery. Staphylococcus aureus (74.74%) is still the most common pathogen, including Methicillin-resistant staphylococcus aureus (MRSA) in 18.78% of the cases, reflecting a shift toward more virulent species. The surgical evacuation yielded a better outcome than medical treatment only (p