Source: Arthroscopy  |  Posted 5 years ago

By Ed Susman

TORONTO, CANADA -- October 16, 2006 -- Patients with spinal epidural abscesses apparently can be cured with intensive antimicrobial therapy instead of surgery, researchers reported here at the Infectious Diseases Society of America (IDSA) 44[^]th[] Annual Meeting.

Researchers reviewed charts of 17 patients treated for spinal epidural abscesses and observed that all the patients survived their procedures, which included surgery in some cases.

"We had a very low rate of residual damage," said Dr. Keiichi Furukawa, MD, staff physician, St. Luke's International Hospital, Tokyo, Japan, in a poster presentation on October 13[^]th[].

The infections were caused by Staphylococcus, Streptococcus and Klebsiella infections.

One of the infections at the area of the cervical spine had caused tetraplegia in a 16-year-old man. Doctors at the hospital performed a laminectomy and drainage of the lesion. The patient underwent treatment with cefazolin and clindamycin for 7 weeks followed by oral clindamycin and levofloxacin for 2 weeks. The combination treatment cured the patients, who subsequently completely recovered from tetraplegia.

Dr. Furukawa said 9 of the patients who presented with the abscesses and who had no structural damage were cured with medical treatment alone. One of the patients had the abscess drained with a computer-assisted tomography guided needle.

"Historically, a combined medical and surgical therapy has been advocated for patients with spinal epidural abscess, using prolonged antimicrobial therapy and surgical drainage," Dr. Furukawa said. "Increasing evidence suggests that certain patients with spinal epidural abscess and no neurological abnormality respond well to appropriate antimicrobial therapy alone."

Although all the patients in the case series survived, improvement was incomplete in 1 case, Dr. Furukawa said. The 81-year-old woman, who had paraplegia due to a spinal epidural abscess caused by Streptococcus oralis, underwent surgical decompression and medical therapy with penicillin and clindamycin, but her paraplegia persisted.

"Intensive antimicrobial combination therapy with high dose cefazolin/clindamycin of methicillin-sensitive Staphylococcus aureus or high-dose penicillin/clindamycin for Streptococcus species was highly effective for patients with spinal epidural abscess," Dr. Furukawa concluded.

[Presentation title: Spinal Epidural Abscess: High Cure Rate with Intensive Antimicrobial Combination Therapy. Abstract 426]