1517. Comparison of Outcomes of Patients with Spinal Epidural Infection without Neurologic Deficit According to the Initial Treatment Plan
Session: Poster Abstract Session: Clinical Infectious Diseases: Osteomyelitis
Saturday, October 10, 2015
Room: Poster Hall
Background: Pyogenic spondylitis is frequently complicated by spinal epidural infections (SEI) such as spinal epidural abscess or phlegmon. At present, a combination of surgical decompression and systemic antibiotics are the mainstay of management regardless of the initial neurology. However, some cases of SEI are treated successfully without surgical interventions. The goals of this study were to describe the outcomes of pyogenic spondylitis with SEI who did not have motor weakness or paralysis at initial presentation and to compare the outcomes of patients who underwent medical treatment versuscombination of medical and surgical treatment initially.

Methods: We retrospectively reviewed the medical records of patients with SEI admitted to four university hospitals between 2004-2013. Patients who presented with motor weakness or paralyses were excluded. Patients were classified into the planned surgery group (PS) and the planned medical treatment group (PM) according to the initial treatment approach. We defined the unplanned surgery group (US) as patients who initially received medical treatment but then underwent surgery due to uncontrolled infection, motor weakness, or paralysis. A poor clinical outcome was defined as motor weakness or paralysis or death.

Results: A total of 204 patients were included. Among them, 114 were classified into the PM group and 90 into the PS group. Seventeen patients (14.9%) underwent unplanned surgery during medical treatment (US group). On univariate analysis, higher C-reactive protein (CRP) and longer length of SEI were associated with unplanned surgery. A poor outcome was not observed in patients in the PS group (0/90) but did develop in 8.8% (10/114) of patients in the PM group (p > 0.05). Univariate analysis determined that severe sepsis at initial presentation, underlying liver cirrhosis or chronic kidney disease, white blood cell count > 12,000/mm3, CRP level > 10 mg/dL, and methicillin resistant Staphylococcus aureusinfection were factors associated with poor clinical outcomes.

Conclusion: A poor clinical outcome developed in 4.9% of pyogenic spondylitis patients with SEI who did not exhibit motor weakness or paralysis at the time of initial presentation. In selected patients, surgical treatment can be avoidable if we choose the appropriate patients group.

Chung-Jong Kim, MD1, Seung-Ji Kang, MD2, Kyoung-Ho Song, MD3, Wan Beom Park, MD, PhD3, Joon Woo Lee, MD PhD4, Sung Hwan Hong, MD PhD5, Seung Jin Lee, MD6, Eu Suk Kim, MD7, Sang-Won Park, MD, PhD3, Hong Bin Kim, MD, PhD8, Myoung-Don Oh, MD, PhD3, Kyung Hwa Park, MD9 and Nam Joong Kim, MD, PhD3, (1)Internal Medicine, Ewha woman's university medical center, Seoul, South Korea, (2)Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea, (3)Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea, (4)Seoul National University Bundang Hospital, Seoul, South Korea, (5)Seoul National Hospital, Seoul, South Korea, (6)Chonnam National University Medical School, Gwang-ju, South Korea, (7)Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea, (8)Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea, (9)Chonnam National University Medical School, Gwangju, South Korea

Disclosures:

C. J. Kim, None

S. J. Kang, None

K. H. Song, None

W. B. Park, None

J. W. Lee, None

S. H. Hong, None

S. J. Lee, None

E. S. Kim, None

S. W. Park, None

H. B. Kim, None

M. D. Oh, None

K. H. Park, None

N. J. Kim, None

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