Efficacy of Additional Surgical Decompression on Functional Outcome in Pyogenic Spinal Epidural Abscess With No Neurological Deficit

Objective: The aim of this study was to investigate the efficacy of additional surgical decompression with antibiotics to treat pyogenic spinal epidural abscess (SEA) with no neurological deficits.

Methods: We retrospectively reviewed the data of patients diagnosed with spontaneous pyogenic SEA in the thoracolumbosacral area who presented with sciatica and no motor deficits in the lower extremities. The treatment took place in a single tertiary hospital. The effects of additional surgical decompression (decompressive laminectomy) and other clinical variables on functional outcome were assessed using the short form 36 (SF-36).

Results: Fifty-nine patients (49 men and 10 women, mean age 65.73±12.29 [41-89] years) were included in the analysis. Surgical decompression had been performed in 31 patients (Group S, treated with additional surgical decompression and antibiotics). There were five (15.2%, 5/33) unplanned operations to control leg sciatica among the patients with initially non-surgical plans, and 28 patients were finally treated with only antibiotics (group N-S). Group S showed a statistically significant increased cost of hospitalization compared to group N-S (15,856.37±7,952.83 vs. 10,672.62±4,654.17 US dollars, p=0.004) with no superiority of 6-month functional outcome after the completion of antibiotic treatment (53.65±4.74 vs. 51.75±7.96 SF-36 scores, p=0.266).

Conclusion: Although there is a possibility of requiring an unplanned operation to control leg sciatica during conservative antibiotic treatment, overall, additional surgical decompression in pyogenic SEA presenting with no motor deficit of the lower extremity showed increased medical burden and no greater benefit in terms of functional outcomes.