ABSTRACT
This review of spinal infections was conducted to better define the population at risk, the affected levels, presentation, causative organisms, duration of antibiotic treatment and indications for surgery. A retrospective analysis of 70 consecutive patients with primary spinal infection [epidural abscess and/or vertebral osteomyelitis] that presented between January 2001 and August 2004 was performed. These patients had not undergone immediate prior spinal surgery. We analyzed patient demographics, co-morbidities, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] and white blood cell count [WBC], management and outcomes. The mean age at presentation was 56.4 years [range 8 to 85], with 69% over the age of 50. Over half [56%] were male and 44% were female. Over a quarter [27%] presented with vertebral osteomyelitis, 40% with spinal epidural abscess, and 33% with both. Pain was the most common symptom, occurring in 77% at presentation. Co-morbid diseases included hypertension [41%], diabetes [33%], heart disease [27%] and pulmonary disease [20%]. Forty-one percent were treated with antibiotics alone while 59% underwent a surgical procedure. Ten percent failed initial medical management and required surgery. Time from diagnosis to surgery ranged from 3 to 10 weeks. Surgery was undertaken for decompression or stabilization. All but one patient improved at last follow-up. Declines in ESR and CRP correlated strongly with treatment success while WBC had less correlation. Parenteral antibiotic therapy averaged 8 weeks. This retrospective study further defines the population at risk for spinal infection, outlines current strategies of medical and surgical management, demonstrates the usefulness of laboratory values and conveys outcomes