{"id":"3978969d-d04f-4eb7-b82d-5190aa7a8556","slug":"what-are-we-waiting-for-an-argument-for-early-surgery-for-spinal-epidural-abscesses","title":"What are we waiting for? An argument for early surgery for spinal epidural abscesses","authors":["Nancy E. Epstein"],"abstract":"Background: In the article: Timing and prognosis of surgery for spinal epidural abscess (SEA): A review, Epstein raises one major point; it is imperative that spinal surgeons “take back decision-making” from our medical cohorts and reinstitute early surgery (<24 h) to better treat SEAs. Methods: Spine surgeons recognize the clinical triad (e.g., fever [50%], spinal pain [92–100%], and neurological deficits [47%]) for establishing the diagnosis of an SEA. We also appreciate the multiple major risk factors for developing SEA; diabetes (15–30%), elevated white blood cell count (>12.5), high C-reactive protein (>115), positive blood cultures, radiographic cord compression, and significant neurological deficits (e.g., 19–45%). Results: Recognizing these risk factors should prompt early open surgery (<24 h from the onset of a neurological deficit). Open surgery better defines the correct/multiple organisms present, and immediately provides adequate/thorough neurological decompression (with fusion if unstable). Although minimally invasive surgery may suffice in select cases, too often it provides insufficient biopsy/culture/irrigation/decompression. Most critically, nonsurgical options result in unacceptably high failure rates (e.g., 41-42.5-75% requiring delayed surgery), while risking permanent paralysis (up to 22%), and death (up to 25%). Conclusion: As spine surgeons, we need to “take back decision-making” from our medical cohorts and advocate for early surgery to achieve better outcomes for our patients. Why should anyone accept the >41-42.5 to up to the 75% failure rate that accompanies the nonsurgical treatment of SEA, much less the >25% mortality rate?","thumbnailUrl":null,"publishDate":"2015-10-08T00:00:00.000Z","doi":"10.4103/2152-7806.166894","categories":["Spine","Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/3978969d-d04f-4eb7-b82d-5190aa7a8556/pdf"}