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- Title
A Classification Scheme for Epidural Spinal Cord Compression in Spinal Epidural Abscess.
- Authors
Huiliang Yang; Shah, Akash A.; Im, Gi Hye; Yueming Song; Schwab, Joseph H.
- Abstract
Introduction: Magnetic resonance imaging (MRI) has been the most common method to diagnose spinal epidural abscess (SEA) and evaluate the degree of epidural spinal cord compression (ESCC). High-grade ESCC frequently serves as an indication for surgical decompression, while no consensus exists in the literature about the precise definition of this term in SEA. The advancement of treatment paradigms in patients with SEA requires a clear grading scheme of ESCC, as the degree of ESCC often serves as a major determinant in the decision to operation. The purpose of this study was to develop a classification scheme for ESCC in patients with SEA and to determine whether this scoring scheme is associated with neurologic deficit at admission, treatment, and outcomes. Material and Methods: We conducted a retrospective cohort study using electronic records in our hospital system. All patients were over 18 years old and had a clinically and radiologically documented cervical or thoracic SEA during the period 1995-2016. All patients had both sagittal and axial T2-weighted MR images prior to initiation of treatment. We developed a 5-point classification scheme of ESCC. Grade 1: epidural impingement, no deformation of thecal sac; grade 2: deformation of thecal sac, without cord abutment; grade 3: deformation of thecal sac, with cord abutment, without cord compression; grade 4: spinal cord compression, with CSF visible around cord; grade 5: spinal cord compression, no CSF visible. We analyzed association of ESCC grade with patients' neurologic deficit at admission, treatment, and outcomes through univariate logistic regression. Results: The study included 351 patients with SEA. The most common degree of ESCC was grade 5 (39%), followed by grade 4 (26%), grade 3 (17%), grade 2 (15%), and grade 1 (3%). Compared to grades 1 and 2, patients with grade 5 compression were more likely to exhibit pre-treatment motor deficit (p < 0.001), sensory change (p < 0.001), and bladder or bowel dysfunction (p = 0.030). Similarly, patients with grade 4 compression were more likely to have motor weakness at presentation (p = 0.017). The presence of grade 5 compression was associated with an increased likelihood of undergoing surgical management (p < 0.001) as well as with presence of a residual motor deficit at follow-up (p = 0.002). Our scheme was not associated with recurrence or mortality. Conclusion: With a cohort of 351 patients, we provided a framework to describe the grade of spinal cord compression in SEA. High-grade ESCC was most common in our study as a result of the narrow spinal canal of the cervical and thoracic spine. More compression was associated with worse neurologic status due to severe myelopathy and spinal cord dysfunction. High-grade ESCC was associated with poor outcome of residual motor deficit at last follow-up. The grade of ESCC was not associated with other poor outcomes, e.g. mortality, recurrence.
- Publication
Global Spine Journal, 2018, Vol 8, p132S
- ISSN
2192-5682
- Publication type
Article
- DOI
10.1177/2192568218771030