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Spinal epidural abscess is uncommon, yet it can have devastating neurological consequences. Urgent operative decompression has been the mainstay of therapy — but can a nonoperative approach also be safe and effective? Investigators retrospectively studied all 367 patients with spinal epidural abscesses managed nonoperatively (antibiotics alone or radiologic drainage plus antibiotics) during 24 years at two academic and three community hospitals in a single U.S. healthcare system.
In all, nonoperative management failed in 27% of patients. Five patient characteristics independently and significantly predicted risk for nonoperative management failure: motor deficit at presentation (relative risk, 5.9), pathologic or compression fracture (RR, 3.…