Baseline parameters and the prediction of treatment failure in patients with intravenous drug use–associated spinal epidural abscesses

Baum, Justin; Viljoen, Stephanus; Gifford, Connor; Minnema, Amy J.; Shaikhouni, Ammar; Grossbach, Andrew J.; Nimjee, Shahid M; Farhadi, H. Francis

doi:10.3171/2021.7.spine21689

Cited by 6 publications

(3 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In their subgroup analysis, they found that age >65 years, neurologic status, diabetes, and methicillin-resistant Staphylococcus aureus were significant risk factors for failing medical management. 16 Recently, other risk factors such as history of 17 In our series, elevated CRP and female sex at the time of presentation were found to be associated with failure of medical management. Socioeconomic disparities within the US health care system are a growing concern.…”

Section: Discussionmentioning

confidence: 51%

Socioeconomic Disparities in Outcomes Following Conservative Treatment of Spinal Epidural Abscesses

et al. 2023

View full text Add to dashboard Cite

Background: Primary spinal epidural abscess (SEA) is a rare but serious pathology that may result in severe neurologic injury. While certain literature has identified medical risk factors for failure of conservative therapy, no current evidence has been published regarding socioeconomic risk factors associated with failure of medical therapy.Methods: A retrospective review was conducted of patients presenting with SEA from primary spinal infections. Patients presenting with magnetic resonance imaging evidence of SEA treated conservatively in the absence of neurologic deficits were included. Baseline clinical and socioeconomic characteristics were collected. Failure of medical management was defined as requiring surgical intervention despite maximal medical therapy due to the development of neurologic deficits or clinically significant deformity.Results: A total of 150 patients were identified as presenting with magnetic resonance imaging evidence of SEAs without evidence of neurologic deficit. Of these patients, 42 required surgical intervention compared with 108 whose infection was successfully treated with medical therapy alone. Estimated average annual income was $64,746 vs $62,615 in those who successfully cleared their infection with medical management without requiring surgery, which was not statistically significant (P = 0.5). Insured patients were 5 times more likely to be successfully treated with antibiotics alone compared with uninsured patients (OR = 5.83, P = 0.008). Payer type, employment status, and incarceration status were not associated with failure of conservative therapy.Conclusions: In the treatment of primary SEA, absence of medical insurance is associated with failure of medical management. Payer status, employment status, average salary, and incarceration are not significant risk factors for failure of conservative management.

show abstract

Section: Discussionmentioning

confidence: 51%

Socioeconomic Disparities in Outcomes Following Conservative Treatment of Spinal Epidural Abscesses

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Eighty-nine of 339 patients (26.3%) in the Shah et al 2019 paper had follow-ups of one year or more [26]. Baum et al reported a loss to follow-up rates (< one year of follow-up) of 15.9% and 21.4% in non-intravenous drug users versus intravenous drug users respectively [27]. Other studies reported seemingly better success with their follow-up.…”

Section: Discussionmentioning

confidence: 98%

Patients Follow-up for Spinal Epidural Abscess as a Critical Treatment Plan Consideration

MacNeille¹,

Lay²,

Razzouk³

et al. 2023

Cureus

View full text Add to dashboard Cite

Introduction: Spinal epidural abscess (SEA) is a rare process with significant risk for morbidity and mortality. Treatment includes an extended course of antibiotics with or without surgery depending on the clinical presentation. Both non-operative and surgically treated patients require close follow-up to ensure the resolution of the infection without recurrence and/or progression of neurologic deficits. No previous study has looked specifically at follow-up in the SEA population, but the review of the literature does show evidence of varying degrees of difficulty with follow-up for this patient population.Methods: This retrospective review looked at follow-up for 147 patients with SEA at a single institution from 2012 to 2021. Statistical analyses were performed to assess differences between groups of surgical versus non-surgical patients and those with adequate versus inadequate follow-up.Results: Sixty-two of 147 (42.2%) patients had inadequate follow-up (less than 90 days) with their surgical team, and 112 of 147 (76.2%) patients had inadequate follow-up (less than 90 days) with infectious disease (ID). The primary statistically significant difference between patients with adequate versus inadequate follow-up was found to be surgical status with those treated surgically more likely to have adequate followup than those treated non-operatively.Conclusion: Improved follow-up in surgical patients should be considered as a factor when deciding on surgical versus non-operative treatment in the SEA patient population. Extra efforts coordinating follow-up care should be made for SEA patients.

show abstract

“…After the multivariate risk prediction model was finalized, a point-based prediction model was calculated according to the method of Sullivan and colleagues. 31,32 Reference factors were determined for each variable within the multivariate model, and then a referent risk factor profile was determined by setting a base category for each continuous risk factor that was assigned 0 points in the scoring system (i.e., for IML length of 0-5 mm). After calculating how far each risk factor category was from the base category in regression units, we set a constant value (i.e., the number of regression units corresponding to 1 point) to reflect the increased risk associated with an increase of, for example, 5 mm of IML length.…”

Section: Discussionmentioning

confidence: 99%

Influence of clinical and radiological parameters on the likelihood of neurological improvement after surgery for degenerative cervical myelopathy

Toop

Gifford

McGahan

et al. 2023

Journal of Neurosurgery: Spine

Self Cite

View full text Add to dashboard Cite

OBJECTIVE Degenerative cervical myelopathy (DCM) is routinely treated with surgical decompression, but disparate postoperative outcomes are frequently observed, ranging from complete neurological recovery to persistent decline. Although numerous clinical and radiological factors have been independently associated with failure to improve, the relative impact of these proposed risk factors remains obscure. In this study, the authors assess the combined role of clinical and radiographic parameters in contributing to failure to attain neurological improvement after surgery. METHODS A consecutive series of patients who underwent surgery for DCM between July 2013 and August 2018 at a single institution was identified from a prospectively maintained database. Retrospective chart review was undertaken to record perioperative clinical and radiographic parameters. Failure to improve on the last follow-up evaluation after surgery, defined as a change in modified Japanese Orthopaedic Association (mJOA) score less than 2, was the primary outcome in univariate and multivariate analyses. RESULTS The authors included 183 patients in the final cohort. In total, 109 (59.6%) patients improved (i.e., responders with ΔmJOA score ≥ 2) after surgery and 74 (40.4%) were nonresponders with ΔmJOA score < 2. Baseline demographic variables and comorbidity rates were similar, whereas baseline Nurick score was the only clinical variable that differed between responders and nonresponders (2.7 vs 3.0, p = 0.02). In contrast, several preoperative radiographic variables differed between the groups, including presence and degree of cervical kyphosis, number of levels with bidirectional cord compression, presence and number of levels with T2-weighted signal change, intramedullary lesion (IML) length, Torg ratio, and both narrowest spinal canal and cord diameter. On multivariate analysis, preoperative degree of kyphosis at C2–7 (OR 1.19, p = 0.004), number of levels with bidirectional compression (OR 1.83, p = 0.003), and IML length (OR 1.14, p < 0.001) demonstrated the highest predictive power for nonresponse (area under the receiver operating characteristic curve 0.818). A risk factor point system that predicted failure of improvement was derived by incorporating these 3 variables. CONCLUSIONS When a large spectrum of both clinical and radiographic variables is considered, the degree of cervical kyphosis, number of levels with bidirectional compression, and IML length are the most predictive of nonresponse after surgery for DCM. Assessment of these radiographic factors can help guide surgical decision-making and more appropriately stratify patients in clinical trials.

show abstract

Baseline parameters and the prediction of treatment failure in patients with intravenous drug use–associated spinal epidural abscesses

Cited by 6 publications

References 24 publications

Socioeconomic Disparities in Outcomes Following Conservative Treatment of Spinal Epidural Abscesses

Socioeconomic Disparities in Outcomes Following Conservative Treatment of Spinal Epidural Abscesses

Patients Follow-up for Spinal Epidural Abscess as a Critical Treatment Plan Consideration

Influence of clinical and radiological parameters on the likelihood of neurological improvement after surgery for degenerative cervical myelopathy

Contact Info

Product

Resources

About