Impact of Vascularity on Spinal Disorders Outcomes, Underestimated yet Probably Crucial: The Example of a Comparative Cohort of Epidural Abscesses

Abstract

Study Design Retrospective comparative cohort. Objective (1) Describe the prevalence of the basivertebral vessel (BVV) in a cohort of spinal epidural abscesses (SEA) at lumbar or thoracic (2) correlate the presence of BVV to the risk of conservative treatment failure (CTF). Methods Twenty-six patients successfully managed without surgery were compared to 26 who required surgical management due to failed conservative management (lumbar and thoracic). Two observers sought the BVV on the sagittal T1 with contrast sequences of the initial MRI in a blinded fashion for Kappa score calculation. BVV-/BVV+: absence/presence. Demographic, radiological, and laboratory parameters, as well as functional scores, were recorded. Results For both observers, 29/52 patients had a BVV+ (55.7%); the agreement was 84% (Kappa: 0.80 CI 95% [0.70-0.90]). 5/23 (21.7%) BVV- patients had a successful medical treatment, while the proportion was 21/29 (72%) for BVV+ ( P = .0003). The positive predictive value for BVV+, predicting successful conservative treatment, was 81%. The negative predictive value for BVV- predicting CTF was 69%. BVV- was predictive of CTF in multivariable logistic regression: OR = 40, CI 95% [5-880], P = .02, for agreed observations between observers. For both observers, the proportion of dorsal abscess was the highest for BVV+ ( P = .01). Conclusion The BVV is part of the epidural network. The absence of BVV was strongly correlated with an increased risk of CTF, leading to the need for subsequent surgical treatment. SEA’s location pattern varied according to BVV detection. Although the spinal vascular anatomy has been well-known for over 100 years, there are still very few studies on its pathophysiological implications.