Table 3.

Indication for initial medically versus surgical management in spinal epidural abscess

Variable	Surgical	Medical
Age	Greater than 65 years of age [66,72,106]; greater than 50 years of age [26]
Co-morbidity	Diabetes mellitus [10,44,57,66,72,106]; active malignancy [44]	Non-diabetic
C-reactive protein greater than 115	Yes [10]	C-reactive protein less than 115
Leukocytosis greater than 12.5	Yes [10]	Leukocytosis less than 12
Microbiology	Methicillin-resistant Staphylococcus aureus [66,71,72,106]	-
Positive blood cultures	Yes [10]	No
Sepsis	Yes [66]	No [66]
Spinal level	Cervical [66,68,107] or cervicothoracic [66]; more than 5 level involvement [25]	Lumbar (below conus medullaris) [66]; abscess involvement is so extensive surgery is not feasible [26]
Anatomic location	Dorsal circumferential [42]	Ventral [42]; dorsal location [44]a)
Spinal instability	Instability [28,66] or pathologic or compression fracture at affected levels [44]	Stable [66]
Baseline neurologic status	Neurologically symptomatic [16,66] especially with neurologic deficit involving spinal cord [72] or motor weakness on presentation [44]; pelagic for <72 hr [42]; Sendi [20]; neurologically symptoms of less than 36-hour duration [20,30,106]; a relative risk factor, but probably less predictive is sensory deficit on presentation [44]	Neurologically intact [5,43]; pelagic for >72 hr [20,42,108]; complete spinal cord injury ≥36 hr [16] to ≥48 hr prior to presentation [1]
Decline in neurologic function	Yes [10]	No
Radiographic findings	Ring-like enhancement on magnetic resonance imaging [109]b)	-

^a)Based on data of exclusively medically treated patients with low incidence of dorsal involvement.

^b)Enhancement of the disc, vertebral body, or para-/intraspinal soft tissues is seen in 94%–100% of patients with “spinal infection”, however, may not be evident in severely immunocompromised patients [110].