Treatment Modalities for Spinal Epidural Abscess: A Systematic Review and Introducing a Novel Minimally Invasive Approach Publisher



Aghili S H ; Safari S ; Rad I C ; Ranjbar M F ; Majidi A
Source: Journal of Emergency Practice and Trauma Published:2025

Abstract

Introduction: Spinal epidural abscess (SEA) is an uncommon but serious infection that may lead to significant neurological deficits if not promptly diagnosed and treated. This study conducts a systematic review of the current literature to evaluate treatment strategies, including both surgical and nonsurgical approaches. It introduces a novel minimally invasive technique to reduce morbidity compared with traditional open surgery. Methods: This systematic review was conducted in accordance with the PRISMA 2020 guidelines and evaluated both surgical and nonsurgical treatment strategies for spinal epidural abscess (SEA). We included English-language studies published up to April 2025 that reported original data on SEA management outcomes in human patients. PubMed, Embase, Scopus, and Web of Science were searched using a combination of MeSH and free-text terms. A manual search in Google and Google Scholar was conducted as well. Two reviewers independently screened titles, abstracts, and full texts, extracted data on treatment modalities (surgical vs. nonsurgical), outcomes, and patient characteristics, and assessed study quality and bias using NHLBI tools for observational studies and case series. Any conflicts in opinion were settled through discussion among the reviewers or, when necessary, by consulting a third independent reviewer. Results: This literature review encompassed 106 eligible studies, spanning from 1957 to 2025. Across the studies, 3143 patients underwent surgical management, and 712 received nonsurgical treatment. Treatment outcomes indicated an average failure rate of 11.7% for surgically treated patients and 34% for those managed non-surgically. Time to symptom resolution, documented in 67 studies, averaged 3.7 months, ranging from several days to over a year. Conclusion: This systematic review, encompassing 106 studies, reveals that the surgical approach to treating spinal epidural abscess is associated with a markedly lower average failure rate (11.7%) compared to nonsurgical approaches (34%)—even though nonsurgical treatment is typically reserved for milder cases—highlighting the critical importance of timely surgical intervention in reducing mortality, persistent neurological deficits, and relapse. © 2025 The Author(s).