Outcome of Therapies for Spine Infections in Children

Outcome After Multimodal Therapies

Spine infections in children

• Outcome dependent on preoperative condition: The main determinant of outcome for patients with spinal infections is the neurological status at the time of diagnosis (84). The outcome after surgical treatment of cervical infections is generally favorable, with improvement and return of neurological function occurring in 66–83% of patients undergoing anterior debridement. Also, patients with disabling neck pain had better clinical outcomes when treated surgically (85).

Spinal epidural abscesses in children

• Outcome dependent on preoperative condition: The main determinant of outcome for patients with spinal epidural abscess is neurological status at the time of diagnosis (39). In one review, 90% of patients without neurological signs had complete resolution with a good outcome. Conversely, only 33% of patients with neurological deficits completely recovered (37). As such, the recognition of spinal epidural abscess in the differential diagnosis is crucial to prevent permanent loss of neurological function.
• Important to intervene within 24 hours: A good result is more likely if decompression is performed within 24 hours of the initial onset of motor deficit (55).
• Children do better than adults: Compared with children, adults with spinal epidural abscesses have worse outcomes, which may be due to the higher incidence of predisposing conditions in this age group (22).
• Wide variation in reported outcomes: The overall mortality rate for children with spinal epidural abscesses ranges from 12–28% (20, 38, 56).
• 11–18% incidence of sequelae reported in survivors: Reported rates for adverse neurological sequelae range between 11 and 18% in pediatric series. Sequelae included spinal deformity, spasticity/hyperreflexia, and chronic pain (21, 22).

Spinal subdural abscesses in children

• Outcome dependent on preoperative condition: The main determinant of outcome for patients with spinal subdural abscess is neurological status at the time of diagnosis (39).

Intramedullary spinal cord abscesses in children

• 20% mortality rate: In a review of 38 cases of pediatric intramedullary spinal cord abscesses by Simon et al. (64), the disease proved fatal in 20% of patients.
• 60% of survivors with neurological sequelae: 60% of the patients reported by Simon et al. had residual neurological deficits (64).

Outcome After Medical Treatment Alone

Spine infections in children

• Overall prognosis excellent: In a series of 42 patients (19 girls, 23 boys), 37 had no functional sequelae, 3 had pain only on sporting activities, one had limited neck mobility, and only one had long-term neurological sequelae (86).
• IV antibiotics preferred: Ring et al. (5) analyzed a series of 47 patients. Of the 38 non-immobilized patients, 22 were treated with intravenous antibiotics, 10 received oral antibiotics, and 6 received no antibiotics. Prolonged or recurrent symptoms occurred in 9 of the 16 patients who did not receive intravenous antibiotics but in only 4 of the 22 patients treated with intravenous antibiotics. Seven patients were treated with immobilization. Only one of five patients treated with immobilization and intravenous antibiotics had a recurrence. Both patients treated with immobilization alone developed recurrent symptoms after immobilization was removed. IV antibiotics are hypothesized to hasten resolution of symptoms over 2–4 days without recurrence as compared to oral antibiotics. The remaining two patients required surgical intervention for abscess evacuation (5). With resolution of diskitis, disk height restoration may gradually occur, but complete restoration is rare (75).
• Up to 40% fusion: Kayser et al. (81) reported 40% of patients undergoing spontaneous fusion of the vertebrae with resolution of symptoms in long-term follow-up.

Spinal epidural abscesses in children

• 63% good outcome in one small series: In adult series, rare nonsurgical management of spinal epidural abscesses has been advocated. In one review of spinal epidural abscess, 6.6% of patients received conservative therapy, and 63% in this group achieved good outcomes (18).

Spinal subdural abscesses in children

• Not available: There is no statistically significant information available on the outcome of medical treatment alone.

Intramedullary spinal cord abscesses in children

• Not available: There is no statistically significant information available on the outcome of medical treatment alone.