ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Isolated Staphylococcus aureus spinal epidural abscesses: severe initial neurological deficits do not predict worse outcomes compared with spondylodiscitis-associated cases.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSpinal epidural abscesses (SEA) are rare but severe infections with a risk of neurological sequelae. Data focusing specifically on Staphylococcus aureus SEA remain scarce, despite this pathogen being the leading cause. The prognosis of primary versus secondary SEA, and the role of medical versus surgical management remain debated. We aimed to describe the clinical, microbiological and therapeutic features of S. aureus SEA and to identify potential prognostic factors.
methodsWe conducted a retrospective review of S. aureus SEA managed in two French tertiary centers. Comparative analyses were performed between primary and secondary SEA, and between patients with favorable versus poor neurological outcomes.
resultsBetween May 2007 and June 2025, 65 patients were included, representing the largest cohort focusing exclusively on S. aureus SEA. Median age was 61 years (IQR 51-71), with a male predominance (63%). Intravenous drug use was frequent (16%). Most cases were secondary to spondylodiscitis (86%), while primary SEA accounted for 14% and were associated with more severe initial neurological deficits. A cutaneous portal of entry was associated with better outcomes, whereas implant-related infections and unidentified sources predicted poorer prognosis. Methicillin-resistant S. aureus showed a non-significant trend toward worse outcomes. Surgery was performed in 40% of patients, mainly in those with deficits. Among medically managed patients, 78% were alive without neurological sequelae at three months.
conclusionThis study highlights clinical differences between primary and secondary SEA and the prognostic value of portal-of-entry identification. Conservative management appears effective in selected patients without neurological deficits, provided careful multidisciplinary monitoring is ensured.
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