Introduction: Holospinal epidural abscess (HEA) is a rare condition associated with significant morbidity. The current literature on HEA largely consists of isolated case reports and series, leading to inconsistent clinical outcome data and a lack of clarity regarding prognostic factors. This review aims to identify clinicoradiological characteristics of HEA and determine potential prognostic indicators that may influence outcomes in affected patients.
Methods: A systematic review of MEDLINE, PubMed, Cochrane, and Google Scholar for patients with holospinal epidural abscess (epidural abscess extending from the cervical to the sacral spine ) was performed. All studies that reported outcomes on individual cases or case series were included. Bivariate and multivariate logistic regression analyses were used to identify the association between various clinical variables and outcomes.
Results: Sixty-one studies involving 77 patients were included, with nearly half (46.7%) reported from the USA. The mean age was 48.7 ± 20 years, and 75.3% were male. Diabetes mellitus was the most common comorbidity (29.8%). Concurrent abscesses were present in 9% of patients. Common symptoms included functional neurological disorder, back pain, and fever. MSSA (40.1%) and MRSA (24.3%) were the most common pathogens. All patients underwent surgical evacuation. Circumferential abscesses were most common. Two patients required durotomy for subdural abscesses. The postoperative complication rate was 19.5%. At last follow-up, approximately half (50.6%) fully recovered, 38.9% had partial recovery, and four patients showed no postoperative recovery. Multivariate analysis showed younger patients ( < 18 years) had higher rates of complete recovery (p = .005). Bladder dysfunction at diagnosis was a significant prognostic factor for complete recovery (OR: 3.8, p = .044).
Conclusion : HEA represents an uncommon sequela of spinal infections. Surgical evacuation and debridement remain the mainstay of treatment, given that most patients are severely ill and symptomatic at presentation. Younger age predicted better outcomes. Because of the rarity of the condition and likely publication bias from the potential underreporting of cases with poor outcomes, the findings in this study warrant meticulous consideration and interpretation.
.jpg)
