Spinal epidural abscess

Last reviewed: 28 Apr 2022
Last updated: 17 May 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • fever
  • spinal pain or tenderness
  • weakness of extremities
  • paralysis
  • sensory disturbance
  • abnormal reflexes
More key diagnostic factors

Other diagnostic factors

  • isolated sphincter dysfunction
Other diagnostic factors

Risk factors

  • intravenous drug use
  • recent spinal surgery or trauma
  • indwelling spinal catheter
  • contiguous local infection
  • immunosuppression
  • diabetes mellitus
  • chronic renal disease
  • concomitant bacteraemia or endocarditis
  • alcohol misuse
  • male sex
  • obesity
  • non-contiguous co-infection (excluding bactereamia)
  • chronic liver disease
More risk factors

Diagnostic investigations

1st investigations to order

  • FBC
  • CRP
  • erythrocyte sedimentation rate
  • MRI spine with and without intravenous contrast
  • blood cultures
More 1st investigations to order

Investigations to consider

  • direct abscess aspiration for culture
  • polymerase chain reaction (PCR) of aspirate
More investigations to consider

Treatment algorithm

INITIAL

suspected epidural abscess

ACUTE

with methicillin-sensitive Staphylococcus aureus (MSSA) infection

with MRSA infection

with gram-negative infection

with Mycobacterium tuberculosis infection

Contributors

Authors

Kenneth F. Casey, MD
Kenneth F. Casey

Associate Adjunct Professor

Clinical Associate Professor of Physical Medicine and Rehabilitation

Wayne State University School of Medicine

Clinical Associate Professor Surgery (Neurosurgery)

Michigan State University

Detroit

MI

Disclosures

KFC is a member of the Medical Advisory Board Facial Pain Association, an editor of the Medicine online journal, and a reviewer for World Neurosurgery (all unpaid), and teaches at Michigan State and Wayne State Volunteer faculty.

Farrin A. Manian, MD, MPH, FACP, FIDSA, FSHE

Chair

Department of Medicine

Mercy Hospital-St. Louis

St. Louis

MO

Disclosures

FAM is an author of references cited in this topic.

Peer reviewers

John M. Embil, MD, FRCPC

Consultant

Infectious Diseases

Associate Professor

Section of Infectious Diseases

Department of Medicine

University of Manitoba

Director

Infection Prevention and Control Unit Health Sciences Centre

Winnipeg

Manitoba

Canada

Disclosures

JME declares that he has no competing interests.

Iain Christie, MB BhB, FRCA

Consultant Anaesthetist

Derriford Hospital

Plymouth

UK

Disclosures

IC declares that he has no competing interests.

Wendy Ziai, MD, MPH

Assistant Professor

Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine

The Johns Hopkins University

Baltimore

MD

Disclosures

WZ declares that she has no competing interests.

  • Differentials

    • Epidural haematoma
    • Multiple sclerosis
    • Malignant spinal cord compression
    More Differentials
  • Guidelines

    • ACR appropriateness criteria: suspected spine infection
    • A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases
    More Guidelines
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