Spinal epidural abscess is an uncommon condition characterised by inflammation with pus within the epidural space.
Potential risk factors include intravenous drug use, diabetes mellitus, recent spinal surgery or trauma, indwelling spinal catheter, contiguous local infection, concomitant bacteraemia or endocarditis, chronic renal disease, and immunosuppression (e.g., HIV infection, malignancy). However, a significant proportion of patients do not have an obvious risk factor.
Classic features are back pain and fever, with the potential for development of neurological deficit, but presentations vary.
Treatment includes intravenous antibiotics. Surgical decompression is required for patients with neurological deficit.
Prognosis is most closely related to the patient's neurological status at presentation.
Spinal epidural abscess (SEA) is an inflammation with pus within the epidural space. The clinical presentation may be insidious, and diagnosis is often difficult in the early stages. Classic features include back pain, fever, and neurological deficit, but only a minority of patients have all three features. SEA has a high morbidity and mortality if untreated.
History and exam
Key diagnostic factors
- presence of risk factors
- spinal pain or tenderness
- weakness of extremities
- sensory disturbance
- abnormal reflexes
Other diagnostic factors
- isolated sphincter dysfunction
- intravenous drug use
- recent spinal surgery or trauma
- indwelling spinal catheter
- contiguous local infection
- diabetes mellitus
- chronic renal disease
- concomitant bacteraemia or endocarditis
- alcohol misuse
- male sex
- non-contiguous co-infection (excluding bactereamia)
- chronic liver disease
1st investigations to order
- erythrocyte sedimentation rate
- MRI spine with and without intravenous contrast
- blood cultures
Investigations to consider
- direct abscess aspiration for culture
- polymerase chain reaction (PCR) of aspirate
suspected epidural abscess
with methicillin-sensitive Staphylococcus aureus (MSSA) infection
with MRSA infection
with gram-negative infection
with Mycobacterium tuberculosis infection
- Epidural haematoma
- Multiple sclerosis
- Malignant spinal cord compression
- ACR appropriateness criteria: suspected spine infection
- A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer