Summary
Definition
History and exam
Key diagnostic factors
- fever
- spinal pain or tenderness
- weakness of extremities
- paralysis
- sensory disturbance
- abnormal reflexes
Other diagnostic factors
- isolated sphincter dysfunction
Risk factors
- intravenous drug use
- recent spinal surgery or trauma
- indwelling spinal catheter
- contiguous local infection
- immunosuppression
- diabetes mellitus
- chronic renal disease
- concomitant bacteremia or endocarditis
- alcohol misuse
- male sex
- obesity
- noncontiguous coinfection (excluding bacteremia)
- chronic liver disease
Diagnostic tests
1st tests to order
- CBC
- CRP
- erythrocyte sedimentation rate
- MRI spine with and without intravenous contrast
- blood cultures
Tests to consider
- direct abscess aspiration for culture
- polymerase chain reaction (PCR) of aspirate
Treatment algorithm
suspected epidural abscess
with methicillin-sensitive Staphylococcus aureus (MSSA) infection
with MRSA infection
with gram-negative infection
with Mycobacterium tuberculosis infection
Contributors
Authors
Kenneth F. Casey, MD
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 hematoma
- Multiple sclerosis
- Malignant spinal cord compression
More DifferentialsGuidelines
- ACR appropriateness criteria: suspected spine infection
- A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases
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