Spinal epidural abscess

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 kidney 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.

A 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.[1]Curry WT Jr, Hoh BL, Amin-Hanjani S, et al. Spinal epidural abscess: clinical presentation, management, and outcome. Surg Neurol. 2005 Apr;63(4):364-71. http://www.ncbi.nlm.nih.gov/pubmed/15808726?tool=bestpractice.com [2]Bond A, Manian FA. Spinal epidural abscess: a review with special emphasis on earlier diagnosis. Biomed Res Int. 2016 Dec 1 [Epub ahead of print]. https://www.hindawi.com/journals/bmri/2016/1614328 http://www.ncbi.nlm.nih.gov/pubmed/28044125?tool=bestpractice.com SEA has a high morbidity and mortality if untreated.