DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20174139

Epidural abscess assessment and management

Shahnila Ali

Abstract


Epidural abscess is a medical emergency. Abscesses can expand to compress the brain or spinal cord and cause severe symptoms, perma-nent neurological deficits, or even death. Most spinal epidural abscesses begin as focal pyogenic infection involving the vertebral disc or junction between the disc and the vertebral body and as inflammation pro-gresses, abscess may extend longitudinally in the epidural space, and damage to the spinal cord can happen. Symptoms on presentation may include fever, malaise, back pain, motor weakness, sensory changes, bladder or bowel dysfunction, or paralysis. Most important diagnostic test is MRI because it is positive early in the course of the infection and pro-vides the best visualization of the location and extent of inflammatory changes. MRI with contrast should be performed as soon as possible. Treatment is both medical and surgical. Empirical antibiotic regimen can be vancomycin, metronidazole and third generation cephalosporin or vancomycin and piperacillin-tazobactam among other combinations. Fur-ther guidance by infectious work up. After diagnosis, neurosurgery con-sultation is taken immediately for surgical evaluation and management.


Keywords


Epidural abscess, ED (Emergency department), MRI (Magnetic resonance imaging)

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References


Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006;355(19):2012-20.

Strine TW, Hootman JM. US national prevalence and correlates of low back and neck pain among adults. Arthritis Rheum. 2007;57:656.

Deyo RA, Rainville J, Kent DL. What can the history and physical ex-amination tell us about low back pain?. JAMA. 1992;268(6):760.

Davis DP, Wold RM, Patel RJ. The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess. J Emerg Med. 2004;26:285-91.

Chao D, Nanda A. Spinal epidural abscess: a diagnostic challenge. Am Fam Physician. 2002;65:1341-6.

Gosavi C, Bland D, Poddar R, Horst C. Epidural abscess complicating insertion of epidural catheters. Br J Anaesth. 2004;92:294.

Gaul C, Neundörfer B, Winterholler M. Iatrogenic (para-) spinal ab-scesses and meningitis following injection therapy for low back pain. Pain. 2005;116:407.

Tompkins M, Panuncialman I, Lucas P, et al. Spinal epidural abscess. J Emerg Med. 2010;39:384-90.

Krishnamohan P, Berger JR. Spinal epidural abscess. Curr Infect Dis Rep. 2014;16:436.

Sendi P, Bregenzer T, Zimmerli W. Spinal epidural abscess in clinical practice. QJM. 2008;101:1.

Rigamonti D, Liem L, Wolf AL. Epidural abscess in the cervical spine. Mt Sinai J Med. 1994;61:357.

Chen WC, Wang JL, Wang JT. Spinal epidural abscess due to Staphylococcus aureus: clinical manifestations and outcomes. J Micro-biol Immunol Infect. 2008;41:215.

Holt HM, Andersen SS, Andersen O. Infections following epidural catheterization. J Hosp Infect. 1995;30:253.

Phillips JM, Stedeford JC, Hartsilver E, Roberts C. Epidural abscess complicating insertion of epidural catheters. Br J Anaesth. 2002;89:778.