Spine, Epidural Abscess, MedPix™ : 1135 - Medical Image Database and Atlas

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Spine, Epidural Abscess
Topic 1135 - Created: 2001-01-11 13:40:54-05 - Modified: 2001-01-14 13:31:46-05

Epidural Abscess Incidence: 2 cases per 10,000 admissions

Complications: Mortality 59%; Paralysis at surgery = 41% recovery; Paralysis > 48 hrs = no recovery.

Risk Factors: IV Drug Abuse (33%), Diabetes (27%); Prior Spinal Surgery (17%).

Classic Presentation (4 Phases): I. Spinal ache or back pain w/ localized tenderness plus fever; II. (2-3 days later) Root or radicular pain w/ fever & peripheral leukocytosis a/w HA & nucchal rigidity; III. (4 days later) Weakness, decreased bowel/bladder sphincter tone w/ ascending anesthesia; IV. (1 day later) Paralysis (1/3).

Atypical Presentation: May have Back/Neck Pain Only, with NO fever and remote IV drug use.

Location: Thoracic 50-80%; Lumbar 17-38%; Cervical 10-25%.

Labs: Elevated Leukocytes (60%); Elevated ESR (95%); Blood Cultures; Do NOT perform Lumbar Puncture.

Microbiology: Staph aureus 60-90%; Streptococcus 18%; E. coli or Pseudomonas 13%; Multiorganism 10%.

Imaging:
* MRI w/ Contrast is Image of Choice
* Plain films and CT Scan may miss
* MRI as Sensitive as CT Myelography, but no invasive risks
* Poor Prognosis if Narrowing >50% of canal or Abscess Length >3cm

Treatment: Decompression Laminectomy and Drainage, then IV ABX x 4-6 weeks, and then PO ABX x 2-3 months.

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Title: Spine, Epidural Abscess ::

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Location: Spine	Sublocation: Extradural	Category: Infection, NOS
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