Epidural abscess (spinal)

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Risk Factors

  • Diabetes mellitus
  • Alcoholism
  • AIDS
  • Trauma
  • Tattooing
  • Acupuncture
  • Contiguous bony or soft tissue infection


Diagnosis

  • Classic triad of fever, back pain, and neuro deficits is rare
  • Fever is only present in ~50% of cases
  • Fever + localized back pain = epidural abscess until proven otherwise
  • Routine lab tests are rarely helpful
  • Only 60% have leukocytosis
  • CT with IV contrast is acceptable (MRI is preferred)
  • Blood cultures are indicated to identify the source organism (Staph in 2/3 of cases)
  • CSF studies are rarely useful (only positive in 20% of cases)


Differential Diagnosis

  • Disc and bony disease
  • Vertebral discitis and osteomyelitis
  • Metastatic tumors
  • Meningitis
  • Herpes zoster, prior to appearance of skin lesions


Treatment

  • Early surgical decompression and drainage
  • Aspiration (for diagnosis) and Abx may be sufficient for pts w/o neuro deficits
  • Antibiotics
  • Vanco + metronidazole + either cefotaxime or ceftriaxone or ceftazadine
  • (Ceftazidine is preferred if pseudomonas is considered likely)
  • Can substitute nafcillin or oxacillin for vanco if not MRSA
  • Treat for 6-8 weeks


Source: UpToDate

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