Spinal Epidural Abscess

• Relatively rare (incidence ~2-3/10000 hospital admissions) although incidence is increasing (? risk increased by diabetes, age, IVDU, immunosuppression)
  • Most common between 50-70; male predominance
• Characterised by a collection of pus between the dura mater and the overlying vertebral column
  • SEA most common in the the posterior thoracic and lumbosacral spine (anterior epidural abscesses usually linked to osteomyelitis of the vertebrae)
• Bacteria gain entry via
  • local spread e.g. vertebral osteomyelitis or psoas abscess (10-30%)
  • haematogenous spread (usually secondary to skin/soft-tissue, urinary and respiratory tract infections) (50%; usually multiple abscesses)
  • iatrogenic e.g. surgery; LP; anaesthesia (15%)
  • NB many cases- no source identified
• Patients present with pain/tenderness over the back and pain often in a root distribution
  • fever
  • neurological deficit (transverse spinal cord syndrome – picture i.e. paraparesis, sensory impairment and sphincter dysfunction)
• Investigations
  • MRI with contrast (/myelography)
  • FBC may show raised WCC, ESR/PV
  • Blood cultures
• Manage with empirical antibiotics and aspiration/drainage
• Early diagnosis/management important to prevent irreversible damage to the spinal cord e.g. causing paraplegia