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

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