Background Infection of the epidural space, between the dura mater and bone, in the spine
Acquired from contiguous spread (e.g. discitis, otitis media/sinusitis/mastoiditis, direct inoculation (e.g. spinal anaesthesia or neurosurgery), or hematogenous spread
Risk factors include intravenous drug use, hemodialysis , diabetes mellitus , and older age Microbiology Etiologies Idiopathic (30%)
Skin and soft tissue infection (22%)
Spinal surgery or procedure (12%)
Injection drug use (10%)
Other sources including epidural catheters (8%)
Bone and joint infections (7%), including decubitus ulcers
Urinary tract (3%)
Upper respiratory tract (3%)
Sepsis (2%)
Abdomen (2%)
Intravascular catheter (<1%) Risk Factors Clinical Manifestations Severe low-back pain often worse with palpation
Fever
Malaise
Neurologic deficits associated with mass effect on spinal cord, interruption of arterial supply, venous thrombosis, or toxin Staging of Spinal Epidural Abscess Stage 1: back pain at the level of the affected spine
Stage 2: nerve-root pain radiating from the involved spinal area
Stage 3: motor weakness, sensory deficit, and bladder and bowel dysfunction
Stage 4: paralysis Diagnosis Usually made by MRI (or CT with contrast)
Blood cultures may be helpful
Cultures from the abscess fluid, if possible Management May need urgent neurosurgical drainage if neurological symptoms
Intravenous antibiotics, ideally after blood cultures are drawn
Typical empiric antibiotics are ceftriaxone and vancomycin
Duration typically 6 to 8 weeks after source control
Patients treated non-operatively may need to have antibiotics continued to radiographic resolution of the abscess
