Spinal epidural abscess: Difference between revisions
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==Background== |
==Background== |
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*Infection of the epidural space, between the dura mater and bone |
*Infection of the epidural space, between the dura mater and bone, in the spine |
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*May be intracranial or spinal, with spinal being far more common |
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*Acquired from contiguous spread (e.g. discitis, otitis media/sinusitis/mastoiditis, direct inoculation (e.g. spinal anaesthesia or neurosurgery), or hematogenous spread |
*Acquired from contiguous spread (e.g. discitis, otitis media/sinusitis/mastoiditis, direct inoculation (e.g. spinal anaesthesia or neurosurgery), or hematogenous spread |
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*Risk factors include intravenous drug use, [[hemodialysis]], [[diabetes mellitus]], and older age |
*Risk factors include intravenous drug use, [[hemodialysis]], [[diabetes mellitus]], and older age |
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*Neurologic deficits associated with mass effect on spinal cord, interruption of arterial supply, venous thrombosis, or toxin |
*Neurologic deficits associated with mass effect on spinal cord, interruption of arterial supply, venous thrombosis, or toxin |
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===Staging of Spinal Epidural Abscess=== |
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*Stage 1: back pain at the level of the affected spine |
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*Stage 2: nerve-root pain radiating from the involved spinal area |
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*Stage 3: motor weakness, sensory deficit, and bladder and bowel dysfunction |
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*Stage 4: paralysis |
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==Diagnosis== |
==Diagnosis== |
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Revision as of 13:55, 20 February 2021
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
- Staphylococcus aureus is most common cause
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
