SPINAL EPIDURAL ABSCESS

A spinal epidural abscess develops in the space outside the dura mater but within the spinal canal as a result of the hematogenous spread of infection from a remote site of infection or by direct extension from a contiguous infection, such as vertebral osteomyelitis, decubitus ulcers, or infected abdominal wounds. Neurologic deficits are the result of direct mechanical compression of the spinal cord and/or inflammatory thrombosis of the intraspinal vessels with subsequent ischemia and infarction. The initial symptom is back pain. Fever may be present. Back pain is followed by radicular pain, then weakness, and then paralysis of appendicular musculature, loss of sensation below the level of the lesion, and loss of bowel and bladder control. MRI is the procedure of choice to demonstrate a spinal epidural abscess and a contiguous area of infection when present. If there is evidence of compression of the spinal cord from the epidural abscess, an emergency decompression with evacuation of pus and granulation tissue is performed. This also allows for identification of the causative organism and guides antimicrobial therapy. Empiric antimicrobial therapy is directed at the most common causative organisms, which are staphylococci (Staphylococcus aureus and coagulase-negative staphylococci) and gram-negative bacilli.

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