Spinal Epidural Abscess

A spinal epidural abscess is an infection in the epidural space surround the spinal cord. It contains bacteria or other microbes and may cause neurological problems by localized pressure on the spinal cord or spinal cord vessels.

Causes

A spinal epidural abscess may occur due to:

  • Direct spread from adjacent infected regions ie osteomyelitis, psoas abscess.
  • Spread from distant infected regions through the bloodstream eg. urinary tract, lung and bone infections.
  • Direct implantation of bacteria into the epidural space around the spinal cord eg post-trauma, epidural.

Signs and Symptoms

People with epidural abscesses may be very sick. They may show:

  • Systemic symptoms and
  • Symptoms related to localised pressure.

Systemic symptoms

There will be normal signs of infection with swinging fevers, hot/cold flushes and drenching sweats.

Localised symptoms

There will be severe back pain localized over the site of the abscess. Specific neurological signs may include gradual paraplegia and loss of control of bowels and bladders.

Investigations

  • Blood tests – these include a septic screen of at least 3 blood cultures, an FBE and inflammatory as a measure of the severity of the infection, electrolytes and liver function tests to rule out multi-organ failure and a coagulation screen prior to any neurosurgical intervention.
  • Radiological tests
  • MRI spine – this is the gold standard to diagnose an epidural abscess.
  • Occasionally abdominal/pelvis CT and /or ultrasounds are needed to diagnose the source of the epidural abscess

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