Makindo Medical Notes.com

A spinal epidural abscess is a rare but serious condition where a collection of pus forms in the epidural space of the spine, which is the area between the bones of the spine (vertebrae) and the membranes covering the spinal cord (dura mater). This abscess can compress the spinal cord and nerves, leading to severe complications, including paralysis and death if not promptly treated.

About

• A cause of back pain and weak legs coming on over hours
• The most common cause of a spinal epidural abscess is a bacterial infection
• Most often Staphylococcus aureus, including MRSA.
• The infection can reach the epidural space through various routes

Aetiology

• Hematogenous spread: blood stream from a distant site of infection, such as a skin infection, urinary tract infection, or endocarditis.
• Direct extension: from adjacent structures, such as from a vertebral osteomyelitis or a psoas abscess.
• Postoperative or post-procedural infection: following spinal surgery, epidural catheterization, or other invasive spinal procedures.
• Trauma: Spinal trauma and open wound can introduce infection directly into the epidural space.

Risk Factors

• Diabetes mellitus
• Immunocompromised state (e.g., HIV/AIDS, chaemotherapy, organ transplantation)
• Chronic kidney disease
• Intravenous drug use
• Spinal surgery or invasive spinal procedures
• Chronic alcohol abuse

Clinical

• Toxic, febrile patient. Usually middle-aged men.
• Pain and tenderness to percuss posteriorly over the spine
• Progressive paraparesis coming on over hours and days.
• Evidence of a motor and sensory level.
• Weakness, numbness, or tingling

Investigations

• Magnetic Resonance Imaging (MRI): modality of choice for diagnosing a spinal epidural abscess
• Blood tests: Blood cultures, High CRP and ESR
• Computed Tomography (CT) scan: when MRI is not available or contraindicated.

Management

• Antibiotic therapy: Empiric broad-spectrum IV antibiotics often including coverage for MRSA. Once the causative organism is identified, antibiotics may be tailored accordingly.
• Surgical drainage: surgical intervention to drain the abscess and relieve pressure on the spinal cord. This may involve laminectomy (removal of part of the vertebra) to access the epidural space.
• Supportive care: pain management, monitoring of neurological status, and rehabilitation to address any neurological deficits.