Spinal epidural abscess

Introduction
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By John E Greenlee MD

Spinal epidural abscess is also known as or subsumes Spinal pachymeningitis externa and Spinal peripachymeningitis. -ed.

Spinal epidural abscess is the result of loculated infection within the fat-filled space that separates the spinal dura and arachnoid. The condition is a neurologic and neurosurgical emergency that, if unrecognized, may cause devastating neurologic injury. Because of its infrequent occurrence, however, the possibility of epidural abscess tends to be ignored in patients presenting with fever and back or neck pain, and failure to recognize this condition also makes epidural abscess a significant cause of litigation for malpractice. In this clinical article, Dr. John Greenlee, Professor of Neurology at the University of Utah School of Medicine and Staff Neurologist at the Veterans Administration Medical Center at Salt Lake City, reviews the pathogenesis, clinical features, diagnosis, and treatment of this disorder.

Key points

  • Acute spinal epidural abscess characteristically presents with a consistent sequence of clinical symptoms and signs: severe focal pain, often unrelieved by narcotics, followed by radicular pain, followed by signs of spinal cord compression.
  • Chronic epidural abscesses may exhibit a similar sequence of symptoms and signs, but these may develop slowly over time. The most common presentation of chronic epidural abscess is that of a compressive lesion.
  • Treatment of spinal epidural abscess, in most cases, involves both antibiotic treatment and surgical drainage. Delay in diagnosis and treatment may result in death or profound, irreversible neurologic impairment.