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| ==Background==
| | #REDIRECT[[Epidural abscess (spinal)]] |
| A spinal epidural abscess (SEA) can either compress or cause vascular compromise to the spinal cord or cauda equina. It produces sensory symptoms and signs, motor dysfunction, and, ultimately, paralysis and death. One half of cases are estimated to be misdiagnosed or have a delayed diagnosis.Frequency
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| United States
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| The frequency in large tertiary care centers is estimated to be about 2.8 cases per 10,000 admissions. The incidence is suspected to be increasing in relation to intravenous (IV) drug abuse.[7]
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| International
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| Because these abscesses occur rarely, the frequency is unknown. It probably parallels the US experience of rarity, although limited diagnostic capabilities in medically underserved countries might increase its importance as a health risk.
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| Mortality/Morbidity
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| If untreated, spinal epidural abscess causes progressive paraplegia and death.
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| Sex
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| Older studies found an equal sex ratio; more recent data indicate a male predominance, likely reflecting the pattern of IV drug use.
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| Age
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| The average age is older than 50 years, but spinal epidural abscess can occur at any age.
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| ==Anatomy==
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| The spinal epidural space is not uniform. Abscesses occur more frequently in the larger, venous plexus containing posterior epidural space (allowing spread over several vertebral areas) and mostly in the thoracic area, which is the longest of the spinal regions. Anteriorly, it is a potential space with the dura tightly adherent to the vertebral bodies and ligaments.
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| Hematogenous spread with seeding of the epidural space is the suspected source of infection in most patients with sources including bacterial endocarditis, infected indwelling catheters, urinary tract infections, peritoneal and retroperitoneal infections, and others. Direct extension of infection from vertebral osteomyelitis occurs in adults and rarely in children. Epidural catheters and injections may lead to direct inoculation of the epidural space. The source of infection is not identified in many patients. The more clinically significant effects of the epidural abscess may be from involvement of the vascular supply to the spinal cord and subsequent infarction rather than direct compression. Staphylococcus aureus is the most commonly reported pathogen. MRSA is increasing particularly in patients with a history of MRSA abscesses, spinal surgery, or implanted devices. Immunosuppressed patients may have infections from unusual bacterial or fungal organisms. Environmental mold Exserohilum rostratum was the unusual pathogen associated with the outbreak of contaminated methylprednisolone.==
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| ==Differential Diagnosis==
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| ==Workup==
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| ==Management==
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| ==Disposition==
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| ==See Also==
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| ==External Links==
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| ==Sources==
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| <references/>
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