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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 initially missed. It is increasing in frequency as IVDA increases. Males are affected slightly more then females with average age about 50 y/o.
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| History is variable. The clinical triad of fever, back pain, and neurologic deficit is not present in most patients. A 4-phase sequential evolution has been described, with (1) localized spinal pain, (2) radicular pain and paresthesias, (3) muscular weakness, sensory loss, and sphincter dysfunction, and finally (4) paralysis.
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| The virulence of the infecting organism and the mode of infection contribute to the tempo of this progression. Abscesses from hematogenous spread tend to progress rapidly, while abscesses from osteomyelitis or discitis may evolve over weeks or months with slow progression of symptoms.
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| Frequently the patient gives a history of back strain or mild injury.
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| An evident source of infection in skin or soft tissue may be found.
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| IV drug users are a high-risk group. Occurrences have been cited even in patients with a remote history of IV drug abuse.[7]
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| Cases are frequently reported in patients with diabetes mellitus, which is a risk factor in 50% of reported patients; alcoholism; and conditions involving chronic immunosuppression.
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| Hematogenous seeding of the epidural space with abscess formation may stem from intravenous lines, urinary catheters, or implantable devices. Direct inoculation of the epidural space may follow spinal surgery, epidural catheter placement, or epidural injections.
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| Symptoms may include the following:
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| Fever, present in only about one third of patients
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| Localized back pain in most patients, often the first symptom
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| Radiculopathy with radiating or lancinating pain, including chest or abdominal pain (At times this may simulate myocardial infarction or other causes of chest or abdominal pain.)
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| Spinal cord syndromes, typically involving paraparesis with prospective progression to paraplegia (Epidural abscesses at the level of the cauda equina cause symptoms consistent with cauda equina syndrome rather than a spinal cord syndrome.)
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| Central cord syndrome from epidural abscess has also been reported.[9]
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| Sphincter dysfunction, including incontinence or increased residual urine volumes
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| Headache and neck pain may be present, especially with cervical epidural abscesses. (Of course, these symptoms might also suggest meningitis.)
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| Causes
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| Most cases arise from hematogenous seeding of the epidural space from a distant source of infection.
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| A few cases are the result of direct extension of infection from the spine or paraspinal tissues.
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| Sources of hematogenous infection
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| Skin and soft tissue
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| Infected catheter
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| Bacterial endocarditis
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| Respiratory tract infection
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| Urinary tract infection
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| Dental abscess
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| Others
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| Sources of contiguous spread
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| Vertebral osteomyelitis
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| Retropharyngeal abscess
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| Dermal sinus tract
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| Psoas abscess
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| Penetrating injury
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| Epidural injections or catheters
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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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| ==Cervical Spondylosis: Diagnosis and Management
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| Epidural Hematoma
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| HIV-1 Associated Vacuolar Myelopathy
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| Leptomeningeal Carcinomatosis
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| Metastatic Disease to the Spine and Related Structures
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| Multiple Sclerosis
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| Spinal Cord Hemorrhage
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| Spinal Cord Infarction
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| Tropical Myeloneuropathies
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| Vitamin B-12 Associated Neurological Diseases==
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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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