Epidural abscess (spinal): Difference between revisions
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Revision as of 17:10, 31 October 2011
Background
- Abscess confined to epidural adipose tissue in spine
- Thoracic and lumbar spine most common, C-spine least common
- Usually hematogenous spread from other source of infection
- S. aureus, strep, pseudomonas, e. coli most common
Risk Factors
- Diabetes mellitus
- Alcoholism
- AIDS
- Trauma
- Tattooing
- Acupuncture
- Contiguous bony or soft tissue infection
Diagnosis
- Fever + localized back pain = epidural abscess until proven otherwise
- Classic triad of fever, back pain, and neuro deficits is rare
- Fever is only present in ~50% of cases
- Routine lab tests are rarely helpful
- Only 60% have leukocytosis
- MRI is diagnostic test of choice
- CT with IV contrast is acceptable (MRI is preferred)
- Blood cultures are indicated to identify the source organism (Staph in 2/3 of cases)
Differential Diagnosis
- Disc and bony disease
- Vertebral discitis and osteomyelitis
- Metastatic tumors
- Meningitis
- Herpes zoster, prior to appearance of skin lesions
Treatment
- Early surgical decompression and drainage
- Aspiration (for diagnosis) and Abx may be sufficient for pts w/o neuro deficits
- Antibiotics
- Vanco + metronidazole + either cefotaxime or ceftriaxone or ceftazadine
- (Ceftazidine is preferred if pseudomonas is considered likely)
- Can substitute nafcillin or oxacillin for vanco if not MRSA
- Treat for 6-8 weeks
- Vanco + metronidazole + either cefotaxime or ceftriaxone or ceftazadine
Source
UpToDate
Rosens