Spinal Epidural Abscess

A serious infection caused by pus accumulation in the epidural space (the outer compartment of the spinal canal), requiring rapid diagnosis and treatment.

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Surgical Infectious Diseases

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1Overview

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What is this Condition?

Spinal epidural abscess is the accumulation of pus in the outermost compartment of the spinal canal, in the space between the bone and the membrane surrounding the spinal cord (epidural space). This collection can compress the spinal cord or nerve roots, leading to weakness and even paralysis; therefore, it is an emergency condition. Infection usually develops from a focus elsewhere in the body via the bloodstream, spreads from adjacent bone-disk infections, or develops following spinal procedures. The classic triad of symptoms includes back pain, fever, and neurological symptoms; however, all three occur together in only a small proportion of patients. Contrast-enhanced spinal MRI is essential for diagnosis. Early diagnosis is critical to prevent permanent neurological damage.

Symptoms

Severe and progressively worsening back or lower back pain (most common and earliest symptom)

Fever and chills

Weakness in the arms or legs, loss of sensation

Disturbance in bladder and bowel control (bladder-bowel dysfunction)

Radiating pain in the legs or numbness

In advanced cases, walking difficulty and paralysis

Diagnosis Methods

The most valuable diagnostic method is contrast-enhanced spinal MRI; this imaging clearly demonstrates the location of the abscess, its extent, and whether it causes compression of the spinal cord. Blood tests show elevated inflammatory markers, and blood culture is performed to identify the responsible microorganism. The combination of back pain, fever, and neurological symptoms is a strong indicator; however, because symptoms may not be complete in all patients, imaging is performed without delay when there is clinical suspicion.

Treatment Methods

Spinal epidural abscess is an emergency. If neurological symptoms (weakness, sensory loss, bladder dysfunction) are present, surgical decompression and drainage of pus must be performed within a short timeframe to prevent permanent neurological damage. Surgery is accompanied by prolonged intravenous antibiotic therapy. In carefully selected patients without significant neurological symptoms, management with close monitoring and antibiotic therapy alone may be considered; however, these patients are carefully followed for development of symptoms.

Emergency surgical decompression and drainage: Pus compressing the spinal cord is surgically drained and pressure is relieved.

Long-term intravenous antibiotic therapy: Treatment targeting responsible microorganisms, lasting for weeks.

Antibiotic treatment with close monitoring in selected patients: In appropriate patients without neurological deficits, conservative treatment without surgery may be considered with close monitoring for symptom development.

Treatment of the source and evaluation of spinal integrity: The infection source is treated; if bone involvement of the spine is present, stability is evaluated from an orthopedic perspective.

Treatment Path

Related Treatments

The procedures and interventions most commonly explored with this condition.

4 links

Lumbar Puncture

Collection of cerebrospinal fluid through a needle in the lower back

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Intracranial Pressure Monitor Placement

Monitor implantation for continuous intracranial pressure monitoring

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External Ventricular Drainage

External Ventricular Drainage procedure

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Endoskopik intraserebral/intraventriküler hematom boşaltımı

Endoskopik intraserebral/intraventriküler hematom boşaltımı procedure

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References

Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023.
Primary Infections of the Spine — Spinal Epidural Abscess. In: Steinmetz MP, Benzel EC, eds. Benzel's Spine Surgery. 5th ed. Elsevier; 2022.
Winn HR, ed. Youmans and Winn Neurological Surgery. 6th ed. Elsevier; 2011.

This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.

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Spinal Epidural Abscess

Surgical Infectious Diseases

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

Related Treatments

Lumbar Puncture

Intracranial Pressure Monitor Placement

External Ventricular Drainage

Endoskopik intraserebral/intraventriküler hematom boşaltımı

References

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Lumbar Puncture

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Endoskopik intraserebral/intraventriküler hematom boşaltımı

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