QJM Advance Access originally published online on November 3, 2007
QJM 2008 101(1):1-12; doi:10.1093/qjmed/hcm100
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Spinal epidural abscess in clinical practice
From the 1Unit of Infectious Diseases, Basel University Medical Clinic, Liestal, Switzerland, 2Center for Infectious Medicine, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Huddinge, Sweden, and 3Department of Internal Medicine, Cantonal Hospital, Aarau, Switzerland
Address correspondence to Dr P. Sendi, Unit of Infectious Diseases, Basel University Medical Clinic Liestal, Rheinstrasse 26, CH-4410 Liestal, Switzerland. email: sendi-pa{at}magnet.ch
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Abstract |
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Spinal epidural abscess (SEA) is a rare but severe infection requiring prompt recognition. The major prognostic factor for a favourable outcome is early diagnosis, leading to appropriate treatment. In clinical practice, a diagnosis of SEA is often not considered, particularly in the early stages of the disease when neurological symptoms are not apparent. Knowledge of persons at risk, clinical features and the required diagnostic procedures may decrease the number of initially misdiagnosed cases. Clinical signs, duration of symptoms and the rate of neurological deterioration show a high inter-individual variability, and the classic triad (spinal pain, fever and neurological deficit) is often not found, especially not at first presentation to a physician. However, most patients complain of severe localized back pain. Inflammatory parameters in the blood are generally elevated, but not specific. Gadolinium-enhanced magnetic resonance imaging is the most sensitive, specific and accurate imaging method. Although neurosurgical decompression is still the treatment of choice in the majority of cases, less invasive procedures (e.g. computed tomography-guided needle aspiration) or antimicrobial treatment alone can be applied in selected cases. The choice of the most appropriate therapy should be discussed immediately after a confirmed diagnosis in consultation with infectious disease, radiology and spinal surgery specialists. The outcome of SEA is largely influenced by the severity and duration of neurological deficits prior to surgery, stressing the importance of early recognition.
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