Makindo Medical Notes

Related Subjects: | Transverse myelitis | Acute Disseminated Encephalomyelitis |Cervical spondylosis |Spinal Cord Anatomy |Acute Disc Prolapse |Spinal Cord Compression |Spinal Cord Haematoma |Foix-Alajouanine syndrome |Cauda Equina |Conus Medullaris syndrome |Anterior Spinal Cord syndrome |Central Spinal Cord syndrome |Brown-Sequard Spinal Cord syndrome

A spinal epidural abscess is a rare but potentially life-threatening condition where pus accumulates in the epidural space, between the spinal vertebrae and the dura mater, the outermost membrane surrounding the spinal cord. This can lead to rapid compression of the spinal cord and nerves, causing severe neurological deficits, paralysis, or even death if not treated promptly.

About

• A spinal epidural abscess commonly presents as severe back pain and progressive weakness in the legs, developing over hours to days.
• Staphylococcus aureus, including MRSA, is the most frequent causative agent.
• The infection may reach the epidural space through various routes, with haematogenous spread being the most common.

Aetiology

• Haematogenous spread: Infection travels through the bloodstream from distant sites, such as skin infections, urinary tract infections, or endocarditis.
• Direct extension: Infection extends from adjacent structures, like vertebral osteomyelitis or a psoas abscess.
• Postoperative or post-procedural infection: Follows spinal surgeries, epidural catheterization, or other invasive spinal procedures.
• Trauma: Spinal injuries or open wounds can introduce pathogens directly into the epidural space.

Risk Factors

• Diabetes mellitus
• Immunocompromised states (e.g., HIV/AIDS, chemotherapy, organ transplant)
• Chronic kidney disease
• Intravenous drug use
• Recent spinal surgery or invasive spinal procedures
• Chronic alcohol abuse

Clinical Presentation

• Acute onset of severe back pain, often with point tenderness over the spine.
• Systemic symptoms such as fever, malaise, and signs of toxicity, often with an elevated heart rate.
• Progressive neurological signs, including paraparesis or quadriparesis, evolving over hours to days.
• Evidence of a sensory and motor level, with weakness, numbness, or tingling in extremities below the level of the lesion.

Red Flags

• Rapidly progressing neurological deficits.
• Signs of systemic infection, including high fever and sepsis.
• History of recent spinal surgery or invasive procedure.
• Known risk factors, such as IV drug use or immunosuppression.

Investigations

• Magnetic Resonance Imaging (MRI): The diagnostic modality of choice, with contrast enhancement showing the abscess location and extent.
• Blood cultures: Frequently reveal the causative organism, often Staphylococcus aureus.
• Blood tests: Elevated CRP and ESR, indicating systemic inflammation.
• Computed Tomography (CT): Used when MRI is unavailable or contraindicated, though less sensitive for soft tissue visualization.

Prompt recognition and treatment of spinal epidural abscess are essential to prevent permanent neurological damage and improve outcomes.

Management

• Empirical Antibiotic Therapy: Initiate IV broad-spectrum antibiotics targeting likely pathogens, including MRSA. Therapy is adjusted based on culture results.
• Surgical Intervention: Surgical drainage is indicated to relieve cord compression. A laminectomy may be performed to access and drain the abscess effectively.
• Supportive Care: Pain management, close neurological monitoring, and rehabilitation for residual neurological deficits.