Epidural Abscesses

Epidural Abscesses

Epidural abscesses are most often found in the thoracolumbar spine. Bacteria can travel hematogenously into the epidural space, by adjacent tissue or from contamination postspinal procedure. Risk factors include diabetes, HIV infection, trauma, alcoholism, IV drug abuse, tattooing, neighboring infection, or hemodialysis. Staph aureus makes up 63% of all infections. Methicillin-resistant Staphylococcus aureus (MRSA) makes up roughly one-fourth of all Staph infections. Fever may or may not be present. Symptoms include severe, focal pain. Based on the extent of compression along the nerves and spinal cord, nerve injury ranges from radicular pain to paralysis. WBC, ESR, CRP, and blood cultures can be drawn. MRI should be performed if there is clinical suspicion of abscess. CT with IV contrast may be an alternative image modality. Abscess fluid culture is recommended. Treatment includes direct incision and drainage as well as antibiotic therapy. Empiric antibiotics following collection of two sets of cultures should start once the suspicion of infection is made. Treatment lasts for 4 to 8 weeks. Repeat MRI should be performed between 4 and 6 weeks. Serial WBC, ESR, and CRP values should be performed.

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