eMedicine Specialties > Neurology > Neurological Infections

Spinal Epidural Abscess: Follow-up

Author: J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
Contributor Information and Disclosures

Updated: Aug 13, 2009

Follow-up

Further Inpatient Care

  • Frequent neurologic assessment to detect any progression of neurologic deficit, particularly weakness, is required.
  • Postsurgical patients require monitoring of neurologic status as well.
  • If the patient has a deficit from spinal cord damage, nursing attention for skin care, catheter care, and physical therapy may be necessary.

Further Outpatient Care

  • Rehabilitation for any residual neurologic deficit may be necessary. This would include restrengthening programs and ambulation retraining.
  • Home health care may help provide ongoing antibiotic and physical therapy.

Transfer

Transfer to a facility with spinal cord imaging and care facilities may be necessary.

Complications

The many complications of spinal cord injury include bladder dysfunction, decubiti, supine hypertension, recurrent sepsis, and other problems.

Prognosis

  • No studies have been done to assist in predicting prognosis.
  • Prognosis in general is related to the duration of spinal cord dysfunction and the degree of cord impairment at the time of diagnosis.

Patient Education

For excellent patient education resources, visit eMedicine's Infections Center and Brain and Nervous System Center. Also, see eMedicine's patient education articles Brain Infection and Antibiotics.

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose spinal epidural abscess promptly is the greatest pitfall.
  • Given the multitudes of patients presenting to emergency departments for treatment of back pain, recognizing this relatively rare, emergent, and potentially treatable condition is a challenge.
  • Neurologic findings or complaints such as weakness in the extremities, root pain, a sensory level, or increased reflexes (often with clonus, spasms, and spasticity) may prompt further evaluation.
  • Localized spinal tenderness or tenderness to percussion suggests local inflammation.
  • Fever, if present, may signal the presence of this deep-seated focal infection.
  • High-risk behavior, and especially IV drug abuse, should heighten suspicion.
 


More on Spinal Epidural Abscess

Overview: Spinal Epidural Abscess
Differential Diagnoses & Workup: Spinal Epidural Abscess
Treatment & Medication: Spinal Epidural Abscess
Follow-up: Spinal Epidural Abscess
Multimedia: Spinal Epidural Abscess
References
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References

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  2. Bremer AA, Darouiche RO. Spinal epidural abscess presenting as intra-abdominal pathology: a case report and literature review. J Emerg Med. Jan 2004;26(1):51-6. [Medline].

  3. Rigamonti D, Liem L, Sampath P, et al. Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol. Aug 1999;52(2):189-96; discussion 197. [Medline].

  4. Joshi SM, Hatfield RH, Martin J, Taylor W. Spinal epidural abscess: a diagnostic challenge. Br J Neurosurg. Apr 2003;17(2):160-3. [Medline].

  5. Prendergast H, Jerrard D, O'Connell J. Atypical presentations of epidural abscess in intravenous drug abusers. Am J Emerg Med. Mar 1997;15(2):158-60. [Medline].

  6. Davis DP, Wold RM, Patel RJ, et al. The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess. J Emerg Med. Apr 2004;26(3):285-91. [Medline].

  7. Trombly R, Guest JD. Acute central cord syndrome arising from a cervical epidural abscess: case report. Neurosurgery. Aug 2007;61(2):E424-5; discussion E425. [Medline].

  8. Tasher D, Armarnik E, Mizrahi A, Liat BS, Constantini S, Grisaru-Soen G. Cat Scratch Disease With Cervical Vertebral Osteomyelitis and Spinal Epidural Abscess. Pediatr Infect Dis J. Jul 31 2009;[Medline].

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  14. Gerberding JL, Romero JM, Ferraro MJ. Case records of the Massachusetts General Hospital. Case 34-2008. A 58-year-old woman with neck pain and fever. N Engl J Med. Oct 30 2008;359(18):1942-9. [Medline].

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  16. Hooten WM, Kinney MO, Huntoon MA. Epidural abscess and meningitis after epidural corticosteroid injection. Mayo Clin Proc. May 2004;79(5):682-6. [Medline].

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  18. Uchida K, Nakajima H, Yayama T, Sato R, Kobayashi S, Chen KB, et al. Epidural abscess associated with pyogenic spondylodiscitis of the lumbar spine; evaluation of a new MRI staging classification and imaging findings as indicators of surgical management: a retrospective study of 37 patients. Arch Orthop Trauma Surg. Jun 30 2009;[Medline].

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Further Reading

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Keywords

spinal cord compression, vertebral osteomyelitis, epidural space infection, Staphylococcus aureus, Staphylococcus species, Pseudomonas species, Escherichia coli, Mycobacterium tuberculosis, brucellosis, spinal cord dysfunction, localized spinal pain, radicular pain and paresthesias, muscular weakness, sensory loss, sphincter dysfunction, paralysis

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Contributor Information and Disclosures

Author

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Edward L Hogan, MD, Professor, Department of Neurology, Medical College of Georgia; Emeritus Professor and Chair, Department of Neurology, Medical University of South Carolina
Edward L Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Neurological Association, American Society for Biochemistry and Molecular Biology, Phi Beta Kappa, Sigma Xi, Society for Neuroscience, and Southern Clinical Neurological Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Florian P Thomas, MD, MA, PhD, Drmed, Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University
Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Paraplegia Society, and National Multiple Sclerosis Society
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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