Epidural Abscess Follow-up

  • Author: Mark R Wallace, MD, FACP, FIDSA; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Sep 13, 2011
 

Further Inpatient Care

  • Frequent neurological examination is warranted during the postsurgical recovery period and is especially critical in patients undergoing medical treatment for spinal epidural abscess.
  • Fever, leukocytosis, or new neurological deficit necessitates repeated imaging, and further (or initial) surgical exploration may be required.[21]
  • Follow-up MRIs to evaluate spinal epidural abscess in patients who are doing well may not be helpful, as the findings may not correlate well with clinical course.[22]
  • Physical therapy may be necessary for individuals with a residual neurological deficit.
Next

Further Outpatient Care

  • Follow-up MRI should be obtained if any clinical deterioration is noted in patients with an intracranial epidural abscess or spinal epidural abscess. Follow-up MRI at 2-4 weeks should be performed in patients with spinal epidural abscess undergoing exclusively medical treatment to ensure the abscess has improved. It is unclear whether surgically treated patients with spinal epidural abscess who are doing well require follow-up MRI, as the MRI findings often correlate poorly with the clinical course.[22]
  • Follow-up with the neurosurgeon is needed.
  • Follow-up with an infectious diseases specialist is advised to monitor intravenous antibiotics.
Previous
Next

Inpatient & Outpatient Medications

See Treatment and Medication.

Previous
Next

Transfer

  • In the United States, by law, any unstable patient must be stabilized to the extent possible, including consultation and surgery, if indicated, before transfer.
Previous
Next

Complications

Death or permanent neurologic sequelae occur in a substantial proportion of patients with epidural abscess, especially those who present with major neurological deficits or sepsis.

Previous
Next

Prognosis

  • The degree of neurologic recovery after surgery correlates with the duration and initial severity of the neurologic defect.
  • Spinal epidural abscess carries a mortality rate of 2%-20%; intracranial epidural abscess, about 10% (see Mortality).
  • A worse outcome has been observed in patients with the following:[1]
    • Multiple medical problems
    • Prior spinal surgery
    • Prior cervical or thoracic abscess location
    • Thrombocytopenia
    • Leukocytosis (>14,000 WBCs/µL)
    • Persistently elevated inflammatory markers
    • Infection with methicillin-resistant staphylococci
    • Significant degree of thecal sac compression
    • Sepsis
Previous
Next

Patient Education

Previous
 
Contributor Information and Disclosures
Author

Mark R Wallace, MD, FACP, FIDSA  Clinical Professor of Medicine, Florida State University College of Medicine; Head of Infectious Disease Fellowship Program, Orlando Regional Medical Center

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Aadia Rana  MD, Assistant Professor of Medicine, Warren Alpert Medical School of Brown University

Disclosure: Nothing to disclose.

Gopala K Yadavalli, MD  Staff Physician and Chief, Infectious Diseases Clinic, Louis Stokes Cleveland Veterans Affairs Medical Center; Associate Program Director, Internal Medicine, University Hospitals Case Medical Center; Assistant Professor of Medicine, Division of Infectious Diseases, Case Western Reserve University School of Medicine

Gopala K Yadavalli, MD is a member of the following medical societies: American Society for Microbiology, American Society of Transplantation, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Fred A Lopez, MD  Associate Professor and Vice Chair, Department of Medicine, Assistant Dean for Student Affairs, Louisiana State University School of Medicine

Fred A Lopez, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, Infectious Diseases Society of America, and Louisiana State Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald A Greenfield, MD  Professor, Department of Internal Medicine, University of Oklahoma College of Medicine

Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist Honoraria Speaking and teaching; Forest Pharmaceuticals Speaking and teaching

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

  1. Sendi P, Bregenzer T, Zimmerli W. Spinal epidural abscess in clinical practice. QJM. Jan 2008;101(1):1-12. [Medline].

  2. Darouiche RO. Spinal epidural abscess. N Engl J Med. Nov 9 2006;355(19):2012-20. [Medline].

  3. Tsiodras S, Falagas ME. Clinical assessment and medical treatment of spine infections. Clin Orthop Relat Res. Mar 2006;444:38-50. [Medline].

  4. Grewal S, Hocking G, Wildsmith JA. Epidural abscesses. Br J Anaesth. Mar 2006;96(3):292-302. [Medline].

  5. Kabbara A, Rosenberg SK, Untal C. Methicillin-resistant Staphylococcus aureus epidural abscess after transforaminal epidural steroid injection. Pain Physician. Apr 2004;7(2):269-72. [Medline].

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

  7. Tang HJ, Lin HJ, Liu YC, Li CM. Spinal epidural abscess--experience with 46 patients and evaluation of prognostic factors. J Infect. Aug 2002;45(2):76-81. [Medline].

  8. Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev. Dec 2000;23(4):175-204; discussion 205. [Medline].

  9. Tunkell, AR. Subdural empyema, epidural abscess, and suppurative intracranial thrombophlebitis. In: Mandell GL, Bennet JE, Dolin R. Mandell, Douglas, and Bennett's Principles and Practices of Infectious Diseases. 2005:1165-8.

  10. Hlavin ML, Kaminski HJ, Fenstermaker RA, White RJ. Intracranial suppuration: a modern decade of postoperative subdural empyema and epidural abscess. Neurosurgery. Jun 1994;34(6):974-80; discussion 980-1. [Medline].

  11. 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].

  12. Chen WC, Wang JL, Wang JT, Chen YC, Chang SC. Spinal epidural abscess due to Staphylococcus aureus: clinical manifestations and outcomes. J Microbiol Immunol Infect. Jun 2008;41(3):215-21. [Medline].

  13. Lury K, Smith JK, Castillo M. Imaging of spinal infections. Semin Roentgenol. Oct 2006;41(4):363-79. [Medline].

  14. An HS, Seldomridge JA. Spinal infections: diagnostic tests and imaging studies. Clin Orthop Relat Res. Mar 2006;444:27-33. [Medline].

  15. Siddiq F, Chowfin A, Tight R, Sahmoun AE, Smego RA Jr. Medical vs surgical management of spinal epidural abscess. Arch Intern Med. Dec 13-27 2004;164(22):2409-12. [Medline].

  16. Sorensen P. Spinal epidural abscesses: conservative treatment for selected subgroups of patients. Br J Neurosurg. Dec 2003;17(6):513-8. [Medline].

  17. Curry WT Jr, Hoh BL, Amin-Hanjani S, Eskandar EN. Spinal epidural abscess: clinical presentation, management, and outcome. Surg Neurol. Apr 2005;63(4):364-71; discussion 371. [Medline].

  18. Pereira CE, Lynch JC. Spinal epidural abscess: an analysis of 24 cases. Surg Neurol. 2005;63 Suppl 1:S26-9. [Medline].

  19. Savage K, Holtom PD, Zalavras CG. Spinal epidural abscess: early clinical outcome in patients treated medically. Clin Orthop Relat Res. Oct 2005;439:56-60. [Medline].

  20. Karikari IO, Powers CJ, Reynolds RM, Mehta AI, Isaacs RE. Management of a spontaneous spinal epidural abscess: a single-center 10-year experience. Neurosurgery. Nov 2009;65(5):919-23; discussion 923-4. [Medline].

  21. Lohr M, Reithmeier T, Ernestus RI, Ebel H, Klug N. Spinal epidural abscess: prognostic factors and comparison of different surgical treatment strategies. Acta Neurochir (Wien). Feb 2005;147(2):159-66; discussion 166. [Medline].

  22. Kowalski TJ, Layton KF, Berbari EF, et al. Follow-up MR imaging in patients with pyogenic spine infections: lack of correlation with clinical features. AJNR Am J Neuroradiol. Apr 2007;28(4):693-9. [Medline].

  23. 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].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.