Spinal Epidural Abscess Workup

Updated: May 31, 2022
  • Author: Omaditya (Goldey) Khanna, MD; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Approach Considerations

The diagnosis of spinal epidural abscesses is difficult due to numerous issues, and a thorough history, physical examination, and lab work should be obtained in a timely fashion. According to one study of retrospective chart reviews of 250 randomly selected patients, 119 had a new diagnosis of spinal epidural abscess, 66 (55.5%) of which experienced diagnostic error. Red flags that were frequently not evaluated in error cases included unexplained fever, focal neurological deficits with progressive or disabling symptoms, and active infection. [12]



Laboratory Studies

The following laboratory tests may be helpful in patients suspected of having an spinal epidural abscess:

  • CBC count, blood cultures, urinalysis/urine culture, and pre-operative lab studies. Fever may be absent in patients; however, leukocytosis is present in about two thirds of patients. [1]
  • Elevated erythrocyte sedimentation rate (ESR) and/or C-reactive protein are often elevated in patients presenting with spinal epidural abscess. [13]
  • Leukocytosis and ESR elevation are nonspecific laboratory findings and are not always present. Neither the presence of these findings nor the degree of laboratory abnormality is specific for spinal epidural abscess. A treatment guideline incorporating ESR, C-reactive protein, and other risk factors has been proposed based on a small patient series. [14]

Imaging Studies

While suspicion for spinal epidural abscess is influenced by patient history, clinical exam and labs, a definitive diagnosis requires obtaining contrast-enhanced MRI, or a CT myleogram in patients who are unable to obtain an MRI. Patients who present with spinal epidural abscess often have non-contiguous lesions, which may not be symptomatic; [15] thus, consideration should be given to obtaining imaging of the spinal neuroaxis in patients with suspected or confirmed abscess.