Spine Spinal epidural abscess: a review of diagnosis and treatment

Spinal epidural abscess (SEA) is a rare potentially life threatening condition caused by accumulation of infectious material adjacent to the dura in the spinal canal. Unrecognized and untreated cases progress to paralysis and death. While the incidence of this condition remains relatively low, recent evidence suggests the incidence is increasing. Early diagnosis and treatment are critical to successful outcomes. Signs and symptoms of SEA can be relatively nonspecific and can lead to diagnostic difficulty and delay. Awareness of presenting symptoms and a high index of suspicion are necessary to avoid morbidity and mortality. Magnetic resonance imaging with gadolinium is the gold standard in diagnosis of this condition. CT myelogram also may be used in patients who cannot undergo MRI. Immediate initiation of antibiotics and emergent surgical decompression is the appropriate treatment in almost all cases. Surgery is followed by treatment with long-term antibiotics based on the offending organism. Nonoperative medical management has been reported to be successful but should be reserved for selected cases.