Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1998 Aug;65(2):209–212. doi: 10.1136/jnnp.65.2.209

Spinal epidural abscess: the importance of early diagnosis and treatment

A Mackenzie 1, R Laing 1, C Smith 1, G Kaar 1, F Smith 1
PMCID: PMC2170211  PMID: 9703173

Abstract

OBJECTIVES—To remind clinicians of the dangers of delayed diagnosis and the importance of early treatment of spinal epidural abscess.
METHODS—A review of the literature on spinal epidural abscess and a comparison of the published literature with local experience.
RESULTS—Imaging with MRI or CT enables early diagnosis of spinal epidural abcess and optimal therapy is surgical evacuation combined with 6-12 weeks (median 8 weeks) of antimicrobial chemotherapy. Clinical features are fever, pain, and focal neurological signs and may be associated with preceding and pre-existing bone or joint disease. The commonest aetiological organism is S aureus.
CONCLUSION—Early diagnosis and appropriate early antimicrobial chemotherapy with surgery is associated with an excellent prognosis.



Full Text

The Full Text of this article is available as a PDF (107.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Auten G. M., Levy C. S., Smith M. A. Haemophilus parainfluenzae as a rare cause of epidural abscess: case report and review. Rev Infect Dis. 1991 Jul-Aug;13(4):609–612. doi: 10.1093/clinids/13.4.609. [DOI] [PubMed] [Google Scholar]
  2. Bader B., Labrune P., Zerah M., Lebras P., Wood C., Devictor D., Huault G. Traitement médical d'une épidurite à staphylocoques. Arch Fr Pediatr. 1986 May;43(5):335–336. [PubMed] [Google Scholar]
  3. Baker A. S., Ojemann R. G., Swartz M. N., Richardson E. P., Jr Spinal epidural abscess. N Engl J Med. 1975 Sep 4;293(10):463–468. doi: 10.1056/NEJM197509042931001. [DOI] [PubMed] [Google Scholar]
  4. Bouchez B., Arnott G., Delfosse J. M. Acute spinal epidural abscess. J Neurol. 1985;231(6):343–344. doi: 10.1007/BF00313714. [DOI] [PubMed] [Google Scholar]
  5. Danner R. L., Hartman B. J. Update on spinal epidural abscess: 35 cases and review of the literature. Rev Infect Dis. 1987 Mar-Apr;9(2):265–274. doi: 10.1093/clinids/9.2.265. [DOI] [PubMed] [Google Scholar]
  6. Darouiche R. O., Hamill R. J., Greenberg S. B., Weathers S. W., Musher D. M. Bacterial spinal epidural abscess. Review of 43 cases and literature survey. Medicine (Baltimore) 1992 Nov;71(6):369–385. [PubMed] [Google Scholar]
  7. Ericsson M., Algers G., Schliamser S. E. Spinal epidural abscesses in adults: review and report of iatrogenic cases. Scand J Infect Dis. 1990;22(3):249–257. doi: 10.3109/00365549009027045. [DOI] [PubMed] [Google Scholar]
  8. Ferree B. A., Stambough J. L., Greiner A. L. Spinal epidural abscess. A case report and literature review. Orthop Rev. 1989 Jan;18(1):75–80. [PubMed] [Google Scholar]
  9. Firsching R., Frowein R. A., Nittner K. Acute spinal epidural empyema. Observations from seven cases. Acta Neurochir (Wien) 1985;74(1-2):68–71. doi: 10.1007/BF01413281. [DOI] [PubMed] [Google Scholar]
  10. Gelfand M. S., Bakhtian B. J., Simmons B. P. Spinal sepsis due to Streptococcus milleri: two cases and review. Rev Infect Dis. 1991 Jul-Aug;13(4):559–563. doi: 10.1093/clinids/13.4.559. [DOI] [PubMed] [Google Scholar]
  11. Go B. M., Ziring D. J., Kountz D. S. Spinal epidural abscess due to Aspergillus sp in a patient with acquired immunodeficiency syndrome. South Med J. 1993 Aug;86(8):957–960. doi: 10.1097/00007611-199308000-00022. [DOI] [PubMed] [Google Scholar]
  12. Hlavin M. L., Kaminski H. J., Ross J. S., Ganz E. Spinal epidural abscess: a ten-year perspective. Neurosurgery. 1990 Aug;27(2):177–184. [PubMed] [Google Scholar]
  13. Jacobsen F. S., Sullivan B. Spinal epidural abscesses in children. Orthopedics. 1994 Dec;17(12):1131–1138. doi: 10.3928/0147-7447-19941201-09. [DOI] [PubMed] [Google Scholar]
  14. Kannangara D. W., Tanaka T., Thadepalli H. Spinal epidural abscess due to Actinomyces israelii. Neurology. 1981 Feb;31(2):202–204. doi: 10.1212/wnl.31.2.204. [DOI] [PubMed] [Google Scholar]
  15. Kaufman D. M., Kaplan J. G., Litman N. Infectious agents in spinal epidural abscesses. Neurology. 1980 Aug;30(8):844–850. doi: 10.1212/wnl.30.8.844. [DOI] [PubMed] [Google Scholar]
  16. Klein J. D., Garfin S. R. Nutritional status in the patient with spinal infection. Orthop Clin North Am. 1996 Jan;27(1):33–36. [PubMed] [Google Scholar]
  17. Lanfermann H., Heindel W., Gierenz M., Haupt W. F., Hildebrandt G., Lackner K. Kernspintomographische Diagnostik intra- und paraspinaler Abszesse. Rofo. 1996 Jul;165(1):36–42. doi: 10.1055/s-2007-1015711. [DOI] [PubMed] [Google Scholar]
  18. Lasker B. R., Harter D. H. Cervical epidural abscess. Neurology. 1987 Nov;37(11):1747–1753. doi: 10.1212/wnl.37.11.1747. [DOI] [PubMed] [Google Scholar]
  19. Martin R. J., Yuan H. A. Neurosurgical care of spinal epidural, subdural, and intramedullary abscesses and arachnoiditis. Orthop Clin North Am. 1996 Jan;27(1):125–136. [PubMed] [Google Scholar]
  20. Maslen D. R., Jones S. R., Crislip M. A., Bracis R., Dworkin R. J., Flemming J. E. Spinal epidural abscess. Optimizing patient care. Arch Intern Med. 1993 Jul 26;153(14):1713–1721. [PubMed] [Google Scholar]
  21. North J. B., Brophy B. P. Epidural abscess: a hazard of spinal epidural anaesthesia. Aust N Z J Surg. 1979 Aug;49(4):484–485. doi: 10.1111/j.1445-2197.1979.tb05847.x. [DOI] [PubMed] [Google Scholar]
  22. Ozuna R. M., Delamarter R. B. Pyogenic vertebral osteomyelitis and postsurgical disc space infections. Orthop Clin North Am. 1996 Jan;27(1):87–94. [PubMed] [Google Scholar]
  23. Paz J. F., Alvarez F. J., Roda J. M., Frutos R., Isla A. Spinal epidural abscess caused by Brucella: case report. J Neurosurg Sci. 1994 Dec;38(4):245–249. [PubMed] [Google Scholar]
  24. Pegues D. A., Carr D. B., Hopkins C. C. Infectious complications associated with temporary epidural catheters. Clin Infect Dis. 1994 Nov;19(5):970–972. doi: 10.1093/clinids/19.5.970. [DOI] [PubMed] [Google Scholar]
  25. Redekop G. J., Del Maestro R. F. Diagnosis and management of spinal epidural abscess. Can J Neurol Sci. 1992 May;19(2):180–187. [PubMed] [Google Scholar]
  26. Smith A. S., Blaser S. I. MR of infectious and inflammatory diseases of the spine. Crit Rev Diagn Imaging. 1991;32(3):165–189. [PubMed] [Google Scholar]
  27. Still J. M., Abramson R., Law E. J. Development of an epidural abscess following staphylococcal septicemia in an acutely burned patient: case report. J Trauma. 1995 Jun;38(6):958–959. doi: 10.1097/00005373-199506000-00027. [DOI] [PubMed] [Google Scholar]
  28. Verner E. F., Musher D. M. Spinal epidural abscess. Med Clin North Am. 1985 Mar;69(2):375–384. doi: 10.1016/s0025-7125(16)31049-5. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES