Spinal Infection: Epidural Abscesses

An epidural abscess is an infection of pus within the spinal canal. This infection forms in the space around the dura, which is the covering that surrounds the spinal cord and nerve root. A pocket(s) of pus may surround the spinal cord and/or the nerve roots, and create enough pressure to affect neurological function (eg, pain, numbness, or difficulty walking).
Illustration of an epidural abscessEpidural abscess is a rare form of infection, affecting only as many as two cases for every 10,000 hospital admissions. However, patients with vertebral osteomyelitis or discitis are at a higher risk of developing an epidural abscess. Anyone can develop an epidural abscess, but is most common in people age 50 and older.

Epidural Abscess Symptoms
The symptoms of an epidural abscess can be subtle. Back pain that develops gradually and gets worse at night is often the first sign of an epidural abscess. Another common symptom people experience is called paresthesia, which is a sensation like pins and needles. Mild weakness is also common, as is abnormal gait, radicular pain, and bowel and/or bladder dysfunction.

Symptoms vary based on the location of the epidural abscess. For example, patients who have the infection in their cervical spine (neck) may have trouble swallowing. And, patients who have an epidural abscess in their thoracic spine may experience dizziness when standing up.

Diagnosing an Epidural Abscess
A doctor will perform a physical examination to evaluate spinal asymmetry, paravertebral swelling, and tender areas. Also, he or she will perform a careful neurological exam.

Other diagnostic tests include the erythrocyte sedimentation rate, which is a specific test that looks at how fast red blood cells fall to the bottom of a tube—the faster they fall, the more likely it is there's inflammation somewhere in the body. The white blood cell count and blood cultures are useful as baseline parameters.

Magnetic resonance imaging (MRI) is the imaging study of choice for further evaluation. This study can define spinal cord compression and the status of the spinal cord, determine the presence and extent of the abscess, provide a diagnosis of co-existing osteomyelitis, and exclude a drainable paraspinal fluid collection (pocket of fluid).

Treating Epidural Abscesses
Treatment for an epidural abscess usually includes antibiotics and surgery, though sometimes antibiotics may be used as the sole treatment. A course of antiobiotic therapy is typically administered through IV (intravenously) for 4 to 6 weeks.  

Surgical decompression of the spinal cord may be needed if you experience increasing neurological deficit, persistent severe pain, or increasing temperature, and white blood cell count. Surgery may be performed to remove the abscess.

Epidural abscesses are rare type of spinal infection, and the symptoms can negatively impact your quality of life. Fortunately, with an early diagnosis, treatments are available to help effectively manage this disease.

To learn about Dr. Eidelson’s practice, click here.

Updated on: 01/17/17
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Discitis is a Spinal Disc Infection and Inflammation

Discitis is usually caused by an infection in the disc and/or disc space between two vertebral bodies, and affects the intervertebral disc.
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