Epidural abscess (spinal): Difference between revisions
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== Background == | == Background == | ||
*Abscess confined to epidural adipose tissue in spine | *Abscess confined to epidural adipose tissue in spine | ||
*Thoracic and lumbar spine most common | *Thoracic and lumbar spine most common; C-spine least common | ||
*Usually hematogenous spread from other source of infection | *Usually hematogenous spread from other source of infection | ||
*S. aureus, strep, pseudomonas, e. coli most common | *S. aureus, strep, pseudomonas, e. coli most common | ||
==Risk Factors== | ==Risk Factors== | ||
# | *98% of pts have at least one of the following risk-factors: | ||
# | #Injection drug use | ||
# | #Immunocompromised | ||
# | #Alcohol abuse | ||
# | #Cancer | ||
# | #Recent spine procedure | ||
# | #Recent spine fracture | ||
#Distant site of infection | |||
#Indwelling catheter | |||
#Chronic renal failure | |||
#DM | |||
== | ==Clinical Features == | ||
# Fever + localized back pain | #Fever + localized back pain is epidural abscess until proven otherwise | ||
##Classic triad of fever, back pain, and neuro deficits is rare | ##Classic triad of fever, back pain, and neuro deficits is rare (13%) | ||
##Fever is only present in ~50% of cases | ##Fever is only present in ~50% of cases | ||
# | |||
## | ==Diagnosis== | ||
#MRI is diagnostic test of choice | #Labs | ||
##ESR elevated in >90% of pts | |||
##WBC elevated in only 60% of pts | |||
##Blood cultures are indicated to identify the source organism (Staph in 2/3 of cases) | |||
#Imaging | |||
##MRI is diagnostic test of choice | |||
##CT with IV contrast is acceptable (MRI is preferred) | ##CT with IV contrast is acceptable (MRI is preferred) | ||
== | ==DDX== | ||
# Disc and bony disease | #Disc and bony disease | ||
# Vertebral discitis and osteomyelitis | #Vertebral discitis and osteomyelitis | ||
# Metastatic tumors | #Metastatic tumors | ||
# Meningitis | #Meningitis | ||
# Herpes zoster | #Herpes zoster (prior to appearance of skin lesions) | ||
==Treatment == | ==Treatment == | ||
# Early surgical decompression and drainage | #Early surgical decompression and drainage | ||
# Aspiration (for diagnosis) and Abx may be sufficient for pts w/o neuro deficits | #Aspiration (for diagnosis) and Abx may be sufficient for pts w/o neuro deficits | ||
# Antibiotics | #Antibiotics | ||
## Vanco + metronidazole + | ##Vanco + metronidazole + (cefotaxime or ceftriaxone or ceftazadine) | ||
### | ###Ceftazidine is preferred if pseudomonas is considered likely | ||
### Can substitute nafcillin or oxacillin for vanco if not MRSA | ###Can substitute nafcillin or oxacillin for vanco if not MRSA | ||
## Treat for 6-8 weeks | ##Treat for 6-8 weeks | ||
==See Also== | ==See Also== | ||
[[Epidural Abscess (Intracranial)]] | *[[Epidural Abscess (Intracranial)]] | ||
==Source== | ==Source== | ||
*UpToDate | *UpToDate | ||
*Rosens | *Rosens | ||
*Tintinalli | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:Neuro]] | [[Category:Neuro]] | ||
Revision as of 07:32, 19 February 2012
Background
- Abscess confined to epidural adipose tissue in spine
- Thoracic and lumbar spine most common; C-spine least common
- Usually hematogenous spread from other source of infection
- S. aureus, strep, pseudomonas, e. coli most common
Risk Factors
- 98% of pts have at least one of the following risk-factors:
- Injection drug use
- Immunocompromised
- Alcohol abuse
- Cancer
- Recent spine procedure
- Recent spine fracture
- Distant site of infection
- Indwelling catheter
- Chronic renal failure
- DM
Clinical Features
- Fever + localized back pain is epidural abscess until proven otherwise
- Classic triad of fever, back pain, and neuro deficits is rare (13%)
- Fever is only present in ~50% of cases
Diagnosis
- Labs
- ESR elevated in >90% of pts
- WBC elevated in only 60% of pts
- Blood cultures are indicated to identify the source organism (Staph in 2/3 of cases)
- Imaging
- MRI is diagnostic test of choice
- CT with IV contrast is acceptable (MRI is preferred)
DDX
- Disc and bony disease
- Vertebral discitis and osteomyelitis
- Metastatic tumors
- Meningitis
- Herpes zoster (prior to appearance of skin lesions)
Treatment
- Early surgical decompression and drainage
- Aspiration (for diagnosis) and Abx may be sufficient for pts w/o neuro deficits
- Antibiotics
- Vanco + metronidazole + (cefotaxime or ceftriaxone or ceftazadine)
- Ceftazidine is preferred if pseudomonas is considered likely
- Can substitute nafcillin or oxacillin for vanco if not MRSA
- Treat for 6-8 weeks
- Vanco + metronidazole + (cefotaxime or ceftriaxone or ceftazadine)
See Also
Source
- UpToDate
- Rosens
- Tintinalli