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spinal abscess. why care

Epidural Abscess. Classic description is focal vertebral pain, which becomes radiating pain along involved nerve roots.Most commonly involves the thoracic spine (50-80% of cases); lumbar in 17-38% and the cervical spine in 10-25% of cases. Spinal epidural abscess most often occurs by systematic hematogenous spread of the infectious organism.A spinal epidural abscess can less commonly occur by direct infection of the epidural space as with a catheter or needle. (eg. Lumbar Puncture).

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spinal abscess. why care

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    1. Spinal Abscess. Why Care? Irreversible paralysis: affects up to 22% of patients, not because of bacterial virulence but due to delayed diagnosis.* 50% of patients are initially misdiagnosed.** Paralysis lasting greater than 24 hrs is irreversible.***

    6. Predisposing factors Trauma, prior surgery, or spinal procedures. Immunocompromised states Pregnancy Diabetes mellitus (Type I or II) Bacteremia: (endocarditis, lung or abdominal abscess, or previous septic episodes) Osteomyelitis IV drug use Alcoholism Chronic renal failure

    7. Epidemiology 20 patients per 100,000 hospital admissions. Age < 50 (due to increased prevalence of injection drug users) Men > Women

    8. Buggs 15% in 1996, up to 40% in 200615% in 1996, up to 40% in 2006

    9. Diagnosis Classic Triad:

    10. Diagnosis Incontinence of bowel/bladder. Weakness / numbness below the level of the lesion.

    12. Diagnosis Nuchal rigidity suggesting the presence of meningeal irritation. “Four clinical stages of spinal epidural abscess” onset of focal vertebral pain. radiation of the pain along regionally involved nerve roots suggesting a radicular component. evidence of spinal cord compression with long tract signs. paralysis below the level of the spinal cord lesion.

    13. Differential Diagnosis Spinal Radiculopathy / polyradiculopathy Herniated Disk Bacterial meningitis. Osteomyelitis Spinal tumor / spinal hematoma. Multiple Sclerosis Spinal cord infraction (radiating pain along involved nerve roots similar to the pain seen with a spinal abscess. Also, these pts often has sensory impairment and weakness in areas supplied by these roots.)(radiating pain along involved nerve roots similar to the pain seen with a spinal abscess. Also, these pts often has sensory impairment and weakness in areas supplied by these roots.)

    14. Pitfalls in diagnosis Stage 2: nerve-root pain radiating from involved spinal area. (no motor weakness or sensory deficit at this point) Cervical or lumbar abscess: neck pain radiating to the arms or low back pain radiating down to the legs, respectively. Thoracic abscess: chest or abdominal pain.*

    15. Pitfalls in Diagnosis

    16. Treatment Neurosurgical consultation for possible decompression. Empiric antibiotics: Nafcillin or Vancomycin (both for S. aureus) along with Ceftriaxone (Gram-negative) and Metronidazole (anaerobic organisms). 4 weeks course if osteomyelitis is not present. …and 8 weeks for osteo is present

    19. Outcomes

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