In an editorial describing his clinical experience of spinal epidural abscess, Heusner (1948) reminds us that “… the decisive factor in the outcome of most cases is the celerity with which the first physician suspects the probable nature of the ailment and summons expert aid”. On pathological grounds he recognized three presentations: (1) an acute metastatic presentation which evolves over hours to days and where the epidural abscess cavity contains frankly purulent material; (2) a subacute presentation evolving over days to weeks where the epidural abscess cavity comprises granulation tissue without significant quantities of necrotic material; (3) a chronic presentation, most often associated with osteomyelitis. The last accounted for only 10% of his series and involved a broader differential diagnosis. In more recent series (Hlavin et al. 1990; Nussbaum et al. 1992; Darouiche et al. 1992; Corboy and Price 1993) this classification has been less distinct with the acute variety predominating.
KeywordsDrug Abuser Radicular Pain Epidural Abscess Vertebral Osteomyelitis Subdural Empyema
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