Skip to main content

Advertisement

SpringerLink
Log in

Spinal Epidural Abscess

  • Central Nervous System Infections (J Lyons, Section Editor)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Spinal epidural abscess (SEA) remains a relatively infrequent diagnosis. Staphylococcus aureus is the most common organism identified, and the infectious source in SEA emanates from skin and soft tissue infections in about 20 % of instances. The thoracic spine is most often involved followed by the lumbar spine. The classic triad of fever, spinal pain, and neurological deficit is present in but a minority of patients. The appearance of neurological deficits with SEA has a significant impact on the prognosis; therefore, early diagnosis is imperative. Magnetic resonance imaging has permitted earlier diagnosis, although significant delays in diagnosis are common due to the nonspecific symptoms that frequently attend the disorder. Due to the rarity of this condition, there have been few randomized controlled trials to evaluate new treatment strategies, and most recommendations regarding treatment are based on case series studies often derived from the experiences at a single center.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hlavin ML et al. Spinal epidural abscess: a ten-year perspective. Neurosurgery. 1990;27(2):177–84.

    Article  PubMed  CAS  Google Scholar 

  2. Rigamonti D et al. Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol. 1999;52(2):189–96. discussion 197.

    Article  PubMed  CAS  Google Scholar 

  3. Nussbaum ES et al. Spinal epidural abscess: a report of 40 cases and review. Surg Neurol. 1992;38(3):225–31.

    Article  PubMed  CAS  Google Scholar 

  4. Baker AS et al. Spinal epidural abscess. N Engl J Med. 1975;293(10):463–8.

    Article  PubMed  CAS  Google Scholar 

  5. Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev. 2000;23(4):175–204. discussion 205.

    Article  PubMed  CAS  Google Scholar 

  6. Hawkins M, Bolton M. Pediatric spinal epidural abscess: a 9-year institutional review and review of the literature. Pediatrics. 2013;132(6):e1680–5. This article provides a good review of limited literature available in the pediatric patients.

    Article  PubMed  Google Scholar 

  7. West KR, Mason RC, Sun M. Nocardia spinal epidural abscess: 14-year follow-up. Orthopedics. 2012;35(1):e128–31.

    PubMed  Google Scholar 

  8. Atalay B et al. Nocardial epidural abscess of the thoracic spinal cord and review of the literature. J Infect Chemother. 2005;11(3):169–71.

    Article  PubMed  Google Scholar 

  9. Gudinchet F, Chapuis L, Berger D. Diagnosis of anterior cervical spinal epidural abscess by US and MRI in a newborn. Pediatr Radiol. 1991;21(7):515–7.

    Article  PubMed  CAS  Google Scholar 

  10. Danner RL, Hartman BJ. Update on spinal epidural abscess: 35 cases and review of the literature. Rev Infect Dis. 1987;9(2):265–74.

    Article  PubMed  CAS  Google Scholar 

  11. Adogwa O et al. Spontaneous spinal epidural abscess in patients 50 years of age and older: a 15-year institutional perspective and review of the literature: clinical article. J Neurosurg Spine. 2014;20(3):344–9.

    Article  PubMed  Google Scholar 

  12. Patel AR et al. Spinal epidural abscesses: risk factors, medical versus surgical management, a retrospective review of 128 cases. Spine J. 2014;14(2):326–30.

    Article  PubMed  Google Scholar 

  13. Siddiq DM, Musher DM, Darouiche RO. Spinal and paraspinal pneumococcal infections—a review. Eur J Clin Microbiol Infect Dis. 2014;33(4):517–27.

    Article  PubMed  CAS  Google Scholar 

  14. Younus F, Jimenez V. Spinal epidural abscess due to Streptococcus pneumoniae in an HIV-infected adult. Infection. 2001;29(4):234–6.

    Article  PubMed  CAS  Google Scholar 

  15. Darouiche RO et al. Bacterial spinal epidural abscess. Review of 43 cases and literature survey. Medicine (Baltimore). 1992;71(6):369–85.

    Article  CAS  Google Scholar 

  16. Huang CR et al. Clinical characteristics and therapeutic outcome of Gram-negative bacterial spinal epidural abscess in adults. J Clin Neurosci. 2011;18(2):213–7.

    Article  PubMed  Google Scholar 

  17. Tasher D et al. Cat scratch disease with cervical vertebral osteomyelitis and spinal epidural abscess. Pediatr Infect Dis J. 2009;28(9):848–50.

    Article  PubMed  Google Scholar 

  18. Boyaci A., et al., Spinal epidural abscess in brucellosis. BMJ Case Rep, 2013. 2013.

  19. Arora S, Kumar R. Tubercular spinal epidural abscess involving the dorsal-lumbar-sacral region without osseous involvement. J Infect Dev Ctries. 2011;5(7):544–9.

    Article  PubMed  Google Scholar 

  20. Baallal H, El Mostarchid B. Multisegmental tubercular spinal epidural abscess. Pan Afr Med J. 2013;14:2.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kaufman DM, Kaplan JG, Litman N. Infectious agents in spinal epidural abscesses. Neurology. 1980;30(8):844–50.

    Article  PubMed  CAS  Google Scholar 

  22. Jiang Z et al. Vertebral osteomyelitis and epidural abscess due to Aspergillus nidulans resulting in spinal cord compression: case report and literature review. J Int Med Res. 2013;41(2):502–10.

    Article  PubMed  Google Scholar 

  23. Gupta PK et al. Aspergillus spinal epidural abscess. Pediatr Neurosurg. 2001;35(1):18–23.

    Article  PubMed  CAS  Google Scholar 

  24. Yung BC. Aggressive thoracic actinomycosis complicated by vertebral osteomyelitis and epidural abscess leading to spinal cord compression. Spine. 2000;25(6):745–8.

    Article  PubMed  CAS  Google Scholar 

  25. Kannangara DW, Tanaka T, Thadepalli H. Spinal epidural abscess due to Actinomyces israelii. Neurology. 1981;31(2):202–4.

    Article  PubMed  CAS  Google Scholar 

  26. Maraki S et al. Roseomonas spinal epidural abscess complicating instrumented posterior lumbar interbody fusion. J Clin Microbiol. 2013;51(7):2458–60.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Charles RW, Mody GM, Govender S. Pyogenic infection of the lumbar vertebral spine due to gas-forming organisms. A case report. Spine. 1989;14(5):541–3.

    Article  PubMed  CAS  Google Scholar 

  28. Sapico FL, Montgomerie JZ. Pyogenic vertebral osteomyelitis: report of nine cases and review of the literature. Rev Infect Dis. 1979;1(5):754–76.

    Article  PubMed  CAS  Google Scholar 

  29. Chiller TM et al. Clinical findings for fungal infections caused by methylprednisolone injections. N Engl J Med. 2013;369(17):1610–9.

    Article  PubMed  CAS  Google Scholar 

  30. Kainer MA et al. Fungal infections associated with contaminated methylprednisolone in Tennessee. N Engl J Med. 2012;367(23):2194–203.

    Article  PubMed  CAS  Google Scholar 

  31. Smith RM. Fungal infections associated with contaminated methylprednisolone injections. N Engl J Med. 2013;369(17):1598–609. This article describes in detail the large outbreak in 2012 of fungal infections, including spinal epidural abscesses, caused by injection of methylprednisone contaminated with Exserohilum rostratum.

    Article  PubMed  CAS  Google Scholar 

  32. Malani AN et al. Magnetic resonance imaging screening to identify spinal and paraspinal infections associated with injections of contaminated methylprednisolone acetate. JAMA. 2013;309(23):2465–72.

    Article  PubMed  CAS  Google Scholar 

  33. Shintani S et al. Iatrogenic acute spinal epidural abscess with septic meningitis: MR findings. Clin Neurol Neurosurg. 1992;94(3):253–5.

    Article  PubMed  CAS  Google Scholar 

  34. Heusner AP. Nontuberculous spinal epidural infections. N Engl J Med. 1948;239(23):845–54.

    Article  PubMed  CAS  Google Scholar 

  35. Frat JP et al. Cervical spinal epidural abscess and meningitis due to Prevotella oris and Peptostreptococcus micros after retropharyngeal surgery. Intensive Care Med. 2004;30(8):1695.

    Article  PubMed  Google Scholar 

  36. Jang YJ, Rhee CK. Retropharyngeal abscess associated with vertebral osteomyelitis and spinal epidural abscess. Otolaryngol Head Neck Surg. 1998;119(6):705–8.

    Article  PubMed  CAS  Google Scholar 

  37. Elian D et al. Spinal epidural abscess: an unusual complication of bacterial endocarditis. Infection. 1984;12(4):258–9.

    Article  PubMed  CAS  Google Scholar 

  38. Wong M et al. Epidural extension of infected chest wall haematoma and empyema causing spinal cord compression. Heart Lung Circ. 2014;23(1):e20–3.

    Article  PubMed  Google Scholar 

  39. Hancock DO. A study of 49 patients with acute spinal extradural abscess. Paraplegia. 1973;10(4):285–8.

    Article  PubMed  CAS  Google Scholar 

  40. Feldenzer JA et al. The pathogenesis of spinal epidural abscess: microangiographic studies in an experimental model. J Neurosurg. 1988;69(1):110–4.

    Article  PubMed  CAS  Google Scholar 

  41. Feldenzer JA et al. Experimental spinal epidural abscess: a pathophysiological model in the rabbit. Neurosurgery. 1987;20(6):859–67.

    Article  PubMed  CAS  Google Scholar 

  42. Hakin RN, Burt AA, Cook JB. Acute spinal epidural abscess. Paraplegia. 1979;17(3):330–6.

    Article  PubMed  CAS  Google Scholar 

  43. Phillips GE, Jefferson A. Acute spinal epidural abscess. Observations from fourteen cases. Postgrad Med J. 1979;55(648):712–5.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  44. Verner EF, Musher DM. Spinal epidural abscess. Med Clin North Am. 1985;69(2):375–84.

    PubMed  CAS  Google Scholar 

  45. Davis DP et al. The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess. J Emerg Med. 2004;26(3):285–91.

    Article  PubMed  Google Scholar 

  46. Tang HJ et al. Spinal epidural abscess—experience with 46 patients and evaluation of prognostic factors. J Infect. 2002;45(2):76–81.

    Article  PubMed  Google Scholar 

  47. McCaig LF, Nawar EW. National hospital ambulatory medical care survey: 2004 emergency department summary. Adv Data. 2006;372:1–29.

    PubMed  Google Scholar 

  48. Thiruganasambandamoorthy, V., et al., Risk factors for serious underlying pathology in adult emergency department nontraumatic low back pain patients. J Emerg Med, 2014.

  49. Bremer AA, Darouiche RO. Spinal epidural abscess presenting as intra-abdominal pathology: a case report and literature review. J Emerg Med. 2004;26(1):51–6.

    Article  PubMed  Google Scholar 

  50. Posada IJ. Acute spinal epidural abscess presenting as acute meningitis. Med Clin. 1986;87(13):566–7.

    CAS  Google Scholar 

  51. Parkinson JF, Sekhon LH. Spinal epidural abscess: appearance on magnetic resonance imaging as a guide to surgical management. Report of five cases. Neurosurg Focus. 2004;17(6):E12.

    PubMed  Google Scholar 

  52. Numaguchi Y et al. Spinal epidural abscess: evaluation with gadolinium-enhanced MR imaging. Radiographics. 1993;13(3):545–59. discussion 559–60.

    Article  PubMed  CAS  Google Scholar 

  53. Johnson K, Gunaratne S, Shaffi M. Pitfalls of triage by imaging in spinal epidural abscess. Emerg Med Australas. 2014;26(2):205–6.

    Article  PubMed  Google Scholar 

  54. Koppel BS et al. Epidural spinal infection in intravenous drug abusers. Arch Neurol. 1988;45(12):1331–7.

    Article  PubMed  CAS  Google Scholar 

  55. Davis DP. Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain. J Neurosurg Spine. 2011;14(6):765–70. This article outlines a good approach to identify patients for emergent MR imaging of the spine using risk factor assessment and erythrocyte sedimentation rate and C-reactive protein as screening laboratory markers among patients presenting to the emergency room with low back pain to decrease diagnostic delays in patients with spinal epidural abscess.

    Article  PubMed  Google Scholar 

  56. Curry Jr WT et al. Spinal epidural abscess: clinical presentation, management, and outcome. Surg Neurol. 2005;63(4):364–71. discussion 371.

    Article  PubMed  Google Scholar 

  57. Sorensen P. Spinal epidural abscesses: conservative treatment for selected subgroups of patients. Br J Neurosurg. 2003;17(6):513–8.

    Article  PubMed  CAS  Google Scholar 

  58. Connor Jr DE. Comparison of operative and nonoperative management of spinal epidural abscess: a retrospective review of clinical and laboratory predictors of neurological outcome. J Neurosurg Spine. 2013;19(1):119–27. This study identifies predictors of neurological outcome and compares operative and non operative management of patients with spinal epidural abscess.

    Article  PubMed  Google Scholar 

  59. Kim S.D., et al., Independent predictors of failure of nonoperative management of spinal epidural abscesses. The Spine Journal, (0).

  60. Siddiq F, Malik AR, Smego Jr RA. Percutaneous computed tomography-guided needle aspiration drainage of spinal epidural abscess. South Med J. 2006;99(12):1406–7.

    Article  PubMed  Google Scholar 

  61. Lyu RK et al. Spinal epidural abscess successfully treated with percutaneous, computed tomography-guided, needle aspiration and parenteral antibiotic therapy: case report and review of the literature. Neurosurgery. 2002;51(2):509–12. discussion 512.

    PubMed  Google Scholar 

  62. Safavi-Abbasi S, Maurer AJ, Rabb CH. Minimally invasive treatment of multilevel spinal epidural abscess. J Neurosurg Spine. 2013;18(1):32–5.

    Article  PubMed  Google Scholar 

  63. McGee-Collett M, Johnston IH. Spinal epidural abscess: presentation and treatment. A report of 21 cases. Med J Aust. 1991;155(1):14–7.

    PubMed  CAS  Google Scholar 

  64. Redekop GJ, Del Maestro RF. Diagnosis and management of spinal epidural abscess. Can J Neurol Sci. 1992;19(2):180–7.

    PubMed  CAS  Google Scholar 

  65. Yang SY. Spinal epidural abscess. N Z Med J. 1982;95(707):302–4.

    PubMed  CAS  Google Scholar 

  66. Del Curling Jr O, Gower DJ, McWhorter JM. Changing concepts in spinal epidural abscess: a report of 29 cases. Neurosurgery. 1990;27(2):185–92.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Joseph Berger received grants from PML Consortium, Biogen Idec, and Novartis. Berger received personal fees from Amgen, Astra-Zeneca, Bristol Myers Squibb, Eisai, Janssen, Millennium, Parexel, Pfizer, Roche, Takeda, Genentech, Genzyme, Incyte, Inhibikase, Johnson and Johnson, Novartis, the American Academy of Neurology, and the Consortium of MS Centers. Prashanth Krishnamohan has no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.

Author information

Authors and Affiliations

  1. Department of Neurology, University of Kentucky College of Medicine, 740 S. Limestone St., Lexington, KY, 40536-0284, USA

    Prashanth Krishnamohan & Joseph R. Berger

Authors
  1. Prashanth Krishnamohan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph R. Berger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joseph R. Berger.

Additional information

This article is part of the Topical Collection on Central Nervous System Infections

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Krishnamohan, P., Berger, J.R. Spinal Epidural Abscess. Curr Infect Dis Rep 16, 436 (2014). https://doi.org/10.1007/s11908-014-0436-7

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11908-014-0436-7

Keywords

Search

Navigation