Spinal epidural abscess

Question 1

Most common bacteria in spinal epidural abscess

Answer 1

Staphyloccocus aureus

Question 2

Bacteria especially prevalent in spinal epidural abscess in IV drug users

Answer 2

Gram-negative bacilli, such as Pseudomonas

Question 3

Remarks on Pott’s disease

Answer 3

also known as tuberculosis spinal epidural absbcess

Question 4

Spinal epidural abscess from a hematologic spread are more likely to be found

Answer 4

in the posterior epidural space

Question 5

Spinal epidural abscess from a direct extension are more likely to be found

Answer 5

in the anterior portion of the spinal column

direct extension from infected adjacent tissue, such as vertebral spondylodiscitis or vertebral osteomyelitis

Question 6

Most spinal epidural abscess affect which part of the spine?

Answer 6

Thoracic and lumbar spine
where the epidural space is wider with a larger venous plexus

Question 7

Spinal epidural abscess affecting this part of the spine has much worse morbidity and neurologic devastation

Answer 7

Cervical spine

Question 8

Most common presenting complaint in spinal epidural abscess

Answer 8

Back pain

2nd is fever

Focal deficit makes up the triad, but occurs only in 10% of patients.

Question 9

Stages of spinal epidural abscess

Answer 9

Stage 1: Back pain, fever, and localized tenderness
Stage 2: Spinal irritation
Stage 3: Bowel/bladder dysfunction and focal deficits
Stage 4: Paralysis

Question 10

Spinal irritation , such as

Answer 10

Radicular pain
Hyperreflexia
Nucal rigidity

Question 11

Risk factors for Spinal epidural abscess

Answer 11

Spinal surgery/procedures (e.g., LP, epidurals,)
Immunocompromised states
Recent systemic illness or infection
IV drug use

Question 12

Gold standard imaging study for spinal epidural abscess

Answer 12

MRI with gadolinum

Question 13

If MRI is not available or if with contraindiations to MRI, consider what

Answer 13

Emergent transfer to an appropriate referral center

CT with myelography (but is limited in its ability to distinguish abscess from other compressive lesions)

Question 14

LP for spinal epidural abscess

Answer 14

Do not perform LP if there is suspicion for spinal abscess.

CSF culture is positive less than a quarter of the time.

and LP poses risk of traversing an abscess and causing meningitis or a subdural infeciton

Question 15

Paramount in the management of spinal epidural abscess

Answer 15

Immediate consultation with a spine surgeon

Question 16

Neurologic outcome is correlated with

Answer 16

degree of neurologic deficit prior to treatment

Question 17

Patients with neurologic deficit usually require

Answer 17

Evacuation of the abscess with decompressive laminectomy,
debridement,
and long-term IV antibiotics

Question 18

Candidates for conservative treatment or CT-guided aspiration

Answer 18

Patients who are neurologically intact,
or who have had neurologic deficits for >72 hours

Question 19

Start empiric antibiotic therapy if

Answer 19

there is an unavoidable delay for surgery
or if the patient exhibits neurologic dysfunction
or signs of sepsis

Question 20

Appropriate antibiotics for spinal epidural abscess

Answer 20

Vancomycin
+
Ceftazidime / Cefepime / Meropenem