Treatment of patients with SEA involves emergency surgery as well as the use of antibiotics. Surgery should prevent progression of neurological damage; in the long run, however, the patient often is left with the same degree of neurological deficit present at the time of surgery. Therefore, early diagnosis and rapid surgical decompression are essential for reaching the best possible outcome (see Table).
The patient is this case did well and had a good recovery, although she was left with some mild weakness in her legs. Key aspects of her ED care were early recognition that her current symptoms were significantly different from her typical back pain episodes; appropriate concern about the presence of bilateral leg symptoms; the presence of DM as an important risk factor for SEA; and early recognition of a low-grade fever, meningismus, and mild leg weakness on physical examination.
The radiology department’s refusal to expedite the MRI scan was less than ideal. However, the CT results were available promptly so that minimal time was lost.
|Spinal Epidural Abscess (from Quick Essentials Emergency Medicine pocketbook) |
Delayed diagnosis in 50% of patients because initially insidious; progression later becomes rapid
1. Back pain that may start as mild and often is thoracic, fever
Early: Spinal tenderness, positive straight-leg raise test result, meningismus, fever in 50% of patients
Staphylococcus, Escherichia coli, Pseudomonas; concomitant discitis, osteomyelitis, or endocarditis common
|Risk factors|| |
Central line (central venous catheter), injection drug abuse, recent procedure, acupuncture
Best: MRI with contrast or CT myelography
|Differential diagnosis|| |
Psoas or deep neck abscess, meningitis, herniated disc, UTI, discitis, osteomyelitis
Surgery stat with spine surgeon (spine orthopedist or neurosurgeon)
UTI, urinary tract infection; ESR, erythrocyte sedimentation rate. Copyright Emresource.org.