Key Points
- Stabilize ABCs; treat life‑threatening derangements immediately.
- Confirm diagnosis early with highest‑yield imaging/labs.
- Initiate guideline‑based therapy and escalate by response.
- Plan disposition and follow‑up explicitly.
Clinical Synopsis & Reasoning
Spinal epidural abscess often arises from hematogenous seeding (classically Staphylococcus aureus) or extension from native vertebral osteomyelitis. Maintain a low threshold for MRI with contrast in back pain plus fever or new neurologic deficits—delay risks irreversible cord injury. Obtain blood cultures, begin empiric MRSA‑active therapy plus gram‑negative coverage, and involve neurosurgery early. Indications for urgent decompression include progressive or severe deficits, instability, large epidural collections causing cord compression, refractory pain, or persistent bacteremia despite appropriate antibiotics.
Treatment Strategy & Disposition
Spinal epidural abscess often arises from hematogenous seeding (classically Staphylococcus aureus) or extension from native vertebral osteomyelitis. Maintain a low threshold for MRI with contrast in back pain plus fever or new neurologic deficits—delay risks irreversible cord injury. Obtain blood cultures, begin empiric MRSA‑active therapy plus gram‑negative coverage, and involve neurosurgery early. Indications for urgent decompression include progressive or severe deficits, instability, large epidural collections causing cord compression, refractory pain, or persistent bacteremia despite appropriate antibiotics.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitating factors
Initial Targets
| Parameter | Target/Action |
|---|
| Hemodynamics | Maintain perfusion; avoid hypotension |
| Monitoring | Serial exam, labs, and imaging |
| Therapy | Start early, reassess, de‑escalate when appropriate |
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|
| CBC | Screen leukocytosis/anemia | Context‑specific | Trend response |
| BMP | Electrolytes/renal function | Derangements common | Replace K+/Mg2+ |
| Key imaging | Condition‑specific (CTA/MRI/Endoscopy) | See text | Do not delay when red flags |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|
| Vancomycin | Glycopeptide (anti‑MRSA) | Hours | Empiric MRSA coverage | AUC‑guided dosing; nephrotoxicity |
| Cefepime or Piperacillin–tazobactam | β‑lactam | Immediate | Gram‑negative coverage incl. Pseudomonas | Renal dosing; CNS effects (cefepime) |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy
Patient Education / Counseling
- Explain red flags, adherence, and follow‑up plan
References
- IDSA 2015 Native Vertebral Osteomyelitis Guideline — Link
- IDSA 2015 NVO Guideline (PDF) — Link