Epidural abscess

- Infectious complication of:

• endocarditis
• vertebral osteomyelitis
• psoas muscle abscess.

Diagnosis

- Symptoms:

• back/neck (cervical) pain
• neurologic deficit (motor weakness, radiculopathy, bladder/bowel dysfunction)
• fever

- MRI – emergent if progressive neurological deficit

- Blood cultures

- Usually requires urgent surgical intervention. Medical therapy alone may be considered if the patient is not a surgical candidate AND has no neurologic deficit and/or shows improvement in symptoms.

- Treat according to C&S results of blood cultures or CT-guided aspirate of abscess. If cultures are positive for Gram positive cocci in clusters/clumps, use vancomycin + cloxacillin until susceptibilities available.

S. aureus/MRSA
Enterobacterales

Streptococcus spp
CoNS
P. aeruginosa
Rare:

Anaerobes

Consider:

- TB, depending on epidemiology

- Candida/fungal if spinal instrumentation or injection