A spinal epidural abscess is a collection of pus in the epidural space, which can compress the spinal cord mechanically. Diagnosis is made by MRI or, if not available, myelography followed by CT. The treatment includes antibiotics and sometimes drainage of the abscess.
(See also overview of diseases of the spinal cord.)
A spinal epidural abscess is a collection of pus in the epidural space, which can compress the spinal cord mechanically. Diagnosis is made by MRI or, if not available, myelography followed by CT. The treatment includes antibiotics and sometimes drainage of the abscess. (See also overview of diseases of the spinal cord.) Spinal Epiduralabszesse are usually present in the thoracic or lumbar area. An underlying infection is common. You can further away (z. B. endocarditis, boils, Zahnwurzelabszess) or in close proximity (e. B. vertebral osteomyelitis, pressure ulcer or retroperitoneal abscess) localized. In a third of cases the cause can not be determined. The most common causative organisms are Staphylococcus aureus, followed by Escherichia coli and mixed anaerobes. Occasionally, the cause is a tuberculous abscess of the thoracic spine (Pott’s disease). Rarely occurs an abscess in the subdural space. Symptoms and signs The symptoms of spinal Epiduralabszesses start with focal or radicular back pain and knock sensitivity, which have greatly increased; the pains are aggravated by lying. Also fever is common. It can develop spinal cord compression; Compression of the lumbar nerve roots, a cauda equina syndrome cause neurological deficits similar to those of a Conus medullaris syndrome (e.g., leg paralysis, saddle anesthesia, dysfunction of the bladder and intestinal see table. Spinal Cord Syndrome). The failures are increasing over hours to days. Diagnosis MRI Because rapid treatment is necessary to prevent neurological deficits or minimize the doctors should consider a spinal epidural abscess in patients with significant atraumatic back pain into consideration, especially if they have focal painful pressure on the tapping of the spine or fever or when they recently had an infection or a dental treatment. Characteristic neurological deficits are more specific, but can occur later; So imaging is delayed until there are these neurological deficits, it makes a worse outcome more likely. The diagnosis of spinal Epiduralabszesses is made using a MRI; myelography followed by CT can be used if no MRI is available. There are recognized cultures of blood samples and swabs from infected areas. A lumbar puncture is contraindicated because it can trigger an entrapment of the spinal cord when the abscess completely blocked the CSF flow. (Editor’s note: In the German literature, a lumbar puncture is not absolutely contraindicated, but in most cases not necessary It follows less the risk of Myelonkompression but rather a puncture of the abscess with subsequent seeding of the pathogen into the subarachnoid space and thus of meningitis. . Failing the detection of pathogens in blood cultures or smears, a CT-guided percutaneous needle aspiration is the excitation assurance can be useful.) Normal radiographs are not routinely indicated, but they may show osteomyelitis in one third of patients. The erythrocyte sedimentation rate is increased, but this finding is nonspecific. Treatment Antibiotics If the abscess caused neurological damage: immediate drainage antibiotics with or without parental access may be sufficient; However, should abscesses that neurological damage cause (z. B. paralysis, disorders of bowel or bladder function), be treated immediately by surgery. The pus surgically obtained is Gram stained and cultured. Depending given as a brain abscess antibiotics on the result of the culture that are effective against staphylococci and anaerobes. If the abscess is formed after a neurosurgical procedure, an aminoglycoside is added to cover gram negative bacteria.