From: Spinal Epidural Abscess: A Review Highlighting Early Diagnosis and Management
Source of infection | Causative condition |
---|---|
Recent spinal instrumentation | Diabetes mellitus |
Epidural anesthesia | Abnormality of the vertebral column |
Hemodialysis (Chronic renal failure) | Trauma of the spine |
Consecutive bones or soft tissue infection | Intravenous drug use |
Bacteremia from distant infection (Urinary tract, Respiratory tract, Abdomen, Endocarditis, Infected vascular access, and Dental abscess) | AIDS |
Malignancy | |
Immunosuppressive therapy, Steroid use | |
Alcoholism | |
Sepsis of unknown origin | Local spinal risk factors (degenerative disc disease, large osteophytes, hypertrophied facet joints) |
Skin (Chronic nonhealing ulcers of the extremities) |
From: Spinal Epidural Abscess: A Review Highlighting Early Diagnosis and Management
Stage | Clinical manifestations |
---|---|
I | Back pain, fever, tenderness |
II | Nerve root symptoms (radicular pain), nuchal rigidity/neck stiffness, decrease in tendon reflex |
III | Muscle weakness, sensory abnormalities (hypesthesia, paresthesia, dysesthesia), bowel and bladder dysfunction |
IV | Complete paralysis |
From: Spinal Epidural Abscess: A Review Highlighting Early Diagnosis and Management
Diabetes mellitus |
Elevated CRP (CRP level >115 mg/L (11.5 mg/dL) |
Leukocytosis (white blood cell count >12,500 cells/L) |
Bacteremia |
Physician-documented decline in motor status while on intravenous antibiotics |
Age older than 65 |
MRSA |
Severe neurological involvement |
Motor deficit at presentation |
Pathologic or compression vertebral fracture in the affected levels |
Active malignancy |
Sensory change |
Dorsal location of abscess |
Primarily radiographic evidence of disease progression |
Progression of bony deformities in the spine |