Clinical reviewSpinal Epidural Abscess
Introduction
Spinal epidural abscess (SEA) represents the accumulation of purulent material in the space between the dura matter and the osseo-ligamentous confines of the vertebral canal. Though first mentioned by Morgagni in 1761, this condition was not clearly defined as a clinical entity until 1820 by Bergamaschi (1, 2). Reports pertaining to spinal epidural abscess before the advent of antibiotic therapy and surgical treatment documented that the disease was nearly always fatal (3). Although the development of modern diagnostic and management methods over the past half century has improved the prognosis, the associated morbidity and mortality remain high.
Prompt diagnosis is the most important determinant of outcome. As the volume of purulent material increases within the epidural compartment, the space available for the neural elements diminishes. If prompt treatment is not instituted, irreversible neurologic deficit can and often does develop. Because these patients typically present first in the emergency department setting, it is imperative for the emergency physician to be familiar with the clinical features, diagnostic evaluation, and basic management principles of spinal epidural abscess.
Section snippets
Epidemiology
Spinal epidural abscess accounts for 0.2–1.2 cases per 10,000 hospital admissions (4). Though uncommon, this condition seems to have increased in incidence over the past 25 years (5). Potential reasons for the increase include: aging of the general population, growing numbers of intravenous drug abusers and patients with human immunodeficiency virus (HIV) infection, a rise in the number of invasive spinal procedures, and the improved sensitivity of neuroradiologic imaging techniques.
The disease
Conclusion
Spinal epidural abscess is an uncommon disease that can lead to irreversible neurologic dysfunction and even death. Patients often present first to an emergency physician. Prompt diagnosis and treatment are important determinants of outcome. Accordingly, all emergency clinicians should be familiar with the clinical presentation, the diagnostic evaluation, and the basic treatment principles of SEA.
A high level of suspicion for spinal epidural abscess is warranted in the patient with: a) back
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