Epidural abscess (spinal) - Revision history

SeanDenny: /* Risk Factors */

2020-12-15T00:25:42Z

Risk Factors

← Older revision		Revision as of 00:25, 15 December 2020
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	**Injection [[substance abuse\|drug use]]		**Injection [[substance abuse\|drug use]]
	**Immunocompromised		**Immunocompromised
	**[[Alcohol ~~abuse~~]]		**[[Alcohol use disorder]]
	**Cancer		**Cancer
	**Recent spine procedure		**Recent spine procedure

Rossdonaldson1: /* Evaluation */

2020-10-24T11:38:43Z

Evaluation

← Older revision		Revision as of 11:38, 24 October 2020
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	==Evaluation==		==Evaluation==
	[[File:Sea.png\|thumb\|A clinical decision algorithm for evaluation of SEA which may decrease diagnostic delay. <ref>Davis DP, Salazar A, Chan TC, Vilke GM. Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain. J Neurosurg Spine. 2011;14(6):765–770. doi:10.3171/2011.1.SPINE1091.</ref>]]		[[File:Sea.png\|thumb\|A clinical decision algorithm for evaluation of SEA which may decrease diagnostic delay. <ref>Davis DP, Salazar A, Chan TC, Vilke GM. Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain. J Neurosurg Spine. 2011;14(6):765–770. doi:10.3171/2011.1.SPINE1091.</ref>]]
	MRI of an abscess causing cauda equina syndrome.		[[File:MRI of the lumbar spine with abscess in the posterior epidural space, causing cauda equina syndrome.jpg\|thumb\|MRI of an abscess causing cauda equina syndrome.]]
	===Work-up===		===Work-up===
	'''Labs<ref>Cornett CA, Vincent SA, Crow J, et al. Bacterial spine infections in adults: evaluation and management. Journal of the American Academy of Orthopaedic Surgeons. 2016; 24(1):11-8.</ref>'''		'''Labs<ref>Cornett CA, Vincent SA, Crow J, et al. Bacterial spine infections in adults: evaluation and management. Journal of the American Academy of Orthopaedic Surgeons. 2016; 24(1):11-8.</ref>'''

Rossdonaldson1: /* Evaluation */

2020-10-24T11:38:13Z

Evaluation

← Older revision		Revision as of 11:38, 24 October 2020
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	==Evaluation==		==Evaluation==
	[[File:Sea.png\|thumb\|A clinical decision algorithm for evaluation of SEA which may decrease diagnostic delay. <ref>Davis DP, Salazar A, Chan TC, Vilke GM. Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain. J Neurosurg Spine. 2011;14(6):765–770. doi:10.3171/2011.1.SPINE1091.</ref>]]		[[File:Sea.png\|thumb\|A clinical decision algorithm for evaluation of SEA which may decrease diagnostic delay. <ref>Davis DP, Salazar A, Chan TC, Vilke GM. Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain. J Neurosurg Spine. 2011;14(6):765–770. doi:10.3171/2011.1.SPINE1091.</ref>]]
			MRI of an abscess causing cauda equina syndrome.
	===Work-up===		===Work-up===
	'''Labs<ref>Cornett CA, Vincent SA, Crow J, et al. Bacterial spine infections in adults: evaluation and management. Journal of the American Academy of Orthopaedic Surgeons. 2016; 24(1):11-8.</ref>'''		'''Labs<ref>Cornett CA, Vincent SA, Crow J, et al. Bacterial spine infections in adults: evaluation and management. Journal of the American Academy of Orthopaedic Surgeons. 2016; 24(1):11-8.</ref>'''

ClaireLewis at 02:24, 3 October 2019

2019-10-03T02:24:08Z

← Older revision		Revision as of 02:24, 3 October 2019
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	*''[[E. coli]]'' (urine spread)		*''[[E. coli]]'' (urine spread)
	*''[[P. aeruginosa]]'' ([[IVDA]])		*''[[P. aeruginosa]]'' ([[IVDA]])
	*Rare: [[anaerobes]], [[mycobacteria]], [[fungi]]		*Rare: [[anaerobes]], [[mycobacterium\|mycobacteria]], [[fungi]]

	===Risk Factors===		===Risk Factors===
	*98% of patients have at least one of the following risk-factors:<ref>Sampath P, Rigamonti D. Spinal epidural abscess: a review of epidemiology, diagnosis, and treatment. J Spinal Disord 1999; 12:89-93</ref>		*98% of patients have at least one of the following risk-factors:<ref>Sampath P, Rigamonti D. Spinal epidural abscess: a review of epidemiology, diagnosis, and treatment. J Spinal Disord 1999; 12:89-93</ref>
	**Injection drug use		**Injection [[substance abuse\|drug use]]
	**Immunocompromised		**Immunocompromised
	**Alcohol abuse		**[[Alcohol abuse]]
	**Cancer		**Cancer
	**Recent spine procedure		**Recent spine procedure
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	**Distant site of infection		**Distant site of infection
	**Indwelling catheter		**Indwelling catheter
	**Chronic renal failure		**Chronic [[renal failure]]
	**Diabetes		**[[Diabetes]]

	{{Epidural compression syndromes types}}		{{Epidural compression syndromes types}}

	==Clinical Features==		==Clinical Features==
	*Fever + localized back pain is epidural abscess until proven otherwise		*[[Fever]] + localized [[back pain]] is epidural abscess until proven otherwise
	**Classic triad of fever, back pain, and neuro deficits is rare (13%)<ref>Reihsaus E. et al. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev 2000; 23:175-204</ref>		**Classic triad of fever, back pain, and [[focal neuro\|neuro deficits]] is rare (13%)<ref>Reihsaus E. et al. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev 2000; 23:175-204</ref>
	**Fever is only present in ~50% of cases		**Fever is only present in ~50% of cases

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	#Back pain at affected site		#Back pain at affected site
	#Nerve root pain from affected level		#Nerve root pain from affected level
	#Weakness, sensory deficit, bladder/bowel dysfunction		#[[Weakness]], [[numbness\|sensory deficit]], [[urinary retention\|bladder]]/bowel dysfunction
	#Paralysis		#Paralysis

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	===Work-up===		===Work-up===
	'''Labs<ref>Cornett CA, Vincent SA, Crow J, et al. Bacterial spine infections in adults: evaluation and management. Journal of the American Academy of Orthopaedic Surgeons. 2016; 24(1):11-8.</ref>'''		'''Labs<ref>Cornett CA, Vincent SA, Crow J, et al. Bacterial spine infections in adults: evaluation and management. Journal of the American Academy of Orthopaedic Surgeons. 2016; 24(1):11-8.</ref>'''
	*WBC elevated in <45% of patients		*[[leukocytosis\|WBC elevated]] in <45% of patients
	*ESR and CRP are almost consistently elevated		*ESR and CRP are almost consistently elevated
	**Sensitivity of ESR in pt with SEA risk factors ~100%<ref>Davis DP, Salazar A, Chan TC, Vilke GM. Prospective evaluation of a clinical		**Sensitivity of ESR in pt with SEA risk factors ~100%<ref>Davis DP, Salazar A, Chan TC, Vilke GM. Prospective evaluation of a clinical
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	'''Imaging'''		'''Imaging'''
	*Strongly consider imaging the entire spine to assess for non-contiguous epidural abscess<ref>Ju, K.L., et al. Predicting Patients with concurrent noncontinguous spinal epidural abscess lesions. Spine J. 2005 15(1):95</ref>		*Strongly consider imaging the entire spine to assess for non-contiguous epidural abscess<ref>Ju, K.L., et al. Predicting Patients with concurrent noncontinguous spinal epidural abscess lesions. Spine J. 2005 15(1):95</ref>
	*MRI with gadolinium is the diagnostic test of choice<ref>Angtuaco E. et al. MR imaging of spinal epidural sepsis. Am J Roentgenoli 1987; 149:1249-53</ref>		*[[mri\|MRI]] with gadolinium is the diagnostic test of choice<ref>Angtuaco E. et al. MR imaging of spinal epidural sepsis. Am J Roentgenoli 1987; 149:1249-53</ref>
	*CT with IV contrast may provide usual information regarding bony integrity and fluid collections while awaiting MRI		*CT with IV contrast may provide usual information regarding bony integrity and fluid collections while awaiting MRI

	==Management==		==Management==
	*Early surgical decompression and drainage<ref>Bluman E. et al. Spinal epidural abscess in adults. J Am Acad Orthop Surg 2004; 12:155-163</ref>		*Early surgical decompression and drainage<ref>Bluman E. et al. Spinal epidural abscess in adults. J Am Acad Orthop Surg 2004; 12:155-163</ref>
	*Aspiration (for diagnosis) and antibiotics may be sufficient for patients without neuro deficits		*Aspiration (for diagnosis) and [[antibiotics]] may be sufficient for patients without neuro deficits
	===[[Antibiotics]]===		===[[Antibiotics]]===
	{{Epidural Abscess Treatment}}		{{Epidural Abscess Treatment}}

Alvarez13: /* Work-up */

2017-06-12T07:16:04Z

Work-up

← Older revision		Revision as of 07:16, 12 June 2017
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	*WBC elevated in <45% of patients		*WBC elevated in <45% of patients
	*ESR and CRP are almost consistently elevated		*ESR and CRP are almost consistently elevated
			**Sensitivity of ESR in pt with SEA risk factors ~100%<ref>Davis DP, Salazar A, Chan TC, Vilke GM. Prospective evaluation of a clinical
			decision guideline to diagnose spinal epidural abscess in patients who present to
			the emergency department with spine pain. J Neurosurg Spine. 2011
			Jun;14(6):765-70. doi: 10.3171/2011.1.SPINE1091. Epub 2011 Mar 18. PubMed PMID:
			21417700.
			</ref>
	*Blood cultures are indicated to identify the source organism (Staph in 2/3 of cases)		*Blood cultures are indicated to identify the source organism (Staph in 2/3 of cases)
	'''CSF<ref>Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006; 355(19):2012-2020.</ref>'''		'''CSF<ref>Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006; 355(19):2012-2020.</ref>'''

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-21T20:54:24Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 20:54, 21 July 2016
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	{{Lower back pain DDX}}		{{Lower back pain DDX}}

	==~~Diagnosis~~==		==Evaluation==
	[[File:Sea.png\|thumb\|A clinical decision algorithm for evaluation of SEA which may decrease diagnostic delay. <ref>Davis DP, Salazar A, Chan TC, Vilke GM. Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain. J Neurosurg Spine. 2011;14(6):765–770. doi:10.3171/2011.1.SPINE1091.</ref>]]		[[File:Sea.png\|thumb\|A clinical decision algorithm for evaluation of SEA which may decrease diagnostic delay. <ref>Davis DP, Salazar A, Chan TC, Vilke GM. Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain. J Neurosurg Spine. 2011;14(6):765–770. doi:10.3171/2011.1.SPINE1091.</ref>]]
	===Work-up===		===Work-up===

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2016-07-06T16:37:01Z

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	== Background==		==Background==
	*Abscess confined to epidural adipose tissue in spine<ref>Darouiche RO et al. Bacterial spinal epidural abscess. Review of 43 cases and literature survey. Medicine (Baltimore) 1992; 71:369-85</ref>		*Abscess confined to epidural adipose tissue in spine<ref>Darouiche RO et al. Bacterial spinal epidural abscess. Review of 43 cases and literature survey. Medicine (Baltimore) 1992; 71:369-85</ref>
	*Thoracic and lumbar spine most common; C-spine least common		*Thoracic and lumbar spine most common; C-spine least common

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2016-07-06T08:45:36Z

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	===Staging===		===Staging===
	Progression through stages is highly variable and may evolve rapidly.		Progression through stages is highly variable and may evolve rapidly.
	# Back pain at affected site		#Back pain at affected site
	# Nerve root pain from affected level		#Nerve root pain from affected level
	# Weakness, sensory deficit, bladder/bowel dysfunction		#Weakness, sensory deficit, bladder/bowel dysfunction
	# Paralysis		#Paralysis

	==Differential Diagnosis==		==Differential Diagnosis==

Neil.m.young: Text replacement - " ==" to "=="

2016-07-05T10:20:09Z

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	== Background ==		== Background==
	*Abscess confined to epidural adipose tissue in spine<ref>Darouiche RO et al. Bacterial spinal epidural abscess. Review of 43 cases and literature survey. Medicine (Baltimore) 1992; 71:369-85</ref>		*Abscess confined to epidural adipose tissue in spine<ref>Darouiche RO et al. Bacterial spinal epidural abscess. Review of 43 cases and literature survey. Medicine (Baltimore) 1992; 71:369-85</ref>
	*Thoracic and lumbar spine most common; C-spine least common		*Thoracic and lumbar spine most common; C-spine least common

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2016-07-04T19:28:10Z

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	==External Links==		==External Links==
	* [http://ddxof.com/spinal-epidural-abscess/ DDxOf: Differential Diagnosis of Spinal Epidural Abscess]		*[http://ddxof.com/spinal-epidural-abscess/ DDxOf: Differential Diagnosis of Spinal Epidural Abscess]

	==References==		==References==