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Epidural Abscess, Emergency Medicine

Richard S. Krause Reviewed 06/2017
 


Basics

Description

  • A rare pyogenic infection of the spinal epidural space

    • 2–25/100,000 admissions

  • Most common in thoracic spine, followed by lumbar and cervical

Etiology

  • Focus of infection is present follo...

Diagnosis

Signs and Symptoms

  • Fever and severe back pain represent “red flag” for potentially serious condition:

    • If pain is radicular or there is neurologic disturbance, likelihood of epidural abscess is...

Treatment

Pre-Hospital

Spinal immobilization if trauma suspected or other cause of fracture suspected 

Initial Stabilization/Therapy

Broad-spectrum parenteral antibiotics early 
  • Must include coverage for ...

Follow-Up

Disposition

Admission Criteria

Patients with epidural abscess should be admitted; MRI is needed emergently; transfer patient if necessary 

Discharge Criteria

Patients with definite or strongly s...

Pearls and Pitfalls

  • Successfully treated epidural abscess may reoccur, especially in the setting of decreased immunity

  • Patients with Staphylococcal bacteremia and back pain or neurologic signs/symptoms...

Additional Reading

  • Darouiche  RO. Spinal epidural abscess. New Engl J Med.  2006;355:2012–2020.

  • Davis  DP, Salazar  A, Chan  TC, et al. Prospective evaluation of a clinical decision guideline to d...

Codes

ICD9

324.1 Intraspinal abscess 

ICD10

G06.1 Intraspinal abscess and granuloma 

SNOMED

  • 61974008 epidural abscess (disorder)

  • 427916006 Abscess in epidural space of thoracic spine (disorder)

  • 429437003 Abs...

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