Spinal epidural abscess

An epidural abscess is a rare yet serious infection occurring in the epidural space of the spine – the region between the outer membrane of the brain and spinal cord (dura mater) and the skull or spinal bones.

Telling symptoms of a spinal epidural abscess include intense mid-back pain, fever and neurological deficits like arm and leg numbness.

Left untreated, this condition can escalate to a life-threatening situation, with the potential for the infection to travel to other body parts, including the bloodstream.

Types of epidural abscesses

Epidural abscesses form in two places, the spine and the skull. They are classified based on their location, while maintaining similar characteristics. The two types include:

• Intracranial epidural abscess is a less frequent infection that forms within the skull, close to the brain.
• Spinal epidural abscess is the more common type, accounting for about 80% of cases. It typically forms in the lower back (lumbar spine) but can occur anywhere along the spinal column.

Both types of epidural abscesses involve the accumulation of pus and an infection that puts pressure on nerves and membranes, potentially causing harm to the central nervous system (brain and spine).

Doctors use the same diagnostic and treatment procedures for both types of abscesses. The only distinction is where the abscess is located.

How the spine and brain are protected

Protective layers known as meninges envelope and cushion the brain and spinal cord.

They are pivotal in:

• Forming a physical barrier to fight off infections.
• Supporting the flow of cerebrospinal fluid (CSF).
• Facilitating blood supply and delivering essential nutrients and oxygen to the brain and spinal cord.

Epidural abscess causes and risk factors

Epidural abscesses, while uncommon, can pose serious consequences if left untreated. Understanding the potential causes and risk factors is vital for early detection and prompt medical treatment.

The primary cause of abscess on the spine is bacterial infection, or spine infection. While much less common, fungal infections or even parasitic infections can also cause epidural abscesses. In some cases, the specific source of infection remains unidentified.

Your risk of a spinal abscess increases if you have:

• An infection such as an infection in the spine, spinal discs (discitis osteomyelitis) or surrounding areas.
• An infection that travels through the blood.
• A weakened immune system.
• Recent surgery or spinal procedures like injections or the placement of catheters.
• Diabetes or autoimmune disease.

Other factors such as intravenous drug use, age and pregnancy can also increase your risk of infections and a spinal epidural abscess.

Symptoms of epidural abscess

Recognizing the symptoms early is crucial for preventing potentially life-threatening complications. The most common warning signs are fever and chills, fatigue and loss of appetite.

The specific symptoms can vary depending on the location and severity of the abscess. Spinal epidural abscess symptoms include:

• Severe back pain
• Tenderness over the spine
• Pain that radiates down the legs
• Numbness, tingling, weakness or difficulty moving arms or legs
• Bladder or bowel dysfunction
• Headache
• Nausea and vomiting
• Seizures

Not everyone with an epidural abscess will experience all these symptoms. However, any combination of these signs, especially alongside fever or severe back pain, warrants immediate medical attention.

Call your Aurora provider right away if you are experiencing these symptoms.

Diagnosing epidural abscess

Early diagnoses of a spinal epidural abscess can make a difference in your outcome. Your Aurora provider will conduct a physical exam and assess your symptoms and medical history.

They will order blood tests to look for markers of an infection, which includes elevated white blood cells and high levels of protein in the blood.

An MRI or CT scan are also an effective tool your provider may use to see the affected area thoroughly and pinpoint any infection or inflammation in the spine.

In rare cases, a lumbar puncture (spinal tap) may be necessary to analyze the cerebrospinal fluid (CSF) surrounding the brain and spinal cord. This test helps rule out other infectious or inflammatory conditions of the central nervous system.

Epidural abscess treatment

Treatment for an epidural abscess is crucial and time-sensitive, as the infection can cause significant neurological damage if left untreated. It may also require emergency hospitalization depending on the severity.

Antibiotics are the cornerstone of treatment for nearly all epidural abscesses. Antibiotics are usually delivered intravenously. The antibiotic used depends on the type of bacteria and the severity of the spine abscess.

In some cases, surgery is necessary to drain the pus and relieve pressure on the spinal cord or nerves.

Your provider may prescribe pain medications to help manage severe pain often associated with an epidural abscess.

Complications of an epidural abscess

An epidural abscess, though rare, can have long-term complications if not treated promptly, including:

• Paralysis
• Loss of feeling due to nerve compression
• Loss of control over bladder and bowel function
• Chronic pain
• Meningitis
• Brain abscess
• Reduced mobility

Early diagnosis and treatment are crucial to minimize the risk of complications and improve outcomes from an epidural abscess.