🧠 A spinal epidural abscess (SEA) is a rare but life-threatening infection in the epidural space, between vertebrae and dura mater. ⚡ It can rapidly compress the spinal cord → causing severe neurological deficits, paralysis, or death if untreated.

📖 About

🔴 Presents with severe back pain ± progressive weakness in legs/arms over hours–days.
🦠 Staphylococcus aureus (incl. MRSA) = most common pathogen.
🩸 Infection usually spreads haematogenously; may also extend from nearby bone/soft tissue or follow surgery.
⚠️ Classical triad = back pain + fever + neurological deficit (but only present in 10–15% at diagnosis).

🔬 Aetiology

Haematogenous spread: Skin infection, UTI, endocarditis.
Direct extension: Vertebral osteomyelitis, psoas abscess.
Post-procedure: Spinal surgery, epidural catheterisation, nerve blocks.
Trauma: Penetrating injury or open wound.

⚡ Risk Factors

Diabetes mellitus.
IV drug use 💉.
Immunosuppression (HIV, steroids, chemo, transplant).
Chronic kidney disease, alcoholism.
Recent spinal surgery or invasive spinal procedure.

🩺 Clinical Presentation

🌡 Severe localised back pain, spinal tenderness.
🤒 Fever, malaise, sepsis signs.
⚡ Progressive motor/sensory deficits → paraparesis, quadriparesis, sensory level.
🚽 Autonomic dysfunction: bladder/bowel disturbance.

🚨 Red Flags

Rapidly worsening weakness or paralysis.
High fever, septic shock features.
Recent spinal surgery or procedure.
History of IV drug use or immunosuppression.

🧪 Investigations

🖥 MRI spine with contrast: Gold standard — defines abscess extent, cord compression.
🧬 Blood cultures: Often positive for S. aureus.
📊 Bloods: Raised CRP, ESR, WCC (inflammatory response).
🩻 CT spine: Alternative if MRI contraindicated (less sensitive for soft tissue).

🚨 SEA is a neurosurgical emergency. Delay in diagnosis/treatment greatly increases risk of permanent paralysis or death.

💊 Management

Empirical IV Antibiotics: Start broad-spectrum (incl. MRSA cover e.g., vancomycin + ceftriaxone) → refine once cultures available. ⚠️ In unstable septic patients → do not delay antibiotics for imaging.
Surgical Drainage: Laminectomy or CT-guided aspiration to relieve compression & obtain cultures.
Supportive Care: Pain relief, neuro monitoring, bladder/bowel care, VTE prophylaxis, rehab for residual deficits.

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Epidural Spinal abscess