title: Evaluation and management of spinal epidural abscess.
abstract: Spinal epidural abscess (SEA) is an uncommon and potentially catastrophic condition. SEA often presents a diagnostic challenge, as the "classic triad" of fever, spinal pain, and neurological deficit is evident in only a minority of patients. When diagnosis is delayed, irreversible neurological damage may ensue. To minimize morbidity, an appropriate level of suspicion and an understanding of the diagnostic evaluation are essential. Infection should be suspected in patients presenting with axial pain, fever, or elevated inflammatory markers. Although patients with no known risk factors can develop SEA, clinical concern should be heightened in the presence of diabetes, intravenous drug use, chronic renal failure, immunosuppressant therapy, or a recent invasive spine procedure. When the clinical profile is consistent with the diagnosis of SEA, gadolinium-enhanced magnetic resonance imaging of the spinal column should be obtained on an emergent basis to delineate the location and neural compressive effect of the abscess. Rapid diagnosis allows for efficient treatment, which optimizes the potential for a positive outcome.
authors.affiliation: Department of Orthopaedics, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Steven F
authors.initials: SF
authors.lastname: DeFroda
authors.affiliation: Department of Orthopaedics, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: J Mason
authors.initials: JM
authors.lastname: DePasse
authors.affiliation: Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Adam E M
authors.initials: AE
authors.lastname: Eltorai
authors.affiliation: Department of Orthopaedics, Division of Spine Surgery, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Daniels
authors.affiliation: Department of Orthopaedics, Division of Spine Surgery, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Palumbo
mesh_terms: D019468:Disease Management; D020802:Epidural Abscess / Q000175:diagnosis* / Q000628:therapy; D005334:Fever / Q000209:etiology; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging; D010146:Pain / Q000209:etiology; D012307:Risk Factors; D013131:Spine
chemical_list: D005682:Gadolinium