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Spinal Epidural Abscess

S pinal epidural abscess (SEA) is a potentially life-threatening condition resulting from pyogenic infections of the epidural space. These infections can cause permanent neurologic injury and death. Progressive spinal instability may also result when associated with vertebral osteomyelitis or aggressive surgical decompression. Before the era of antibiotics and aseptic surgery, epidural abscesses were usually fatal. Contemporary series report mortality of approximately 15%.1 Timely diagnosis and treatment are the keys to optimizing outcome. This review will focus on the entity of SEA and discuss salient points in pathophysiology, diagnosis, and treatment. Current controversies in treatment approaches also will be reviewed. EPIDEMIOLOGY The reported incidence of SEA is one to two cases per 10,000 inpatient admissions and appears to be increasing over time.2,3 There is a 2:1 male gender predominance.1 The incidence of SEA varies with the demographic characteristics of the local patient population because SEA is strongly associated with a variety of risk factors. Diabetes, immunosuppressive medications or diseases, alcoholism, and old age compromise host immunity. Intravenous drug use and hemodialysis provide pathogens entry into the bloodstream. Finally, penetrating trauma, surgery, and therapeutic spinal injections allow direct inoculation of pathogens into the epidural space. The increase in the incidence of SEA over time is probably related to the aging of the population, increased use of immunosuppressive drugs, growth in the use of therapeutic invasive spinal procedures, and improvements in diagnostic imaging modalities. Although the vast majority of patients with SEA have one or more risk factors, SEA can arise spontaneously in otherwise healthy hosts, and a high index of suspicion is essential to avoid delay in diagnosis.