neurologic disorders
Spinal Epidural Abscess
Key Points
A spinal epidural abscess typically causes local or radicular back pain, percussion tenderness, and fever; if the abscess compresses the spinal cord, neurologic deficits (leg paresis, saddle anesthesia, bladder and bowel dysfunction) develop. Because rapid treatment is necessary to prevent or minimize neurologic deficits, clinical suspicion of spinal epidural abscess should be high (eg, if patients have unexplained atraumatic back pain, particularly with focal percussion tenderness or risk factors); if it is suspected, MRI or, if unavailable, myelography followed by CT should be done immediately. If an abscess is causing neurologic deficits, immediately drain the abscess surgically; treat all abscesses with antibiotics that cover staphylococcus, anaerobes, and sometimes gram-negative bacteria. 