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Mir H. Ali, MD, PhD
Orthopedic Spine Surgery
Patient Educational Series

Spine Infections - Part II: Epidural Abscess

While spine infections are rare, they can be dangerous and must be treated early and appropriately.

Epidural Abcess

On rare occasions, infection in the spine can cause an epidural abscess to form. The term epidural abscess suggests that this infection has started to spread around the nerves and spinal cord, making it more difficult to treat with antibiotics and non- operative treatment. Moreover, the mass that is formed may cause pressure on the nerves and/or spinal cord, causing these structures to stop functioning normally. This can cause a variety of symptoms, ranging from simple numbness all the way to complete paralysis. Thus, it is important that every patient with a spine infection be assessed for possible epidural abscess prior to embarking on a treatment plan before neurological problems develop.

An epidural abscess is best visualized via a cervical or lumbar MRI with intravenous contrast depending on the area of the infection. If an epidural abscess is found, surgical treatment must be considered more seriously. If an epidural abscess is not found, then non-operative treatment with a course of intravenous antibiotics and bracing is strongly recommended for the treatment of osteomyelitis/discitis. In these cases surgical treatment is only used if the initial treatment fails.

The outcome of surgical treatment for epidural abscess is directly related to how early the infection is diagnosed and treated. If the infection is treated surgically and the spinal elements are decompressed prior to developing significant neurological problems, then the outcome is quite good. However, if surgical treatment is delayed and/or the diagnosis missed and then treatment is initiated after the patient begins to have significant neurological problems, then the outcome is poor. Thus, again this information highlights the importance of early detection and appropriate decision-making amongst members of the treatment team and the patient.

The diagnosis of epidural abscess in the spine can be difficult and complex. The decision about whether an epidural abscess is present or not is made by the orthopedic spine surgeon in conjunction with a neuroradiologist, who is well trained in reviewing these types of MRIs. An infectious disease specialist is also consulted to help determine the need for initial antibiotics, antibiotics after surgery while the culture results are pending, and once the infecting organism is definitively isolated/identified.

Spine infections are very rare and epidural spine infections make up a very small minority of the spine infections. Nonetheless, it should be kept foremost in our minds because of the importance in early diagnosis/treatment and its prognosis. Please discuss any further questions with a board-certified orthopedic spine surgeon.

Mir H. Ali, MD,PhD
Director - Deerpath Spine Institute
Orthopedic Spine Surgeon - Rezin Orthopedics & Sports Medicine

Dr. Ali is a board certified orthopedic spine surgeon trained in the diagnosis as well as the treatment of non-operative and operative spinal disorders. Dr. Ali practices in the far western and southwestern suburbs of Chicago and utilizes surgery as a last resort when all other non-operative treatments have failed to relieve pain and/or reduce risk of nerve damage/injury. All recommendations on this site are for general situations and a particular situation requires evaluation before specific treatment recommendations can be made.