Epidural Abscess

Description

• A rare pyogenic infection of the spinal epidural space:
  • 2–25/100,000 admissions
• Most common in thoracic spine, followed by lumbar and cervical

Etiology

• Focus of infection is present followed by either hematogenous spread (∼50%) or direct extension:
  • No focus identified in ∼1/3
• Most common source is skin infection:
  • Any pyogenic infection may be source
• Staphylococcus aureus accounts for >50% of cases:
  • Many are MRSA
  • Streptococcus is second most common
• Haemophilus influenzae, gram-negative bacilli, mycobacteria, anaerobic, coagulase-negative Staphylococcus, fungal, and mixed infections also occur
• Complication of epidural catheter or spinal surgery
• Unusual complication of lumbar puncture (usually follows multiple attempts)

• Children present similar to adults with back pain, fever, and neurologic signs as well as nonspecific systemic symptoms
• Infants may exhibit only fever, irritability, and associated meningitis
• Sphincter disturbance is frequently seen
• Usually secondary to hematogenous spread
• Location and bacteriology similar to adults