Spinal epidural abscess

An epidural abscess is a serious but rare infection that forms in the epidural space on the spine, the area between the tough outer membrane surrounding your brain and spinal cord (dura mater) and the bones of your skull or spine.

It’s characterized by severe back pain in the middle of your back, fever and neurological deficits (numbness in arms and legs).

An epidural abscess can be life-threatening if left untreated, as the infection can spread to other parts of the body including the bloodstream.

Types of epidural abscesses

Epidural abscesses are a collection of pus and an infection can put pressure on the delicate nerves and membranes, potentially causing significant neurological damage.

There are two types of epidural abscesses:

• Spinal epidural abscess is the more common type, accounting for about 80% of cases. It typically forms in the lower back (lumbar spine) but can occur anywhere along the spinal column.
• Intracranial epidural abscess is a less frequent infection that forms within the skull, close to the brain.

Both types are diagnosed and treated the same way. The only difference is where the abscess develops within the central nervous system (brain and spine).

How the spine and brain are protected

The brain and spinal cord have protective layers called meninges. The meninges surround and cushion the brain and spinal cord. They play a crucial role in:

• Providing a physical barrier against infection.
• Supporting the flow of cerebrospinal fluid (CSF).
• Supporting blood supply and providing vital nutrients and oxygen to the brain and spinal cord.

Epidural abscess causes and risk factors

While rare, epidural abscesses can pose life-threatening consequences if left untreated. Understanding the potential risk factors is vital for early detection and receiving prompt treatment.

A spine infection caused by bacteria is the most common cause of epidural abscess. Fungal or parasitic infections, while significantly less common, can also cause spine abscesses. In some cases, the specific source of infection remains unidentified.

Your risk of a spinal abscess increases if you have:

• A weakened immune system
• Diabetes or autoimmune disease
• Surgery or spinal procedures like injections or the placement of catheters
• An infection such as an infection in the spine, spinal discs (discitis osteomyelitis) or surrounding areas
• An infection that can travel through the blood

Other factors such as pregnancy, age and drug use by syringe can also increase your risk of infections and an epidural abscess.

Symptoms of epidural abscess

Timely recognition of symptoms is critical to prevent potentially life-threatening complications. Common warning signs include fever, chills, fatigue and loss of appetite.

Symptoms of spinal epidural abscess may vary based on location and severity, and include:

• Bladder or bowel dysfunction
• Headache
• Nausea and vomiting
• Numbness, tingling, weakness or difficulty moving arms or legs
• Pain that radiates down the legs
• Seizures
• Severe back pain
• Tenderness over the spine

Not everyone with an epidural abscess will have these symptoms. However, any combination of them, especially alongside fever or severe back pain, warrants immediate medical attention.

Call your Advocate provider immediately if you are experiencing these symptoms.

Diagnosing epidural abscess

Getting an early diagnosis of epidural abscess can significantly improve the outcome.

To diagnose an epidural abscess, your Advocate provider will perform a physical examination, evaluating symptoms and medical history. Blood tests will also be ordered to identify signs of infection, such as elevated white blood cells and increased protein levels.

Digital imaging is also used in diagnosing epidural abscess. By utilizing MRI or CT scans, your provider can see the affected area and precisely locate any infection or inflammation in the spine.

In rare instances, a lumbar puncture (spinal tap) may be required to analyze cerebrospinal fluid (CSF) around the brain and spinal cord. This test aids in ruling out other infectious or inflammatory conditions within the central nervous system.

Epidural abscess treatment

Timely treatment for an epidural abscess is vital, given the potential for significant neurological damage if left untreated. In rare instances, emergency hospitalization may be necessary for severe infections.

Antibiotics, primarily administered intravenously (IV), are commonly the cornerstone of treatment for epidural abscesses. The choice of antibiotics depends on the bacteria causing the infection, the abscess severity and any drug allergies you may have.

Surgery may be essential in certain cases to drain pus and alleviate pressure on the spinal cord or nerves.

Your provider may also prescribe pain medications to help manage the severe pain often associated with an epidural abscess.

Complications of an epidural abscess

If left untreated, a spine abscess can lead to long-term complications. These include:

• Brain abscess
• Chronic pain
• Loss of control over bladder and bowel function
• Loss of feeling due to nerve compression
• Meningitis
• Paralysis
• Reduced mobility

Getting prompt treatment for an epidural abscess can minimize your risk of developing complications and improve outcomes.