Spinal Epidural Abscess - Causes, Symptoms, and Treatment

Introduction

Spinal epidural abscess (SEA) is a rare but potentially life-threatening condition that can lead to severe neurological deficits if not promptly diagnosed and treated. This infection of the epidural space surrounding the spinal cord and nerves has been gaining increased attention in recent years due to a rising incidence, likely linked to an aging population.

What Is Spinal Epidural Abscess?

A spinal epidural abscess is an uncommon but serious infection that develops in the epidural space of the spine. The epidural space is located between the protective outer membrane of the spinal cord, known as the dura mater, and the vertebrae that make up the spinal column. This space contains blood vessels and fatty tissues and acts as a cushion for the spinal cord and surrounding nerves. An abscess is a collection of pus that forms as the body's natural defense mechanism against bacterial infection. In the case of a spinal epidural abscess, bacteria enter the epidural space, and the body attempts to contain the infection by forming an abscess. This collection of pus can put pressure on the spinal cord and nerves, causing a range of neurological symptoms and potentially leading to permanent damage.

What Are the Causes and Risk Factors of Spinal Epidural Abscess?

Spinal epidural abscesses are typically caused by bacterial infections. The most common pathogens responsible for SEA are Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA), and Streptococcus species. These bacteria can enter the epidural space through various means, including:

• Bacteria can enter the bloodstream from infections in other parts of the body, such as skin, bones, or urinary tract, and travel to the epidural space via the blood vessels.

• In some cases, nearby infections or surgeries in the spine can directly lead to the formation of a spinal epidural abscess.

• Infections in adjacent structures, such as vertebral bones or intervertebral discs, can extend into the epidural space.

Several risk factors include:

• People with diabetes are at a higher risk due to their compromised immune systems and the potential for impaired blood circulation.

• Injecting drugs increases the risk of introducing bacteria into the bloodstream.

• Conditions or medications that suppress the immune system, such as HIV (human immunodeficiency virus), cancer treatments, or immunosuppressive drugs, can make the body more susceptible to infections.

• Conditions like kidney disease, liver disease, or heart disease can increase the risk of bacterial infections.

• Any procedure or injury involving the spine can create a potential entry point for bacteria.

What Are the Symptoms of Spinal Epidural Abscess?

Common symptoms include:

• As the abscess puts pressure on the spinal cord or nerves, it leads to neurological symptoms, such as weakness, numbness, or tingling in the extremities.

• A raised body temperature is a common sign of infection.

• Back pain is often the earliest symptom, and it can be mild to severe, typically localized to the affected area of the spine.

• In severe cases, an abscess can affect the nerves controlling bowel and bladder function, leading to incontinence.

• Pain that worsens with movement or activities that increase pressure on the spinal cord, such as coughing or sneezing.

• Involuntary muscle contractions may occur due to irritation of the spinal cord.

What Are the Ways of Diagnosis of Spinal Epidural Abscess?

Diagnosing a spinal epidural abscess is a complex process that requires a combination of clinical evaluation and imaging studies. The following steps are typically involved in the diagnostic process:

• A thorough history of the patient's symptoms and a physical examination can provide crucial information about the presence of risk factors and specific neurological deficits.

• Blood tests, including a complete blood count (CBC) and inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), can help identify signs of infection.

• MRI (magnetic resonance imaging) can visualize the spinal cord and epidural space, allowing for the identification of abscesses, their location, and their impact on the spinal cord and nerves.

• In some cases, a lumbar puncture (spinal tap) may be performed to analyze cerebrospinal fluid for signs of infection.

What Are the Ways of Treatment of Spinal Epidural Abscess?

Early intervention is crucial in the management of spinal epidural abscess to prevent permanent neurological damage and complications. Treatment involves a combination of medical and surgical approaches:

• Intravenous antibiotics are administered to target the specific bacteria causing the infection. The choice of antibiotics is guided by culture and sensitivity testing when available.

• In many cases, surgical intervention is necessary to drain the abscess and relieve pressure on the spinal cord and nerves. This procedure is typically performed by a neurosurgeon or an orthopedic spine surgeon.

• Patients with spinal epidural abscess may require supportive care, including pain management, physical therapy, and rehabilitation to regain lost function.

• After treatment, patients are closely monitored for signs of improvement and potential complications.

What Is the Prognosis of Spinal Epidural Abscess?

The prognosis for individuals with spinal epidural abscess depends on several factors, including the timeliness of diagnosis and treatment. With prompt and appropriate intervention, many individuals can recover fully or partially. However, if the abscess causes significant damage to the spinal cord and nerves, permanent neurological deficits may persist.

What Are the Ways of Prevention of Spinal Epidural Abscess?

Preventing spinal epidural abscess is challenging due to its multifactorial nature. Nevertheless, there are steps that can reduce the risk:

• Practicing proper hygiene and wound care can help prevent skin and soft tissue infections that may lead to the hematogenous spread of bacteria.

• Healthcare facilities should maintain rigorous infection control practices to minimize the risk of healthcare-associated infections.

• Physicians should prescribe antibiotics judiciously, and patients should adhere to prescribed antibiotic regimens to reduce the risk of antibiotic resistance.

Conclusion

Spinal epidural abscess is a serious and potentially life-threatening condition that demands early recognition and intervention. The rising incidence of SEA underscores the importance of maintaining good hygiene, managing chronic illnesses, and adhering to infection control practices in healthcare settings. With swift diagnosis, appropriate treatment, and proper prevention measures, the prognosis for those affected by spinal epidural abscess can be significantly improved, minimizing the risk of permanent neurological damage.