Liou and Shih reported 2 cases of epidural abscess involving the cervical spine. They outlined findings that can help to make the diagnosis. The authors are from Kaohsiung Medical University in Taiwan.
Features that can help to make the diagnosis:
(1) localized spinal pain
(2) fever
(3) presence of one or more risk factors (see below)
(4) elevated ESR and serum CRP
(5) spinal MRI
Risk factors for spinal epidural abscess (SEA):
(1) diabetes mellitus
(2) spinal trauma
(3) spinal surgery or procedure
(4) hemodialysis
(5) bacteremia
(6) malignancy
(7) AIDS
(8) alcohol abuse
Causes for misdiagnosis:
(1) masking of symptoms by corticosteroids, NSAIDs or opioids
(2) incomplete history and physical
(3) autonomic dysfunction
(4) blunted immune response
(5) absence of signs and symptoms
(6) failure to consider the diagnosis
(7) assuming that deficits are related to a herniated disk or other spinal disorder
Staphylococcus aureus is the most common pathogen.
Emergency/urgent surgery is usually necessary if the patient develops neurologic deficits.
