A spinal epidural abscess is a collection of pus in the space around the spinal cord, most often caused by Staphylococcus aureus. It can quickly compress the cord, so back pain with fever needs fast evaluation.
Key symptoms
- Severe, focal back pain
- Fever, though it may be absent
- Pain shooting into the legs or arms
- Weakness, numbness or bladder problems in later stages
What you find on exam
- Tenderness over the spine
- Motor and sensory exam with reflexes
- Bladder retention and rectal tone
- Look for risk factors: injection drug use, recent spine procedure, diabetes
Tests
- MRI of the whole spine with contrast right away
- Blood cultures before antibiotics
- ESR and CRP, usually high; blood count
Treatment basics
- Empiric IV antibiotics: vancomycin plus ceftriaxone or cefepime
- Urgent neurosurgery consult for drainage
- Tailor antibiotics to culture results for about 6 to 8 weeks
Red flags
- New leg weakness or numbness
- Urinary retention or incontinence
- Fever with back pain in an injection drug user
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.