Podcast # 360: Epidural Abscess Screening

Author: Dylan Luyten, MD.

Educational Pearls:

• Dangerous causes of back pain: AAA, cauda equina syndrome, epidural abscess.

• Young person with back pain needs to be evaluated for injection drug use (major risk factor).

• Patient with focal neurologic deficits (FND) require an MRI.  Patients without FND can be screened with ESR and CRP. An ESR < 20 & CRP < 1 can effectively rule out epidural abscess as it has a 90% sensitivity for epidural abscess.

• Treatment is IV antibiotics and surgical debridement.

References

Davis DP et al. Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain, Journal of Neurosurgery: Spine. 2011. 14:765-770.