Spinal epidural abscess.

Copyright © 2006 Massachusetts Medical Society. Despite advances in medical knowledge, imaging techniques, and surgical interventions, spinal epidural abscess remains a challenging problem that often eludes diagnosis and receives suboptimal treatment. The incidence of this disease — two decades ago diagnosed in approximately 1 of 20,000 hospital admissions1 — has doubled in the past two decades, owing to an aging population, increasing use of spinal instrumentation and vascular access, and the spread of injection-drug use.2-5 Still, spinal epidural abscess remains rare: the medical literature contains only 24 reported series of at least 20 cases each.1-24 This review addresses the pathogenesis, clinical features, diagnosis, treatment, common diagnostic and therapeutic pitfalls, and outcome of bacterial spinal epidural abscess.