Chapter 7 - Spinal epidural abscess and subdural empyema

Abstract

Spinal epidural abscess is a very serious condition that can result in devastating consequences, irreversible paralysis, and even death. Although the rate of occurrence of this infection has increased remarkably in recent years, a sizable number of cases continue to be misdiagnosed and/or improperly managed. It is most commonly caused by Staphylococcus aureus which can reach the epidural space by either contiguous or hematogenous spread. Although some cases of spinal epidural abscess may be effectively treated with antibiotics alone, combined medical–surgical treatment constitutes the ultimate management. The neurologic condition before decompressive laminectomy is an important predictor of the final neurologic outcome. Although spinal subdural abscess is also most commonly caused by S. aureus , it is much less common than spinal epidural abscess and arises mostly from adjacent infections. As with spinal epidural abscess, the optimal treatment of spinal subdural infection comprises both surgical debridement and antibiotic therapy. A thoughtful multidisciplinary approach is crucial to securing a favorable outcome of both types of spinal infection.